OBJECTIVES: There is an absence of reliable non-invasive diagnostic imaging to detect May-Thurner Syndrome (MTS) and other pelvic vein compression syndromes, which delays appropriate care. This study aims to detect MTS and other pelvic vein compression syndromes for adults with lower extremity leg pain and edema by comparing refined duplex ultrasound, venography, and intravascular ultrasound (IVUS) findings.
METHODS: Between 2015 to 2022, 237 patients were identified at a single center in Dallas, Texas with clinical signs and symptoms of chronic venous hypertension who underwent duplex ultrasound, venography, and IVUS. EMR and imaging results were obtained, and this data was stored on an excel spreadsheet. These findings were then analyzed to determine the correlation of preoperative duplex ultrasound to intraoperative venography and IVUS. R statistical software was used to perform logistic regression analysis, determining correlation among these 3 imaging modalities.
RESULTS: The study population had a median age of 68 years, standard deviation of 14.4 years, ranging from 27 to 95 years. Male to female ratio was approximately 4:6. Risk factors with a relative frequency >0.20 included hypertension, hyperlipidemia, chronic embolism, T2DM without complications, and compression of vein. Our analysis shows that duplex ultrasound correlated the following findings with the presence of ≥50% stenosis on venography: decreased compressibility at the left CFV p=0.02; decreased or absent compressibility at the right CFV p=0.01; decreased, absent, or pulsatile spontaneity at the right CFV p=0.03; thrombosis at right CFV p=0.009 or left CFV p=0.01. Duplex ultrasound of the left CFV correlated the following findings with the presence of ≥50% stenosis on IVUS: the absence of reflux p=0.008; continuous phasicity p=0.04; normal competency p=0.008; continuous flow p=0.04. No venography findings were statistically significant predictors of ≥50% stenosis on IVUS.
CONCLUSIONS: The duplex ultrasound findings above predicted the presence of pelvic vein compression based on the presence of ≥50% stenosis on IVUS. These findings suggest that preoperative duplex ultrasound may diagnose MTS and other pelvic vein compression syndromes. These findings are also suggestive of the requirement of both venography and IVUS to confirm the diagnosis. Further studies are needed to validate our results.