Ultrasound Scan:
Iliocaval

Deep vein thrombosis (DVT) refers to the formation of a blood clot, known as a thrombus, within a deep vein, most commonly in the legs. It typically occurs in the veins that lie deep within the muscles and are responsible for returning blood to the heart. However, DVT can also occur in other parts of the body, such as the arms or pelvis. DEEP VEIN THROMBOSIS can be a serious condition because if the blood clot breaks loose from the vein, it can travel through the bloodstream and lodge in the lungs, causing a potentially life-threatening condition called pulmonary embolism. DVT and pulmonary embolism together are known as venous thromboembolism (VTE).

We request a 4 hr fast for this study.

Eating creates a gas that ultrasound is unable to scan through and may obstruct structures we need to see.

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This scan usually takes between 20- 30 minutes.

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The purpose of an Iliocaval ultrasound is to assess the main abdominal veins for blood clots (DVT) or compression. This ultrasound requires direct contact with your skin. The scan starts at the groin crease and ends at the diagram. We often don't require you to remove any clothing but will ask if your trousers can be shuffled down to the hips and your shirt and jumper lifted up nice and high. We will ask for you to lie down on the examination bed. During the scan we will apply ultrasound gel to your abdomen and use the ultrasound machine to at the vessels.

An iliocaval ultrasound, also known as lower extremity venous Doppler ultrasound or lower extremity venous duplex ultrasound, is performed to evaluate the veins in the lower extremities, specifically the iliac veins and the inferior vena cava (IVC). Here are some common reasons why an iliocaval ultrasound may be done:

Deep vein thrombosis (DVT) evaluation

An iliocaval ultrasound is commonly used to diagnose or rule out deep vein thrombosis. It can assess the presence of blood clots in the iliac veins or the IVC, which can lead to serious complications if left untreated.

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Iliocaval compression syndrome

Iliocaval compression syndrome, also known as May-Thurner syndrome or iliac vein compression syndrome, occurs when the left iliac vein is compressed by the overlying right iliac artery. An iliocaval ultrasound can help visualise the anatomy of the iliac veins and assess for any signs of compression or narrowing.

Venous insufficiency

Iliocaval ultrasound may be performed to evaluate the flow of blood in the iliac veins and identify any abnormalities related to venous insufficiency. Venous insufficiency occurs when the valves within the veins do not function properly, leading to backward flow (reflux) of blood and venous pooling.

Follow-up after intervention

If a person has undergone previous interventions, such as stent placement or angioplasty, for iliac vein or IVC disease, follow-up iliocaval ultrasound examinations may be performed to assess the effectiveness of the procedure, monitor the condition, and detect any potential complications or recurrent issues.

The results of an iliocaval ultrasound can help diagnose or rule out deep vein thrombosis, evaluate the iliac veins and IVC for compression or narrowing, assess blood flow characteristics, and guide further management decisions.

Iliocaval disease refers to conditions that affect the iliac veins and the inferior vena cava (IVC), which are major blood vessels in the lower abdomen and pelvis. Several risk factors can increase the likelihood of developing iliocaval disease. These risk factors include:

Deep vein thrombosis (DVT) history

A history of previous deep vein thrombosis, especially in the lower extremities, increases the risk of developing iliocaval disease. DVT can cause damage to the veins and impair blood flow, potentially leading to conditions affecting the iliac veins and IVC.

Venous compression syndromes

Certain anatomical variations or abnormalities, such as May-Thurner syndrome (iliac vein compression syndrome), can lead to compression of the iliac veins or IVC. These compression syndromes increase the risk of developing conditions affecting the affected vessels.

Thrombophilia

Thrombophilia refers to an increased tendency to develop blood clots. Inherited or acquired thrombophilic disorders, such as factor V Leiden mutation, protein C or S deficiency, or antiphospholipid syndrome, can increase the risk of developing DVT or other venous diseases that can affect the iliac veins and IVC.

Surgery or trauma

Certain surgeries or traumatic events, such as major abdominal or pelvic surgeries, can disrupt the normal anatomy and blood flow dynamics in the iliac veins and IVC, leading to the development of conditions affecting these vessels.

Cancer

Some cancers, particularly those in the abdominal or pelvic region, can increase the risk of developing blood clots and venous disorders that can affect the iliac veins and IVC.

Hormonal factors

Hormonal changes or imbalances can influence blood clotting tendencies and increase the risk of developing venous disorders. Hormonal factors associated with increased risk include pregnancy, use of hormonal contraceptives (such as birth control pills), hormone replacement therapy, or certain hormone-related conditions.

Obesity

Excess body weight, particularly abdominal obesity, is associated with an increased risk of developing venous diseases, including conditions affecting the iliac veins and IVC.

Age and gender

Advancing age and being female are general risk factors for venous diseases, including iliocaval disease.

Iliocaval disease refers to conditions that affect the iliac veins and the inferior vena cava (IVC), which are major blood vessels in the lower abdomen and pelvis. The symptoms of iliocaval disease can vary depending on the specific condition and the extent of involvement. Here are some common symptoms associated with iliocaval disease:

Leg pain or discomfort

Many individuals with iliocaval disease experience pain or discomfort in the legs. The pain is often described as a deep, aching sensation that may be present in the thigh, calf, or lower leg. It may worsen with prolonged standing or walking.

Leg swelling (edema)

Impaired blood flow in the iliac veins or IVC can lead to fluid accumulation in the legs, resulting in swelling or edema. The swelling is typically more pronounced in the ankle, calf, or lower leg.

Varicose veins

Iliocaval disease can contribute to the development of varicose veins in the legs. Varicose veins are enlarged, twisted veins that may appear bulging or ropelike. They can cause discomfort, aching, or a heavy sensation in the legs.

Deep vein thrombosis (DVT)

In some cases, iliocaval disease can increase the risk of developing deep vein thrombosis. DVT refers to the formation of blood clots in the deep veins, usually in the legs. Symptoms of DVT may include leg pain, warmth, redness, and swelling.

Chronic venous insufficiency

Chronic venous insufficiency can occur as a result of iliocaval disease. It refers to the impaired function of the leg veins, leading to blood pooling, venous reflux, and related symptoms. Symptoms can include leg pain, heaviness, fatigue, itching, or the development of skin changes or ulcers.

If we find a DVT we will advise you of this finding at the time of your scan. We will ask you to wait while we contact your referring doctor to find out what they would like to do. Iliocaval DVT is usually taken seriously and we would likely strongly recommend you attend your hospitals emergency department. If your referring doctor would like to see you on the same day as your scan or we request you attend the emergency department, we will provide you with a printed version of the ultrasound worksheet and written report so you are able to show this to any healthcare provider you may end up seeing. The worksheet and report will be sent to your referring doctor before you leave our rooms as well.

The treatment for iliocaval disease, which refers to conditions affecting the iliac veins and the inferior vena cava (IVC), depends on the specific condition and the extent of involvement. The primary goals of treatment are to restore proper blood flow, relieve symptoms, and prevent complications. Treatment options may include:

Anticoagulation therapy

In cases of acute deep vein thrombosis (DVT) or venous clotting, anticoagulant medications may be prescribed to prevent the further growth of blood clots and reduce the risk of complications. Anticoagulation therapy does not typically dissolve existing blood clots but helps prevent new clots from forming.

Thrombolytic therapy

Thrombolytic therapy, also known as clot-dissolving therapy, may be considered in cases of acute DVT with significant symptoms or complications. It involves the administration of medications that can dissolve blood clots and restore blood flow.

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Endovascular procedures:

• Catheter-directed thrombolysis: In certain cases of acute DVT, catheter-directed thrombolysis may be performed. It involves the insertion of a catheter into the affected veins to deliver medications directly to the blood clot, helping to dissolve it and restore blood flow.

• Angioplasty and stenting: Angioplasty is a procedure that involves the insertion of a balloon-tipped catheter into the narrowed or blocked veins. The balloon is inflated to widen the narrowed area, and a stent (a small mesh tube) may be placed to keep the vein open and improve blood flow.

Surgical bypass

In cases where endovascular procedures are not feasible or effective, surgical bypass may be considered. This procedure involves creating a detour around the blocked or narrowed section of the vein, using a graft (artificial or natural blood vessel) to restore blood flow.

Iliocaval reconstruction

For conditions involving iliac vein compression syndromes, such as May-Thurner syndrome, iliocaval reconstruction may be performed. This surgical procedure involves repositioning or removing the compressing structures and creating a new pathway for blood flow through the affected veins.