Iliac vein compression: epidemiology, diagnosis and treatment

Vasc Health Risk Manag. 2019 May 9:15:115-122. doi: 10.2147/VHRM.S203349. eCollection 2019.


Iliac vein compression (LIVC) is a prevalent finding in the general population, but a smaller number of patients are symptomatic. ILVC should be considered in symptomatic patients with unexplained unilateral lower leg swelling. Patients typically complain of one or more of the following symptoms: lower leg pain, heaviness, venous claudication, swelling, hyperpigmentation and ulceration. ILVC can be thrombotic, combined with acute or chronic DVT, or non-thrombotic. ILVC is best diagnosed with intravascular ultrasound (IVUS), but computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have emerged as valid screening tests. Venography underestimates the severity of ILVC but may provide insights into the anatomy and the presence of collaterals. Based on current available evidence, endovascular therapy with stenting remains the main treatment strategy for ILVC. Dedicated nitinol venous stents are currently under review by the Food and Drug Administration for potential approval in the United States. These stents have been released outside the US. There is no consensus to the optimal anticoagulation regimen post-ILVC stenting. Oral anticoagulants, however, remain a preferred therapy in patients with history of thrombotic ILVC.

Keywords: iliac vein; imaging; may-thurner; stent; treatment.

Publication types

  • Review
  • Video-Audio Media

MeSH terms

  • Administration, Oral
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Computed Tomography Angiography
  • Diagnostic Imaging / methods*
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / instrumentation
  • Humans
  • Iliac Vein* / diagnostic imaging
  • Iliac Vein* / physiopathology
  • Iliac Vein* / surgery
  • Magnetic Resonance Angiography
  • May-Thurner Syndrome* / diagnostic imaging
  • May-Thurner Syndrome* / epidemiology
  • May-Thurner Syndrome* / physiopathology
  • May-Thurner Syndrome* / therapy
  • Phlebography / methods
  • Predictive Value of Tests
  • Prevalence
  • Stents
  • Treatment Outcome
  • Ultrasonography, Doppler, Color
  • Ultrasonography, Interventional


  • Anticoagulants