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Kapsalis C, Bright AJ, Leonard J, Mijares Diaz F, Reddy S, Byrd B, Shetty P, Ogunleye A. May-Thurner syndrome diagnosis and management with concurrent lymphedema. Phlebology 2025:2683555251345061. [PMID: 40395087 DOI: 10.1177/02683555251345061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2025]
Abstract
BackgroundMay-Thurner syndrome (MTS) is an anatomical anomaly characterized by compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) presenting with left lower extremity swelling and venous hypertension. Persistent symptoms after MTS treatment often lead to referral for lymphedema workup to explore non-venous causes. We aimed to describe the presentation of MTS and the findings from the lymphedema workup.MethodsA retrospective review was conducted of patients with MTS and lower extremity lymphedema workup between 2013 and 2022 at a public academic hospital. Demographic data, diagnostic information, treatment details, and outcomes were collected. Descriptive statistical analysis was performed.ResultsOf 523 patients identified, 390(75%) were female, 133(25%) male with a mean BMI of 29.6 kg/m2. Mean age at diagnosis and symptom onset was 54.9(±17.1) and 47.6 (±18.2 )years, respectively. 465 patients (89%) were treated operatively with a combination of stenting, venoplasty, and thrombolysis while 47 (9%) were managed conservatively with compression garments and/or anticoagulation only. The LCIV was most commonly affected, followed by the left external iliac vein. The predominant symptoms were lower extremity deep vein thrombosis in 341 (65%) patients, lower limb edema in 286 (54%), and varicose veins in 129 (24.6%). Of six patients with lymphedema workup, three(50%) showed asymmetric or delayed uptake on lymphoscintigraphy and the remaining three had normal studies.ConclusionIn our study, May-Thurner syndrome was an uncommon but significant cause of lower extremity swelling and venous thromboembolism, especially in middle-aged females. Patients with persistent symptoms after intervention may benefit from diagnostic workup for lymphedema and treatment. More research is needed on the co-occurrence of lymphedema with MTS and its pathophysiology.
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Affiliation(s)
- Christina Kapsalis
- Division of Plastic and Reconstructive Surgery, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Annie J Bright
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Janit Leonard
- Division of Plastic and Reconstructive Surgery, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Fernando Mijares Diaz
- Division of Plastic and Reconstructive Surgery, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Saigopala Reddy
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Blair Byrd
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Pragna Shetty
- Division of Plastic and Reconstructive Surgery, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Adeyemi Ogunleye
- Division of Plastic and Reconstructive Surgery, University of North Carolina Medical Center, Chapel Hill, NC, USA
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Gavrilov S, Bredikhin R, Akhmetzyanov R, Grishenkova A, Apkhanova T, Burenchev D, Efremova O, Ilyukhin E, Kamaev A, Konchugova T, Kulchitskaya D, Mishakina N, Pryadko S, Rachin A, Seliverstov E, Sonkin I, Soroka V, Fomina E, Shimanko A, Tsukanov Y, Kirienko A, Sazhin A, Stoyko Y, Suchkov I, Zolotukhin I. Pelvic Varicose Veins in Women. Russian Experts Consensus. JOURNAL OF VENOUS DISORDERS 2025; 19:63. [DOI: 10.17116/flebo20251901163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2025]
Abstract
Pelvic Varicose Veins in Women. Russian Experts Consensus.
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Skeik N, Li R, Cravero E, Engstrom B, Manunga J. Antithrombotic therapies for patients with acute iliofemoral deep vein thrombosis following endovenous recanalization: A single-center study and literature review. Phlebology 2025:2683555251321903. [PMID: 39967566 DOI: 10.1177/02683555251321903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2025]
Abstract
OBJECTIVES There is no consensus regarding the optimal antithrombotic therapy following endovenous recanalization. We aim to assess the effectiveness of anticoagulant, antiplatelet, or combination therapy to provide evidence-based recommendations for antithrombotic therapy following interventional procedures. METHODS An Institutional Review Board approved, retrospective study of patients presented to our facility with iliofemoral venous thrombosis requiring thrombolysis and/or thrombectomy with or without venous angioplasty/stenting between January 1, 2010 and April 1, 2023. Incidence of vein or stent patency, thrombosis, and bleeding were considered primary endpoints and were compared between patients on anticoagulant, antiplatelet, or combination therapies at each post-interventional surveillance, up to five visits. RESULTS The cohort yielded 128 patients, including 116 adults and 12 minors. We identified a notable trend in the post-recanalization medical routines of patients: those initially prescribed combination therapy post-procedure eventually transitioned to either exclusive anticoagulant or antiplatelet therapy. The initial combination antithrombotic therapy was associated with trends towards higher vein patency (59% vs 47% with anticoagulant vs 25% antiplatelet, p = .3), less recurrent vein and stent thrombosis (46% vs 54% with anticoagulants vs 100% antiplatelet, p = .10), and overall low major bleeding complications (3.2% vs 6.8% anticoagulant, p = .5) at first follow-up compared to those on anticoagulant or antiplatelet regimens alone. CONCLUSION Although the optimal post-interventional antithrombotic therapy remains uncertain, combination therapy was associated with trends towards higher vein patency and lower recurrent thrombosis, with low overall major bleeding complications at the first follow-up visit following interventions. Future studies encompassing larger and more diverse populations are essential to corroborate the findings presented in this report and offer valuable insights for optimizing the management of patients with this condition.
