Written by
michael cumming, m.d., M.B.A.

Venous claudication is one of the severe sequalae of lower extremity deep venous thrombosis (DVT).  It occurs most commonly after iliofemoral DVT (IFDVT).  IFDVT typically occurs because of compression of the iliac veins in the pelvis.  This is referred to as Iliac Vein Compression Syndrome (IVCS) - previously known as May Thurner Syndrome.  The compression point restricts the flow of blood out of the leg and back to the heart.  This increases the risk of developing a DVT.  The most common variant of IVCS occurs where the right common iliac artery crosses over and compresses the left common iliac vein.  This is the reason why leg vein problems and DVT are more common on the left.  There are variants that occur at other locations in the pelvis

 

Venous claudication occurs when there is severe restriction of blood flow out of the leg.  It causes severe thigh and leg tightness and pain with exercise.  The pain typically takes 20-30 minutes of rest to resolve.  Leg elevation can improve the time it takes to relieve the pain.

 

Correction of the outflow obstruction can dramatically improve the quality of life of patients suffering from IVCS and IFDVT.  The goal is to restore inline flow from the leg to the inferior vena cava (IVC).  This is primarily accomplished through endovascular reconstruction of the iliac and femoral veins using stents.

 

Below are links to 2 examples of patients with venous claudication after IFDVT.  One patient, a 36 year old female, after treatment had dramatic improvement with resolution of all limitations in activity.  The other patient, a 22 year old male, after treatment had only partial improvement.  The difference between the 2 patients was the status of the deep venous in the leg.  The female patient had a nearly normal deep venous system, while the male patients had post thrombotic changes in the veins limiting blood flow out of the leg.    Both of these patients would have benefited from more aggressive treatment at the time of their initial diagnosis.

36 year old female with iliofemoral DVT secondary to iliac vein compression.

22 year old male with iliofemoral DVT secondary to iliac vein compression.

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