Predictive factors for iliac vein compression syndrome in patients with varicose veins

Objective This study aimed to identify predictors of iliac vein compression syndrome (IVCS) in patients with varicose veins and to evaluate the necessity of routine lower extremity venography for preoperative assessment of these patients. Methods A retrospective analysis was conducted on data from 1165 patients with lower-limb varicose veins who underwent preoperative venography at Wuhan Union Hospital, Tongji Medical College, China, between January 2019 and September 2023. Logistic regression analyses identified factors associated with concurrent IVCS, and a nomogram was constructed based on these findings. Results Out of 1165 patients, 75 (6.4%) had IVCS according to venography and 769 had iliac vein ultrasound and found 2 (0.17%) positives. Multivariate analysis revealed the independent predictive value of left-sided involvement (odds ratio (OR) = 3.22, 95% confidence interval (CI): 1.24–8.33, p = 0.016), history of deep vein thrombosis (DVT) in the affected limb (OR = 3.11, 95% CI: 1.21–8.00, p = 0.018), pain (OR = 2.24, 95% CI: 1.17–4.26, p = 0.014), and positive results on iliac vein ultrasound (OR = 25.56, 95% CI: 2.10–311.26, p = 0.011) for the presence of IVCS in patients with lower-limb varicose veins. A nomogram incorporating these predictors demonstrated moderate predictive ability (AUV = 0.689, 95% CI: 0.607–0.771), with good calibration upon validation. Conclusions Patients with left lower extremity varicose veins, pain symptoms, history of DVT in the affected limb, and positive iliac vein ultrasound findings are at a higher risk of concurrent IVCS. Patients with varicose veins who have the aforementioned risk factors may need to undergo preoperative angiography.