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Affiliation(s)
- Nedaa Skeik
- Section of Vascular and Endovascular Surgery Minneapolis Heart Institute at Abbott Northwestern Hospital Minneapolis, Minneapolis, MN, USA
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Rina Li
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Ellen Cravero
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Bjorn Engstrom
- Minneapolis Radiology Associates (MRA), Minneapolis, MN, USA
| | - Jesse Manunga
- Section of Vascular and Endovascular Surgery Minneapolis Heart Institute at Abbott Northwestern Hospital Minneapolis, Minneapolis, MN, USA
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
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Yang S, Zhao J, Hou P, Gu Y. Effect of Balloon Dilatation and Stent Implantation in Iliac Vein Compression Syndrome. Thorac Cardiovasc Surg 2025. [PMID: 39952272 DOI: 10.1055/a-2496-5378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2025]
Abstract
OBJECTIVE To investigate the efficacy of balloon dilatation combined with stent implantation in the treatment of iliac vein compression syndrome (IVCS). METHODS This research was a retrospective study that enrolled 127 IVCS patients for clinical data. The patients were divided into percutaneous transluminal angioplasty (PTA) group (n = 63) and stent implantation group (n = 64). The PTA group was treated with iliac vein balloon dilatation, and the stent implantation group was treated with combined stent implantation based on the PTA group. In both the groups, the quality of life was assessed using Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ); complications occurring during the perioperative period and at postoperative follow-up were recorded; the vascular patency rate was calculated, and patient's condition was evaluated using the Villalta scale. RESULTS The stent implantation group exhibited lower postoperative CIVIQ scores than the PTA group, and the stent implantation group (4.60%) had lower complication rate than the PTA group (19.05%). At 2 years of follow-up, the stent implantation group (92.19%) had higher vascular patency rate than the PTA group (79.37%). Villalta scores were lower in the stent implantation group than in the PTA group at 6, 12, and 24 months postoperatively. CONCLUSION Iliac vein balloon dilatation combined with stent implantation for the treatment of IVCS can improve vessel patency rates, alleviate patients' clinical symptoms, and enhance their quality of life.
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Affiliation(s)
- Sen Yang
- Department of Vascular Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Jian Zhao
- Department of Vascular Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Peng Hou
- Department of Vascular Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Yan Gu
- Department of Vascular Surgery, Tianjin First Central Hospital, Tianjin, China
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Kouyialis TA, Zertalis M, Charalambous N, Papoulas M. Left renal vein transposition using autologous gonadal vein graft in patient with combined anterior nutcracker and May-Thurner syndromes. BMJ Case Rep 2025; 18:e263818. [PMID: 39947727 PMCID: PMC11831056 DOI: 10.1136/bcr-2024-263818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 01/02/2025] [Indexed: 02/19/2025] Open
Abstract
Anterior nutcracker syndrome (ANCS) and May-Thurner syndrome (MTS) are part of a rare group of vascular compression syndromes where extrinsic compression of arteries or veins results in non-specific clinical presentation posing diagnostic and management challenges. We present the case of a female patient in her early 40s with a 3 year history of left flank and pelvic pain, left leg swelling and microscopic haematuria attributed to a rare combination of ANCS and MTS. Compression of the left common iliac vein (MTS) was managed with left common iliac stenting and compression of the left renal vein (LRV; ANCS) was managed surgically with a novel modified technique of LRV transposition using an autologous gonadal vein graft with subsequent resolution of all symptoms. To our knowledge, this is the fourth case presenting the coexistence of the two syndromes in the literature and the first presenting the modified treatment approach.
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Affiliation(s)
- Theoklis Andrea Kouyialis
- Nicosia General Hospital, Nicosia, Cyprus
- University of Edinburgh Medical School, Edinburgh, Midlothian, UK
| | - Marios Zertalis
- Vascular and Interventional Radiology, Aretaeio Private Hospital, Strovolos, Nicosia, Cyprus
| | - Nikolas Charalambous
- Vascular and Interventional Radiology, Aretaeio Private Hospital, Strovolos, Nicosia, Cyprus
| | - Michail Papoulas
- Department of Transplant Surgery, Nicosia General Hospital, Nicosia, Cyprus
- Department of Surgery, Aretaeio Private Hospital, Strovolos, Nicosia, Cyprus
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Schwarzman L, Aguilar J, Megowan N. A rare case of May-Thurner syndrome due to external compression of the right and left common iliac veins. J Vasc Surg Cases Innov Tech 2025; 11:101658. [PMID: 39687061 PMCID: PMC11647079 DOI: 10.1016/j.jvscit.2024.101658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Accepted: 10/14/2024] [Indexed: 12/18/2024] Open
Abstract
May-Thurner syndrome, also known as external iliac compression syndrome, is a rare but commonly underdiagnosed cause of asymmetric lower extremity edema. Here we describe a case of May-Thurner syndrome owing to external compression of the right and left common iliac veins presenting as chronic worsening asymmetric right greater than left lower extremity edema. Initial etiology workup was unremarkable, and further diagnostics revealed compression of the right common iliac vein at the bifurcation of the right common iliac artery between the right external and internal iliac arteries with concomitant compression of the left common iliac vein. Stenting of the right common iliac vein was completed, with significant symptomatic improvement at 30-day follow-up. This case documents a unique variant of May-Thurner syndrome rarely described in the literature.
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Affiliation(s)
- Logan Schwarzman
- Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Jack Aguilar
- Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Nichelle Megowan
- Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA
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Liu D, Wang S, Yang Y, Zhao L, Zhang J, Chen Z. The Long-Term Prognosis of Endovascular Thrombectomy in Patients with Acute Left Iliofemoral Vein Thrombosis Combined with Left Iliac Vein Compression. Ann Vasc Surg 2025; 110:373-384. [PMID: 39424180 DOI: 10.1016/j.avsg.2024.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/07/2024] [Accepted: 09/17/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND This study investigated the long-term outcomes of different thrombus removal methods in patients with acute left iliofemoral vein thrombosis (IFDVT) accompanied by left iliac vein compression (LIVC). METHODS This was a single-center cohort study. 240 patients with acute left-sided IFDVT complicated by LIVC were categorized based on their treatment approach into 2 groups: those receiving anticoagulation alone with no pharmacomechanical catheter-directed thrombolysis applied (No-PCDT group) and those undergoing anticoagulation combined with pharmacomechanical catheter-directed thrombolysis (PCDT group). The PCDT group was further divided into 3 subgroups: anticoagulation combined with percutaneous mechanical thrombectomy (PMT group), anticoagulation combined with catheter-directed thrombolysis (CDT group), and anticoagulation combined with both PMT and catheter-directed thrombolysis (PMT + CDT group). The incidence of postthrombotic syndrome (PTS) was assessed using Villalta scores and Venous Clinical Severity Scores (VCSS). Patients were followed up for 24 months to compare long-term outcomes. RESULTS The No-PCDT group consisted of 123 individuals, while the PCDT group comprised 117, with 36 in the CDT subgroup, 41 in the PMT subgroup, and 40 in the PMT + CDT subgroup. The follow-up period ranged from 3 to 24 months. The PCDT group was associated with a reduced incidence of PTS and a lower risk of high VCSS (Villalta scale ≥5 or presence of ulcer: 22% PCDT vs. 39% No-PCDT; odds ratio [OR], 0.446; 95% confidence interval [CI], 0.253-0.787; P = 0.005; and VCSS ≥ 4: 22% PCDT vs. 34% No-PCDT; OR, 0.551; 95% CI, 0.311-0.978; P = 0.042). Among the 3 subgroups of PCDT cohort, compared to the CDT group, the PMT group showed a decreased incidence of PTS and a lower risk of high VCSS (Villalta scale ≥ 5 or ulcer: 12% PMT vs. 39% CDT; OR, 0.218; 95% CI, 0.069-0.690; P = 0.010; and VCSS ≥ 4: 12% PMT vs. 36% CDT; OR, 0.246; 95% CI, 0.077-0.781; P = 0.017). The PMT + CDT group also demonstrated a reduced incidence of PTS (18% PMT + CDT vs. 39% CDT; OR, 0.333; 95% CI, 0.116-0.958; P = 0.041) compared to the CDT group, but did not show a significant reduction in the risk of high VCSS (20% PMT + CDT vs. 36% CDT; P = 0.121). Compared to the PMT group, the PMT + CDT group did not significantly reduce the incidence of PTS (12% PMT vs. 18% PMT + CDT; P = 0.504) or the rate of high VCSS (12% PMT vs. 20% PMT + CDT; P = 0.343). CONCLUSIONS In patients with acute left IFDVT complicated by LIVC, PMT may serve as a more efficacious method for thrombus removal compared to CDT and combined PMT + CDT in reducing both the incidence of PTS and the risk of high VCSS.
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Affiliation(s)
- Dafang Liu
- Department of Vascular Surgery, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China; Department of Vascular Surgery, Beijing Luhe Hospital Capital Medical University, Beijing, People's Republic of China
| | - Sheng Wang
- Department of Vascular Surgery, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Yaoguo Yang
- Department of Vascular Surgery, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Liang Zhao
- Department of Vascular Surgery, Beijing Luhe Hospital Capital Medical University, Beijing, People's Republic of China
| | - Jie Zhang
- Department of Vascular Surgery, Beijing Luhe Hospital Capital Medical University, Beijing, People's Republic of China
| | - Zhong Chen
- Department of Vascular Surgery, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China.
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Yang R, Ye Y, Hu Y, Wang H. Acute May-Thurner syndrome following pedicle screw perforation: A case report and literature review. Asian J Surg 2024; 47:5213-5214. [PMID: 38879365 DOI: 10.1016/j.asjsur.2024.05.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/31/2024] [Indexed: 12/05/2024] Open
Affiliation(s)
- Rui Yang
- Department of Orthopedics, Central Hospital of Dalian University of Technology, Dalian City, Liaoning Province, China; School of Graduates, Dalian Medical University, Dalian City, Liaoning Province, China
| | - Yusong Ye
- The Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province, China
| | - Yunxiang Hu
- Department of Orthopedics, Central Hospital of Dalian University of Technology, Dalian City, Liaoning Province, China; School of Graduates, Dalian Medical University, Dalian City, Liaoning Province, China
| | - Hong Wang
- Department of Orthopedics, Central Hospital of Dalian University of Technology, Dalian City, Liaoning Province, China.
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Basu R, Reddy M, Kaabneh A, Mohamedelamin Khidir Ahmed A, Bamne S. May-Thurner Syndrome: An Unusual Case of Unilateral Severe Deep Vein Thrombosis in a Middle-Aged Women. Cureus 2024; 16:e75621. [PMID: 39803134 PMCID: PMC11725018 DOI: 10.7759/cureus.75621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2024] [Indexed: 01/16/2025] Open
Abstract
A 50-year-old female presented with a 10-day history of progressive swelling and pain in the left lower extremity, ultimately diagnosed with deep vein thrombosis (DVT) and May-Thurner Syndrome (MTS). Initial ultrasound indicated thrombosis involving the left external iliac, femoral, and popliteal veins, among others. Blood tests revealed normocytic anemia, but thrombophilia screening and other blood markers were normal. Computed tomography angiography (CTA) identified compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA), leading to thrombus formation. Initial management included anticoagulation with enoxaparin and iron supplementation. Interventional radiology was consulted, and an inferior vena cava (IVC) filter was placed. Through popliteal vein access, catheter-directed thrombolysis with Actilyse significantly reduced the thrombus burden. Venoplasty with a 12 mm balloon was performed to relieve the stenosis in the LCIV; however, recurrent stenosis required stent implantation. Post-stenting venography showed complete resolution of the stenosis and restored blood flow. This case illustrates the critical role of multimodal management in treating complex DVT with MTS, including anticoagulation, thrombolysis, and stent placement.
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Affiliation(s)
- Ranjan Basu
- Internal Medicine, NMC Specialty Hospital, Abu Dhabi, ARE
| | - Manohar Reddy
- Internal Medicine, NMC Specialty Hospital, Abu Dhabi, ARE
| | | | | | - Shrirang Bamne
- Critical Care Medicine, NMC Specialty Hospital, Abu Dhabi, ARE
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Gaspar AR. A Clinical Suspicion That Led to the Diagnosis of May-Thurner Syndrome. Cureus 2024; 16:e76463. [PMID: 39867004 PMCID: PMC11765910 DOI: 10.7759/cureus.76463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2024] [Indexed: 01/28/2025] Open
Abstract
May-Thurner syndrome is an anatomical anomaly characterized by venous compression of the iliac vein by the arterial system. It is more common in women. It may be asymptomatic or lead to symptoms related to hypertension/venous occlusion, namely, edema of the lower limb. The exact value of its prevalence is unknown. This case reports a 52-year-old woman with a personal history of cervical cancer. She went to her family doctor in June 2021 with complaints of edema of the left thigh, evolving over one week, without associated trauma or pain. She was directed to the emergency service, where after carrying out blood analysis, an indication for topical anti-inflammatories and monitoring of alarm signs was given. She went to the emergency service two more times in the next month with the same indications for treatment. In September 2022, during a family doctor's appointment, she again mentioned concerns regarding asymmetry of her legs. On objective examination, varicose veins were observed bilaterally. Blood analysis and arterial and venous echo-Doppler were required. There were no changes in the blood analysis. The echo-Doppler was not very conclusive, showing only slightly insufficient perforating veins. It was decided to request an abdominopelvic computed tomography (CT) whose result in February 2023 demonstrated extrinsic compression at the emergence of the left common iliac vein by the right iliac artery, likely related to May-Thurner syndrome. This clinical case recalls the importance of the family doctor in the longitudinal monitoring of his patients. The unique opportunity to learn about their background and evaluate them when surveying diagnostic hypotheses led to an unexpected diagnosis.
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Galanis N, Dousis A, Taprantzis N, Chrysikos D, Shehade A, Troupis T. An Aneurysm of the Internal Iliac Vein and Its Confluent Branches Due to Congenital Arteriovenous Communication: A Case Report. Cureus 2024; 16:e74726. [PMID: 39734998 PMCID: PMC11682542 DOI: 10.7759/cureus.74726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2024] [Indexed: 12/31/2024] Open
Abstract
Iliac vein aneurysms are a relatively rare clinical medical case requiring careful management. In general, vessel aneurysms are always an intriguing entity to approach due to the various options for diagnosis and treatment, which are heavily dependent on the unique characteristics of the condition. Such features include etiology, location, and coexistence with other abnormalities. In this case report, we describe the case of a patient who presented with an aneurysm in his internal iliac vein, as well as its tributaries, as a result of congenital arteriovenous communication.
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Affiliation(s)
- Nektarios Galanis
- Department of Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Antreas Dousis
- Department of Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Nikolaos Taprantzis
- Department of Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Dimosthenis Chrysikos
- Department of Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Ameer Shehade
- Department of Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Theodore Troupis
- Department of Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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Rodríguez Carvajal R, Bretos-Azcona PE, Láinez Rube R, Hernández Carbonell MT, Ruales Romero AM. Effectiveness and safety of detachable fibered coils as a single therapy for embolization in venous origin chronic pelvic pain. Phlebology 2024:2683555241288725. [PMID: 39359115 DOI: 10.1177/02683555241288725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
OBJECTIVES To investigate the effectiveness and safety of endovascular treatment by embolization with detachable fibered coils of insufficient pelvic veins, as the primary cause of Venous Origin Chronic Pelvic Pain (VOCPP). METHODS This observational, retrospective study analyzes data from the PELVIC registry from 2014 to 2022. Sociodemographic, diagnostic, preoperative, intraoperative, and postoperative follow-up variables were reported. RESULTS A total of 255 patients were included, with follow-up periods up to 5 years. The study's effectiveness was significant with a 60% decrease in pelvic pain at the first follow-up after treatment measured by a Visual Analogue Scale (p = 0.001). There were also decreases in the severity levels of dyspareunia (p = 0.03), dysmenorrhea (p = 0.12) and presence of Pelvic Venous Disorders symptoms in general (-43.8%; p = 0.001). No major adverse events were recorded. Only 5 patients (2%) experimented technical issues in coil implantation, all of them solved in situ. CONCLUSION The treatment of VOCPP by embolization with detachable fibered coils has proven to be an effective and safe option for insufficient pelvic veins.
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Affiliation(s)
- Rubén Rodríguez Carvajal
- International Vascular and Endovascular Institute (IVEI), IVEI Clínica Vascular Marbella, Hospiten Estepona Hospital, Málaga, Spain
- International Board of Compression Therapy Study Group (CTG), Florence, Italy
| | | | - Rocío Láinez Rube
- International Vascular and Endovascular Institute (IVEI), IVEI Clínica Vascular Marbella, Hospiten Estepona Hospital, Málaga, Spain
| | - María Teresa Hernández Carbonell
- International Vascular and Endovascular Institute (IVEI), IVEI Clínica Vascular Marbella, Hospiten Estepona Hospital, Málaga, Spain
| | - Ana Margarita Ruales Romero
- International Vascular and Endovascular Institute (IVEI), IVEI Clínica Vascular Marbella, Hospiten Estepona Hospital, Málaga, Spain
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Nadim B, Alizada S, Gupta S, Steigner ML, Menard MT, Aghayev A. Under pressure: a head-to-toe review of vascular compression syndromes. Clin Radiol 2024; 79:722-735. [PMID: 39107192 DOI: 10.1016/j.crad.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 08/09/2024]
Abstract
Vascular compression syndromes are a group of conditions resulting from mechanical compression of blood vessels by adjacent structures leading to compromised blood flow and various associated symptoms. They frequently affect young, otherwise healthy individuals and are often underdiagnosed due to their rarity and vague clinical manifestations. Achieving an accurate diagnosis depends on the integration of clinical presentation and imaging findings. Imaging modalities including color doppler ultrasound, computed tomography angiography, magnetic resonance angiography, and catheter-directed digital subtraction angiography are essential for diagnosis and management. Dynamic imaging is crucial in eliciting findings due to the positional nature of many of these syndromes. In this paper, we will present a "head-to-toe" overview of vascular compression syndromes including Vascular Eagle Syndrome, Vascular Thoracic Outlet Syndrome, Quadrilateral Space Syndrome, Hypothenar Hammer Syndrome, Median Arcuate Ligament Syndrome, Renal Artery Entrapment Syndrome, Left Renal Vein Compression/Nutcracker Syndrome, May-Thurner Syndrome, Adductor Canal Syndrome, and Popliteal Artery Entrapment Syndrome. Treatment is variable but typically involves a combination of conservative and surgical management. Surgical approaches focus on decompression of affected neurovascular structures. Endovascular treatment alone is rarely recommended. We aim to equip general radiologists with the knowledge needed to accurately diagnose patients with vascular compression syndromes, allowing for timely treatment.
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Affiliation(s)
- B Nadim
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
| | - S Alizada
- Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - S Gupta
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
| | - M L Steigner
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
| | - M T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - A Aghayev
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
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Zhang F, Song HX, He ZP, Zheng LH, Han YR, Wang BY, Liu P. Analysis of computed tomography venography for the diagnosis and endovascular treatment of iliac venous compression syndrome with venous leg ulcers: a retrospective study. Sci Rep 2024; 14:22314. [PMID: 39333192 PMCID: PMC11436635 DOI: 10.1038/s41598-024-72425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/06/2024] [Indexed: 09/29/2024] Open
Abstract
Iliac vein compression syndrome (IVCS) is a clinical condition defined as obstruction of the iliac vein caused by chronic compression imposed by various causes. Currently, the clinical role of computed tomography venography (CTV) in the diagnosis of IVCS is unclear. Accurately diagnosing IVCS using CTV may enhance the understanding of the pathological anatomy of iliac veins, which may lead to better treatment outcomes, especially for recalcitrant venous leg ulcers (VLU). We aimed to investigate diagnostic criteria, contributing clinical factors, and stenting for IVCS with VLU in this study. CTV, digital subtraction angiography (DSV), and Doppler ultrasound (DUS) data were obtained from the medical and imaging records of 62 patients. Additionally, contributing factors and stenting for IVCS were analysed. Patients (100%) had clinical, aetiological, anatomic, or pathological C6 disease. CTV reduced the procedure time and contrast medium dose and provided more information than DSV. Risk factors for IVCS with VLU included female sex (P = 0.036) and advanced age (P = 0.014). The rate of ulcer healing was lower in the IVCS group without stent implantation (P = 0.020). Significant improvements were noted in venous clinical severity scores (P < 0.001) and chronic venous insufficiency questionnaire-20 scores (P < 0.001) after stenting for IVCS with C6 ulcers. CTV provides a more accurate diagnosis than DUS and DSV and allows detection of possible causes of IVCS. Female sex and advanced age were potential contributing factors for IVCS. Satisfactory outcomes were observed with stenting in the treatment of IVCS with C6 ulcers.
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Affiliation(s)
- Feng Zhang
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei, 050031, People's Republic of China
| | - Hai-Xia Song
- Department of Neurology, Shijiazhuang People's Hospital, Hebei, China
| | - Zhao-Peng He
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei, 050031, People's Republic of China
| | - Li-Hua Zheng
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei, 050031, People's Republic of China
| | - Ya-Ru Han
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei, 050031, People's Republic of China
| | - Bo-Yu Wang
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei, 050031, People's Republic of China
| | - Peng Liu
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei, 050031, People's Republic of China.
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15
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Nguyen D, Berman SS, Balderman JA, Sabat JE, Mendoza B, Leon LR, Pacanowski JP, Kraemer C. Initial experience with the ambulatory management of acute iliofemoral deep vein thrombosis with May-Thurner syndrome with percutaneous mechanical thrombectomy, angioplasty and stenting. J Vasc Surg Venous Lymphat Disord 2024; 12:101875. [PMID: 38513797 PMCID: PMC11523435 DOI: 10.1016/j.jvsv.2024.101875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/07/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Patients undergoing intervention for acute iliofemoral deep vein thrombosis (IFDVT) with May-Thurner syndrome (MTS) typically require inpatient (IP) hospitalization for initial treatment with anticoagulation and management with pharmacomechanical thrombectomy. Direct oral anticoagulants and percutaneous mechanical thrombectomy (PMT) devices offer the opportunity for outpatient (OP) management. We describe our approach with these patients. METHODS Patients receiving intervention for acute IFDVT from January 2020 through October 2022 were retrospectively reviewed. Patients undergoing unilateral thrombectomy, venous angioplasty, and stenting for IFDVT with MTS comprised the study population and were divided into two groups: (1) patients admitted to the hospital and treated as IPs and (2) patients who underwent therapy as OPs. The two groups were compared regarding demographics, risk factors, procedural success, complications, and follow-up. RESULTS A total of 92 patients were treated for IFDVT with thrombectomy, angioplasty, and stenting of whom 58 comprised the IP group and 34 the OP group. All 92 patients underwent PMT using the Inari ClotTriever (Inari Medical), intravascular ultrasound, angioplasty, and stenting with 100% technical success. Three patients in the IP group required adjuvant thrombolysis. There was no difference in primary patency of the treated IFDVT segment at 12 months between the two groups (IP, 73.5%; OP, 86.7%; P = .21, log-rank test). CONCLUSIONS Patients with acute IFDVT and MTS deemed appropriate for thrombectomy and iliac revascularization can be managed with initiation of ambulatory direct oral anticoagulant therapy and subsequent return for ambulatory PMT, angioplasty, and stenting. This approach avoids the expense of IP care and allows for effective use of resources at a time when staffing and supply chain shortages have led to inefficiencies in the provision of IP care for nonemergent conditions.
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Affiliation(s)
- Daniel Nguyen
- Pima Heart and Vascular, Tucson, AZ; The University of Arizona School of Medicine, Tucson, AZ
| | - Scott S Berman
- Pima Heart and Vascular, Tucson, AZ; Section of Vascular Surgery, The University of Arizona, Tucson, AZ.
| | | | - Joseph E Sabat
- Pima Heart and Vascular, Tucson, AZ; Section of Vascular Surgery, The University of Arizona, Tucson, AZ
| | | | - Luis R Leon
- Pima Heart and Vascular, Tucson, AZ; Section of Vascular Surgery, The University of Arizona, Tucson, AZ
| | - John P Pacanowski
- Pima Heart and Vascular, Tucson, AZ; Section of Vascular Surgery, The University of Arizona, Tucson, AZ
| | - Cody Kraemer
- Pima Heart and Vascular, Tucson, AZ; Section of Vascular Surgery, The University of Arizona, Tucson, AZ
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16
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Dalal YD, Mehta DP, Alford K. Cardiac Arrest Due to Pulmonary Embolism Without Clinical Features of Deep Vein Thrombosis in a Young Female: A Rare Presentation of May-Thurner Syndrome. Cureus 2024; 16:e68596. [PMID: 39238925 PMCID: PMC11376008 DOI: 10.7759/cureus.68596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 09/07/2024] Open
Abstract
Deep vein thrombosis (DVT) is a serious condition with a high disease burden. Pulmonary embolism is one of the disastrous complications of DVT. The etiology of DVT includes factors responsible for hypercoagulation, venous injury, and factors causing stasis in the deep veins. May-Thurner syndrome (MTS) is one of the rarely thought of causes of DVT. MTS is an anatomical variant where the right common iliac artery compresses the left common iliac vein against the lumbar vertebrae. This leads to thrombus formation and stenosis in the left common iliac vein at the site of cross-over, resulting in an iliofemoral DVT. We present a case of a young female who presented with acute bilateral pulmonary embolism and subsequent cardiac arrest. She was treated with mechanical thrombectomy, angioplasty, and stent placement under the umbrella of anticoagulant agents. We aim to present this case to highlight that MTS should be considered a differential etiological condition in iliofemoral DVT. MTS is a rarely considered condition by clinicians while evaluating patients with lower limb DVT. When unaddressed, MTS can lead to recurrent DVT, post-thrombotic syndrome, and fatal complications like pulmonary embolism. Clinicians should investigate for possible MTS in patients with left lower extremity venous thrombotic events, irrespective of the presence of other risk factors.
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Affiliation(s)
- Yagnya D Dalal
- Internal Medicine, Gujarat Cancer Society Medical College, Hospital and Research Centre, Ahmedabad, IND
- Nephrology, Research Medical Center, Kansas City, USA
| | - Devagna P Mehta
- Internal Medicine, Gujarat Cancer Society Medical College, Hospital and Research Centre, Ahmedabad, IND
- Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA
| | - Kelly Alford
- Nephrology, Research Medical Center, Kansas City, USA
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17
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Guo C, Gao S, Hu L, Shang D, Li Y. Predictive factors for iliac vein compression syndrome in patients with varicose veins. Vascular 2024:17085381241275269. [PMID: 39179517 DOI: 10.1177/17085381241275269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2024]
Abstract
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.
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Affiliation(s)
- Chao Guo
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ShuTing Gao
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Longqing Hu
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Shang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiqing Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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18
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Al Ghananeem Z, Deshpande A, Sundaresan V, Abuzenah M, Abuzenah H. May-Thurner Syndrome: A Rare, Yet Recognized, Cause of Deep Vein Thrombosis. Cureus 2024; 16:e66357. [PMID: 39246883 PMCID: PMC11380549 DOI: 10.7759/cureus.66357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 09/10/2024] Open
Abstract
May-Thurner syndrome (MTS) involves the chronic compression of the left common iliac vein (CIV) by the overlying right common iliac artery (CIA) against the lumbar vertebrae. This compression can result in signs and symptoms of deep vein thrombosis (DVT) affecting the left side. In this case report, we present the clinical details of a 19-year-old patient diagnosed with severe MTS, which manifested as DVT with symptoms of severe thigh pain, redness, and difficulty walking. Additionally, the patient experienced pleuritic chest pain, ultimately diagnosed as pulmonary embolism (PE). Her management involved surgical removal of the thrombus and endovascular stenting of the left CIV. Following her recovery, she progressed favorably, and her follow-up assessment yielded satisfactory results.
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Affiliation(s)
- Zaid Al Ghananeem
- Vascular Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR
| | - Amit Deshpande
- Vascular Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR
| | - Vaibhav Sundaresan
- Vascular Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR
| | - Mohammad Abuzenah
- General Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR
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19
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Longoria S, Romito JW, Shah SH, Ray B. Unusual Cause of Acute Stroke in a Young Woman with Patent Foramen Ovale - Duplicated Inferior Vena Cava and May-Thurner Syndrome. Neurohospitalist 2024; 14:278-283. [PMID: 38895017 PMCID: PMC11181982 DOI: 10.1177/19418744241231314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
The etiology of acute ischemic stroke (AIS) may often remain uncertain despite diligent work-up, especially in young people. Although patent foramen ovale (PFO) is a frequent association during such work-up, the actual source of thromboembolism, like deep vein thrombosis (DVT), may not be found. Such associative pathology makes it challenging to prescribe anticoagulation for secondary stroke prevention. We describe a young woman with a known history of PFO who presented with AIS and underwent endovascular reperfusion therapy. Post-thrombectomy, she developed hypoxic respiratory failure due to pulmonary embolism. Initiation of therapeutic anticoagulation was complicated by a retroperitoneal bleed necessitating imaging studies for etiological work-up. Computed tomographic angiography and venogram showed no active contrast extravasation but demonstrated duplication of the inferior vena cava with DVT in the right iliofemoral vein (RIFV). The proximity of the right common iliac artery compressing RIFV against the pelvic inlet is described as May-Thurner syndrome (MTS). Afterward, the patient was successfully treated with anticoagulation and PFO closure. MTS is a rare and underdiagnosed cause of iliofemoral DVT. In patients with known PFO, MTS is a possible cause that needs consideration. Hence, appropriate diagnostic tests are necessary to initiate appropriate management and to prevent AIS recurrence.
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Affiliation(s)
- Summer Longoria
- Division of Neurocritical Care, Department of Neurology and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, Texas Health Presbyterian Hospital, Dallas, TX, USA
- Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jia W. Romito
- Division of Neurocritical Care, Department of Neurology and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, Texas Health Presbyterian Hospital, Dallas, TX, USA
- Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Samir H. Shah
- Department of Neurology, Texas Health Presbyterian Hospital, Dallas, TX, USA
| | - Bappaditya Ray
- Division of Neurocritical Care, Department of Neurology and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, Texas Health Presbyterian Hospital, Dallas, TX, USA
- Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
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20
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Nolan R, Sangha HS, Arous EJ. Endovascular Treatment of May-Thurner Syndrome in an Office-Based Laboratory. Cureus 2024; 16:e63903. [PMID: 39099949 PMCID: PMC11298161 DOI: 10.7759/cureus.63903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2024] [Indexed: 08/06/2024] Open
Abstract
May-Thurner syndrome (MTS) is a rare condition that increases the risk of left-sided iliofemoral venous thrombosis due to compression of the left common iliac vein by the right common iliac artery. Treatment for symptomatic MTS typically includes combined anticoagulation and endovascular therapy. This patient presented to the emergency department with acute left lower extremity pain and swelling. After imaging confirmed MTS, the patient was discharged from the ED and expeditiously treated in an office-based lab (OBL) setting with venous thrombectomy, angioplasty, and stenting. The setting where endovascular therapy is performed may significantly impact access to care for patients. Additionally, cost-effectiveness is a factor that should be considered when deciding the treatment site of service. We demonstrate the safety and cost-viability of performing venous thrombectomy, angioplasty, and stenting in an outpatient setting for the treatment of acute iliofemoral venous thrombosis.
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Affiliation(s)
- Ryan Nolan
- School of Medicine, University of Nevada Reno, Reno, USA
| | - Harneet S Sangha
- School of Medicine, Elson S. Floyd College of Medicine, Spokane, USA
| | - Edward J Arous
- Department of Vascular Surgery, The Vascular Care Group, Worcester, USA
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21
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Young VA, Obi C, Oladini LK, Josephs SC, Hofmann LV. Venous Compressive Disorders. Tech Vasc Interv Radiol 2024; 27:100964. [PMID: 39168547 DOI: 10.1016/j.tvir.2024.100964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Venous compressive disorders are a heterogenous group of vascular syndromes characterized by extrinsic venous compression that can lead to complications of venous hypertension or venous thrombosis. Endovascular damage secondary to deep venous thrombosis (DVT) can result in post-thrombotic syndrome (PTS), a potentially debilitating condition that can be associated with significant morbidity in the pediatric population. Here we discuss 4 venous compressive disorders: iliac vein compression (May-Thurner syndrome [MTS]); subclavian vein compression at the venous thoracic inlet (Paget-Schroetter syndrome); left renal vein compression (nutcracker syndrome); and popliteal vein compression (popliteal entrapment syndrome) with a focus on clinical evaluation and diagnostic methods. Where endovascular therapy is appropriate, specific procedural considerations including procedure indications, equipment, procedural steps, technical challenges, complications, clinical follow-up and expected outcomes are discussed.
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Affiliation(s)
- Victoria A Young
- Department of Radiology, Division of Pediatric Radiology, Stanford University School of Medicine, Palo Alto, CA.
| | - Chrystal Obi
- Department of Radiology, Division of Pediatric Radiology, Stanford University School of Medicine, Palo Alto, CA
| | - Lola K Oladini
- Department of Radiology, Division of Pediatric Radiology, Stanford University School of Medicine, Palo Alto, CA
| | - Shellie C Josephs
- Department of Radiology, Division of Pediatric Radiology, Stanford University School of Medicine, Palo Alto, CA
| | - Lawrence V Hofmann
- Department of Radiology, Division of Pediatric Radiology, Stanford University School of Medicine, Palo Alto, CA
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22
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Dwivedi A, Singh SN, Sharma A, Sharma R, Mishra T. A Systematic Review of Radiological Diagnosis and Management of May-Thurner Syndrome. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S1012-S1016. [PMID: 38882842 PMCID: PMC11174332 DOI: 10.4103/jpbs.jpbs_1135_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/10/2023] [Accepted: 11/17/2023] [Indexed: 06/18/2024] Open
Abstract
May-Thurner syndrome (MTS) is an anatomical condition of external luminal compression of common iliac vein due to a partial obstruction of the common iliac vein between common iliac artery and lumbar vertebra causes deep-vein thrombosis, venous hypertension, and chronic venous insufficiencies. In this article, we review present evidence of the clinical diagnosis and management of MTS. Here, we conducted a literature review of studies on MTS. We also reviewed different clinical features, presentation, diagnostic methods, and therapeutic procedure for this condition. Most studies mentioned the diagnosis of this condition is performed by color Doppler, computed tomographic angiography, venography, and problem-solving cases by intravascular ultrasound technique. Nonsurgical methods of management are first line, and vascular surgery is reserved for refractory cases. Multiple modalities are required to reach the diagnosis of MTS, and noninvasive intervention radiology methods are the first line of management. This review highlights the presentations of MTS and outlines diagnostic procedure and management.
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Affiliation(s)
- Abhishek Dwivedi
- Department of Radiodiagnosis, FH Medical College and Hospital, Agra, Uttar Pradesh, India
| | - Satyender N Singh
- Department of Radiology, Tata Memorial Centre, Varanasi, Uttar Pradesh, India
| | - Ankur Sharma
- Department of Radiodiagnosis, FH Medical College and Hospital, Agra, Uttar Pradesh, India
| | - Rachit Sharma
- Department of Radiology, Military Hospital, Jaipur, Rajasthan, India
| | - Tanu Mishra
- Department of Radiology, Autonomous State Medical College, Basti, Uttar Pradesh, India
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23
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Cho LD, Bai H, Collins LC, Chen J, Cooke PV, Kang Y, Vasan V, Kim J, Gonzalez C, Dionne E, Kim SY, Ting W. Race differences in iliofemoral vein stenting for chronic venous insufficiency. Vascular 2024; 32:385-390. [PMID: 36395482 DOI: 10.1177/17085381221140612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Major disparities in outcomes by race are present throughout vascular surgery, yet little has been published on iliac vein stent outcomes by race. This retrospective study assessed iliac vein stent outcomes by patient race. METHODS Patients who underwent iliac vein stenting at a single institution for chronic venous insufficiency (CVI) from 2011 to 2021 were reviewed. Demographic, preoperative, perioperative, and postoperative data were collected. Self-reported race groups included Asian, Black, Hispanic, and White. Univariate differences were analyzed using χ2 tests for categorical variables and 1-way ANOVA for continuous variables. Outcomes included change in Venous Clinical Severity Score (VCSS) at interval timepoints relative to a preoperative baseline and reinterventions. Logistic regression models were used to determine the unadjusted and adjusted odds ratio (OR) of any minor and major reintervention. Multivariate regression models controlled for demographic and comorbidity characteristics. RESULTS A total of 827 patients were included. Asian patients were younger and had a greater proportion of male patients, lower Body mass index (BMI), less smoking history, and fewer comorbidities. White patients were more likely to have a history of deep vein thrombosis (DVT). White patients presented with the most severe CVI symptoms as defined by both Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification and preoperative VCSS composite scores. There were no differences in acute DVT, number of stents deployed, and bilateral versus unilateral stent placement. Black patients had the longest average days of follow-up, followed sequentially by Hispanic, White, and Asian. Black patients had the most reinterventions, while Asian patients had the fewest. Asian patients were less likely to have a major reintervention. No differences in VCSS composite or change in VCSS were observed. CONCLUSIONS In patients with CVI, Asian patients presented younger and healthier, while White patients presented with the most severe symptoms. No differences were observed in VCSS outcomes, though Black patients had the most reinterventions.
