I read with great interest the article by Chen et al1Chen Z.H. Huang Y. Wang L.P. Peng M.Y. Li C. Huang W. Preliminary study of the hemodynamics of iliac venous compression syndrome using magnetic resonance imaging. that was recently reported and wanted to congratulate the authors for their excellent contribution to the subject. A few points that might be of interest to our esteemed readers are listed below.First, although some studies have not reported benefits from endovenous stenting, these studies have been few and far between.2Shiferson A. Aboian E. Shih M. Pu Q. Jacob T. Rhee R.Y. Iliac venous stenting for outflow obstruction does not significantly change the quality of life of patients with severe chronic venous insufficiency. Rigorously and appropriately selected patients have demonstrate significant benefits from iliofemoral endovenous intervention.3Saleem T. Knight A. Raju S. Diagnostic yield of intravascular ultrasound in patients with clinical signs and symptoms of lower extremity venous disease. These benefits include healing of ulcers and improvements in swelling, pain, the venous clinical severity score, and quality of life.Second, iliac vein compression was noted in multiple venous segments in almost 43% of patients.1Chen Z.H. Huang Y. Wang L.P. Peng M.Y. Li C. Huang W. Preliminary study of the hemodynamics of iliac venous compression syndrome using magnetic resonance imaging. Multifocal iliofemoral venous compression syndrome is not uncommon and can result from compression from the common iliac artery or hypogastric artery or are retroinguinal in location. The key is not to miss any lesions when performing stenting.Third, the presence of collateral vessels and a decreased flow rate as a corollary of stenosis correlated significantly with lower limb symptom severity.1Chen Z.H. Huang Y. Wang L.P. Peng M.Y. Li C. Huang W. Preliminary study of the hemodynamics of iliac venous compression syndrome using magnetic resonance imaging. Thus, we wondered whether the authors also evaluated whether each of these findings contributed differentially or equally to lower limb symptom severity. Formulation of a weighted scoring system using magnetic resonance imaging findings would be helpful in this regard. Also, it is important to be mindful that not all patients with severe disease will have venous collateral vessels.Fourth, another question is whether intravascular ultrasound was used to guide venous interventions. Recent data have supported its use compared with other multidimensional contrast imaging modalities in guiding intervention for chronic iliofemoral venous obstruction.4Comparison of intravascular ultrasound and multidimensional contrast imaging modalities for characterization of chronic occlusive iliofemoral venous disease: a systematic review. Intravascular ultrasound, however, can only provide real-time morphologic data. Its supplementation by physiologic data obtained from these specialized magnetic resonance imaging techniques is, therefore, of great interest.Fifth, although the Villalta score is more comprehensive because of its inclusion of subjective symptoms, this subjectivity has also often been cited as a major drawback of this scoring system.5Soosainathan A. Moore H.M. Gohel M.S. Davies A.H. Scoring systems for the post-thrombotic syndrome.

Finally, some assumptions of the Poiseuille’ law must be remembered and how they differ in their application in the venous system. These include laminar flow, Newtonian fluid characteristics, and the circular dimension of noncompliant vessels.

ReferencesChen Z.H. Huang Y. Wang L.P. Peng M.Y. Li C. Huang W.

Preliminary study of the hemodynamics of iliac venous compression syndrome using magnetic resonance imaging.

J Vasc Surg Venous Lymphat Disord. 10: 131-138.e3Shiferson A. Aboian E. Shih M. Pu Q. Jacob T. Rhee R.Y.

Iliac venous stenting for outflow obstruction does not significantly change the quality of life of patients with severe chronic venous insufficiency.

JRSM Cardiovasc Dis. 8 ()Saleem T. Knight A. Raju S.

Diagnostic yield of intravascular ultrasound in patients with clinical signs and symptoms of lower extremity venous disease.

J Vasc Surg Venous Lymphat Disord. 8: 634-639

Comparison of intravascular ultrasound and multidimensional contrast imaging modalities for characterization of chronic occlusive iliofemoral venous disease: a systematic review.

J Vasc Surg Venous Lymphat Disord. 9: 1545-1556.e2Soosainathan A. Moore H.M. Gohel M.S. Davies A.H.

Scoring systems for the post-thrombotic syndrome.

J Vasc Surg. 57: 254-261Article InfoIdentification

DOI: https://doi.org/10.1016/j.jvsv.2021.10.017

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© 2022 by the Society for Vascular Surgery. Published by Elsevier Inc.

ScienceDirectAccess this article on ScienceDirect Linked ArticlePreliminary study of hemodynamics of iliac venous compression syndrome using magnetic resonance imaging

Journal of Vascular Surgery: Venous and Lymphatic DisordersVol. 10Issue 1

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In clinical practice, the degree of iliac vein stenosis has often been inconsistent with the symptoms of chronic venous disease (CVD). To the best of our knowledge, no clinical studies have evaluated the hemodynamic changes associated with iliac vein stenosis. Magnetic resonance imaging (MRI) can noninvasively provide hemodynamic information. In the present study, we assessed the degree of stenosis associated with iliac venous compression syndrome and the relationships between iliac venous compression syndrome-induced, MRI-determined hemodynamic changes and lower limb symptoms.

Full-Text PDF A decrease in flow rate difference is more likely to be "pathological" IVCS

Journal of Vascular Surgery: Venous and Lymphatic DisordersVol. 10Issue 4

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We would like to thank Saleem et al1 for his letter and interest in our article. Endovascular treatment for patients with severe iliac vein compression syndrome (IVCS) that addresses all lesions has recognized benefits.2 Because a small number of patients will experience limited benefits, we have observed that some patients will have severe iliac vein stenosis with mild symptoms and some will have no stenosis but will have obvious venous insufficiency.3 In both cases, the cause could be venous reflux.

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