Incidence and Risk Factors of Deep Venous Thrombosis in Asymptomatic Iliac Vein Compression: A Prospective Cohort Study.
BACKGROUND
Deep vein thrombosis (DVT) may be associated with iliac vein compression. Up to now, the majority of data has come from a retrospective study about the correlation between DVT and iliac vein compression. This prospective study was to determine the incidence of DVT in individuals with iliac vein compression and identify risk factors predictive of DVT.


METHODS
A total of 500 volunteers without symptoms of venous diseases of lower extremities and overt risk factors of deep venous thrombosis between October 2011 and September 2012 in Shijitan Hospital were enrolled in this cohort study. All the participants underwent contrast-enhanced abdominal computed tomography (CT) to evaluate iliac vein compression. Baseline demographic information and degree of iliac vein compression were collected. They were categorized into ≥50% or <50% iliac vein compression group. Ultrasound examination was performed to screen DVT at the time of CT examination and 3, 6, 9, and 12 months after the examination. Primary event was DVT of ipsilateral lower extremity. Correlation between DVT and iliac vein compression was estimated by multivariate Logistic regression after adjusting for age, gender, malignancy, surgery/immobilization, chemotherapy/hormonal therapy, and pregnancy.


RESULTS
In 500 volunteers, 8.8% (44) had ≥50% iliac vein compression and 91.2% (456) had <50% iliac vein compression. Ipsilateral DVT occurred in six volunteers including two in iliofemoral vein, two in popliteal vein, and two in calf vein within 1 year. Univariate analysis showed that the incidence of DVT was 6.8% in ≥50% compression group, significantly higher than that in <50% compression group (0.7%) (χ2 = 12.84, P = 0.01). Patients with malignancy had significantly higher incidence of DVT than those without malignancy (χ2 = 69.60,P< 0.01). Multivariate Logistic regression indicated that iliac vein compression and malignancy were independent risk factors of DVT. After adjustment for malignancy, patients with ≥50% iliac vein compression had 10-fold increased risk of developing DVT (adjusted relative risk [RR] = 10.162, 95% confidence interval [CI]: 1.149-89.865, P = 0.037). In subgroup analysis, patients with malignancy and ≥50% iliac vein compression had 12-fold increased the risk of DVT than those without malignance and ≥50% compression (RR = 12.389, 95% CI: 2.327-65.957, P = 0.003).


CONCLUSIONS
Iliac vein compression is common, but the incidence of DVT is low. Only individuals with ≥50% iliac vein compression or compression combined with other risk factors might have significantly increased the risk of DVT. Further study is recommended to improve prevention strategies for DVT in significant iliac vein compression.
Department of Vascular Surgery, The Ninth Clinical Medical College of Peking University, Beijing Shijitan Hospital, Beijing 100038, China.
Min-Kai
MK
Wu
Department of Vascular Surgery, The Ninth Clinical Medical College of Peking University, Beijing Shijitan Hospital, Beijing 100038, China.
Xiao-Yun
XY
Luo
Department of Vascular Surgery, The Ninth Clinical Medical College of Peking University, Beijing Shijitan Hospital, Beijing 100038, China.
Fu-Xian
FX
Zhang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D062108:May-Thurner Syndrome / Q000150:complications* / Q000453:epidemiology*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult