Study Assesses Effects of Intravascular Volume Expansion on Deep Pelvic Vein Size

November 3, 2024—A study assessed the effects of intravascular volume expansion on deep pelvic vein size using the 200-150-125 rule for the cross-sectional area (CSA) of the common iliac, external iliac, and common femoral veins (CIV, EIV, and CFV), which was described by Raju et al (J Vasc Surg Venous Lymphat Disord. 2014;2:260-267).

Khanjan Nagarsheth, MD, presented the study findings during the late-breaking clinical trials session at The VEINS, the Venous Endovascular Interventional Strategies annual venous education symposium held by The VIVA Foundation on November 2-3 in Las Vegas, Nevada.

As summarized in The VEINS press release, the study included 73 patients who underwent diagnostic venography with intravascular ultrasound (IVUS) for suspected deep pelvic vein stenosis between August 2021 and April 2024.

Patient characteristics included the following: female, 87.6%; mean age, 31.8 ± 11.2 years; and mean body mass index, 29.3 ± 7.8 kg/m². The left lower extremity was affected in 75.3% of patients.

The patients received 500 mL of intravenous fluid, followed by a 20-minute wait. IVUS measurements were taken before and after hydration in the left CIV, EIV, and CFV.

The press release reported that after fluid administration, statistically significant changes in CSA were observed in all vein segments:

• Left CIV: 149.7 to 191.6 mm² (P < .001)
• Left EIV: 115.8 to 138.8 mm² (P < .001)
• Left CFV: 91.9 to 109.1 mm² (P < .001)

Left CIV stenosis (≥ 50% stenosis compared to adjacent reference area) was seen in 28.8% of patients. In this subset, CSA changed from 62.9 to 95.8 mm2 (P < .001), with 76.2% of cases changing to < 50% stenosis after fluid administration.

The study concluded that intravascular volume expansion before venography with IVUS showed an increase in deep pelvic vein CSA.

A hypovolemic state, which may exist in patients receiving nothing by mouth before venography, may underestimate deep pelvic vein size, as noted by Lee et al (World J Surg. 2018;42:3150-3157). So, patient fluid status should be considered before performing these studies and intervening for deep pelvic vein stenosis, advised the investigators in The VEINS press release.