Variations of Venous Compression

We RPhSs are all aware of the critical importance of properly diagnosing compression syndromes such as pelvic vein reflux and May-Thurner when performing a venous insufficiency study in preparation for ablation. These diagnoses are often the difference between a successful procedure and a hugely unsuccessful one, if the proper sequence of events is not implemented. Often, compression syndromes are only detected after the patient has become grossly symptomatic due to an increase in interstitial pressure, leading to clinical manifestations such as collateral formation. But how familiar is the average technologist with the many variations and presentations of compression syndrome? This attached link is a reminder to be aware of the lesser-known syndromes such as the several less-common variants of iliac compression, nutcracker phenomenon/anatomy, popliteal entrapment, VTOS/Paget-Schroetter presentation, and extrinsic compression when performing duplex studies. Often, the only indication which may hint to an obstruction or compression is distal PW Doppler waveform, or direct manipulation of the patient’s leg with the intent to provoke compression. No vein practice should ever fall victim to under-education and inexperience when it comes to quality patient care and satisfaction before, during, and after vein procedures.