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HI Nancy,

I just participated in a meeting in Tennessee and was asked to speak about the imaging of iliac veins.  I did some research into the literature and found some interesting stuff.  

There was a good paper a couple of years ago that was very helpful and I have attached it to this message:
Marston W, et al. Incidence of and risk factors for iliocaval venous obstruction in patients with active or healed venous leg ulcers. J Vasc Surg 2011;53:1303-8

Basically, they found a 12-fold increase in the incidence of iliocaval venous obstruction in patients with a prior DVT and 17-fold increase if the patient had deep system reflux.  All their patients with superficial reflux only had no issues with the iliocaval system.

They also found 100% specificity with an abnormal CFV Doppler waveform but only 77% sensitivity.

So bottom line to answer part of your question, here is what they recommended:
If the CFV waveform is abnormal, evaluate the iliocaval system (they liked CT venography better than ultrasound; and IVUS is really gaining in popularity)
If the CFV waveform is normal and they have not had a prior DVT or do not demonstrate deep system reflux, no iliocaval exam is needed
If the CFV waveform is normal and they have a history of DVT or present with deep system reflux, then evaluate the iliocaval system

I hope this helps,

Ann Marie 

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Nancy Williams
Sent: Wednesday, September 3, 2014 5:42 PM
To: [log in to unmask]
Subject: Vein Matrix for Reflux

Working on a vein Matrix for Reflux studies. Trying to simplify. Goes something like this ...
Negative for DVT/Reflux = patient goes home Negative for DVT/+ Deep Reflux but Negative for Deep Reflux = evaluate iliacs. Iliacs negative = Patient goes home Negative for DVT/+ Superficial GSV reflux = Evaluate for perforators etc, etc. 

You get the idea. My question is...if anyone has already done one of these and wants to share I would be soooo happy not to have to do one myself. And it is not because I'm lazy...I just really would really rather copy your work and take the credit, hahaha. 

Any takers?

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