A Cadaveric Study Evaluating Intraluminal Abnormalities of the Left Common Iliac Vein

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Journal of Vascular Surgery


Intraluminal abnormalities within the left common iliac vein (LCIV) are characteristic of May-Thurner syndrome. These spurs are thought to result from compression or pulsation by the overlying right common iliac artery (RCIA) and increase risk for thrombosis. This study was designed to expand on the literature by surveying and photographing LCIV adhesions and exploring whether certain factors are associated with adhesion presence.

Dissection to expose the aorta, inferior vena cava, and common iliac veins was performed in fifty-one cadavers. The spinal level of the iliac vein confluence was noted. The point at which the RCIA crosses the LCIV was examined for plaque before transecting the artery to expose the vein. The inferior vena cava was incised to facilitate observation into the LCIV lumen. Abnormalities were documented. Logistic regression was conducted to determine whether sex, plaque presence, or level of iliac vein confluence was associated with adhesions.

Intraluminal adhesions within the LCIV were observed in 16 of 51 cadavers (31.4%), all of which were located where the RCIA crosses the LCIV. Utilizing an established classification system, 67% (n = 10) were classified as triangular and 25% (n = 4) were classified as columnar. One linear adhesion and one complex adhesion with synechiae were observed (Figure). Among this population, males were 73% less likely to have an adhesion (odds ratio, 0.269; P = .041). No significant relationship was found between presence of plaque in the overlying RCIA and presence of adhesion (odds ratio, 0.933; P = .824). Last, a significantly larger percent of adhesions was found within cadavers with an iliac vein confluence located at the L5/S1 level (χ2 = 9.650; P = .002).

Our findings show that adhesions are more common when the confluence of the common iliac veins occurs at a lower spinal. The level of the iliac vein confluence may be important in identifying patients at increased risk of intraluminal venous disease and may make certain procedures (eg, spinal exposure) higher risk. Our findings also suggest that plaque within the RCIA cannot be used as a diagnostic predictor in detecting patients with adhesions. Further investigation is needed to understand what leads to adhesion formation.



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