Iliac Vein Obstruction & DVTs

ABOUT

  • The iliac veins are the main veins in the pelvis that return the blood from the legs to the heart.

    These veins can be obstructed (narrowed or blocked) by blood clots (called deep vein thromboses, or DVTs), or other causes.

    Obstructions in the iliac veins can slow the blood flow out of the leg as it travels back to the heart.

  • There are two main causes of iliac obstructions, either a blood clot (deep venous thromboses or DVT), or an anatomic obstruction.

    Deep venous thromboses are more likely to occur in people with the following risk factors:

    • Older age

    • Immobility (eg, during as a long flight)

    • Pregnancy

    • Cancer

    • Clotting disorders

    • Surgery

    • Some medications (such as oral contraceptives)

    The most common cause of anatomic obstructions is an anatomic variation called May Thurner syndrome. This is where one of the arteries in the pelvis compresses the iliac vein. This results in narrowing of the vein, and can either slow the blood flow out of the leg, or cause a DVT.

    Either of the above two problems causes a reduction in blood flow out of the leg as it travels back up to the heart.

  • Assessment begins with a thorough discussion about your medical history, followed by clinical examination.

    An ultrasound called a venous duplex, is the first line test to examine blood flow through the iliac veins..

    A CT scan with intravenous contrast may be needed to further image the iliac veins, and potentially plan for surgery.

    These imaging modalities will determine why, and which veins are not working properly, and will help determine which type of management is best.

  • As the blood flow out of the leg to the heart is reduced, fluid can then accumulate in the leg. As a result, some people can experience the following symptoms:

    • Swelling

    • Pain

    • Cramping

    • Heaviness

    • Itching

    • Chronic inflammation of the skin

TREATMENT

HOW DO YOU TREAT ILIAC VEIN OBSTRUCTION?

There are several treatment options for iliac vein obstructions, depending on the site of the narrowing/blockage, and the symptoms.

Treatment options include:

  • Compression stockings – custom-made, firm stockings which cover from the toes to the knee, and compress the veins and remove extra fluid from the leg.

  • Endovascular surgery – also called ‘keyhole surgery’. This involves a small incision in the groin, and after a wire is passed across the narrowing or blockage, a balloon is inflated to open up the narrowing, and a stent (a tubular metal frame, called an iliac vein stent) is used to keep the vein open.
    If a new DVT is diagnosed in the iliac veins, recent evidence suggests it is beneficial to have this removed as soon as it occurs to prevent chronic problems in the future. This is best performed via keyhole methods, where the clot is removed (called percutaneous thrombectomy)

We will discuss which treatment option may be most suitable for you, with consideration of your preferences and factors such as:

  • The severity of your symptoms

  • Whether the iliac veins are just narrowed, or entirely blocked, and whether the blockage is a new DVT (within a few weeks) or chronic

  • Which veins are affected

  • Your personal medical history

What are the risks of treatment of iliac vein obstruction?

Any operation requiring a general anaesthetic has risks like stroke, heart attacks, respiratory failure, or death. As such, we avoid general anaesthetics in people who are at high risk of these complications.

The main risks of interventions for iliac vein obstruction are listed below. These are often prevented by careful planning and treatment. While these can be life-threatening, they are actively watched for, and if they occur are immediately managed:

  • Bleeding or bruising

  • New DVT or blockage of veins

  • Abdominal or back pain

  • Stent migration

  • Infection

Do I need to follow-up with my Vascular Surgeon after the operation?

Dr Shiraev will want to see you after your operation, to make sure you have recovered well, your wounds are healing, and answer any questions you may have.

Unfortunately, if a venous stent is required, there is always a risk that the stent blocks in the future, so this will need to be monitored.

In the longer term, people with iliac vein obstructions benefit from monitoring, which will involve a regular checkup and ultrasound.

This advice is general, and is not intended to replace a formal clinical assessment and discussion with a health professional.