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Affiliation(s)
- Logan D Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Halbert Bai
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jenny Chen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter V Cooke
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yeju Kang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vikram Vasan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jinseo Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Elyssa Dionne
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sung Yup Kim
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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24
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Chen JX, Xu LL, Cheng JP, Xu XH. Challenging anticoagulation therapy for multiple primary malignant tumors combined with thrombosis: A case report and review of literature. World J Clin Cases 2024; 12:1704-1711. [PMID: 38576733 PMCID: PMC10989423 DOI: 10.12998/wjcc.v12.i9.1704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/21/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Venous thromboembolism significantly contributes to patient deterioration and mortality. Management of its etiology and anticoagulation treatment is intricate, necessitating a comprehensive consideration of various factors, including the bleeding risk, dosage, specific anticoagulant medications, and duration of therapy. Herein, a case of lower extremity thrombosis with multiple primary malignant tumors and high risk of bleeding was reviewed to summarize the shortcomings of treatment and prudent anticoagulation experience. CASE SUMMARY An 83-year-old female patient was admitted to the hospital due to a 2-wk history of left lower extremity edema that had worsened over 2 d. Considering her medical history and relevant post-admission investigations, it was determined that the development of left lower extremity venous thrombosis and pulmonary embolism in this case could be attributed to a combination of factors, including multiple primary malignant tumors, iliac venous compression syndrome, previous novel coronavirus infection, and inadequate treatment for prior thrombotic events. However, the selection of appropriate anticoagulant medications, determination of optimal drug dosages, and establishment of an appropriate duration of anticoagulation therapy were important because of concurrent thrombocytopenia, decreased quantitative fibrinogen levels, and renal insufficiency. CONCLUSION Anticoagulant prophylaxis should be promptly initiated in cases of high-risk thrombosis. Individualized anticoagulation therapy is required for complex thrombosis.
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Affiliation(s)
- Jia-Xin Chen
- Department of Gerontology, China Resources and Wisco General Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
- Medical College, Wuhan University of Science and Technology, Wuhan 430065, Hubei Province, China
| | - Ling-Ling Xu
- Department of Gerontology, China Resources and Wisco General Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
- Medical College, Wuhan University of Science and Technology, Wuhan 430065, Hubei Province, China
| | - Jing-Ping Cheng
- Department of Gerontology, China Resources and Wisco General Hospital, Wuhan 430080, Hubei Province, China
| | - Xun-Hua Xu
- Department of Radiology, China Resources and Wisco General Hospital, Wuhan 430080, Hubei Province, China
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25
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Jiang L, Zhuang H, Song T, Li XQ. Clinical Outcomes at 3 Years After Stenting for Thrombotic and Non-thrombotic Iliac Vein Compression Syndrome Patients. Clin Appl Thromb Hemost 2024; 30:10760296231220053. [PMID: 38213124 PMCID: PMC10787525 DOI: 10.1177/10760296231220053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Iliac vein stenting for the treatment of iliac vein compression syndrome (IVCS) has been gradually developed. This article investigated the long-term patency and improvement of clinical symptoms after endovascular stenting for iliac vein obstruction patients. From 2020 to 2022, 83 patients at a single institution with IVCS underwent venous stent implantation and were divided into two groups: non-thrombotic IVCS (n = 55) and thrombotic IVCS (n = 28). The main stent-related outcomes include technical success, long-term patency, and thrombotic events. The technical success rate of all stent implantation was 100%. The mean length of hospital stay and cost were higher in the thrombotic IVCS group than in the non-thrombotic ICVS group, as well as the length of diseased vessel segment and the number of stents implanted were higher than in the control non-thrombotic group. The 1-, 2-, and 3-year patency rates were 85.4%, 80% and 66.7% in the thrombosis group, which were lower than 93.6%, 88.7%, and 87.5% in the control group (P = .0135, hazard ratio = 2.644). In addition, patients in both groups had a foreign body sensation after stent implantation, which resolved spontaneously within 1 year after surgery. Overall, there were statistically significant differences in long-term patency rate outcome between patients with thrombotic and non-thrombotic IVCS, the 1-, 2-, and 3-year patency rates in non-thrombotic IVCS patients were higher than those in thrombotic IVCS patients.
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Affiliation(s)
- Lei Jiang
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Hao Zhuang
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Tao Song
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Xiao-Qiang Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Vascular Surgery, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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Bertino FJ, Hawkins CM, Woods GM, Shah JH, Variyam DE, Patel KN, Gill AE. Technical Feasibility and Clinical Efficacy of Iliac Vein Stent Placement in Adolescents and Young Adults with May-Thurner Syndrome. Cardiovasc Intervent Radiol 2024; 47:45-59. [PMID: 38097769 DOI: 10.1007/s00270-023-03628-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 11/19/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE To report technical feasibility and clinical efficacy of iliac vein stent placement in adolescent patients with May-Thurner Syndrome (MTS). MATERIALS AND METHODS Single-institution retrospective review of the medical record between 2014 and 2021 found 63 symptomatic patients (F = 40/63; mean age 16.1 years, 12-20 years) who underwent left common iliac vein (LCIV) stent placement for treatment of LCIV compression from an overriding right common iliac artery, or equivalent (n = 1, left IVC). 32/63 (50.7%) patients presented with non-thrombotic iliac vein lesions (NIVL). 31/63 (49.2%) patients presented with deep vein thrombosis of the lower extremity and required catheter-directed thrombolysis after stent placement (tMTS). Outcomes include technically successful stent placement with resolution of anatomic compression and symptom improvement. Stent patency was monitored with Kaplan-Meier analysis at 3, 6, 12, 24, and 36 months. Anticoagulation and antiplatelet (AC/AP) regimens were reported. RESULTS Technical success rate was 98.4%. 74 bare-metal self-expanding stents were placed in 63 patients. Primary patency at 12, and 24-months was 93.5%, and 88.9% for the NIVL group and 84.4% and 84.4% for the tMTS group for the same period. Overall patency for the same time intervals was 100%, and 95.4% for the NIVL group and 96.9%, and 96.9% for the tMTS group. Procedural complication rate was 3.2% (2/63) with no thrombolysis-related bleeding complications. Clinical success was achieved in 30/32 (93.8%) and 29/31 (93.5%) patients with tMTS and NIVL groups, respectively. CONCLUSION CIV stent placement in the setting of tMTS and NIVL is technically feasible and clinically efficacious in young patients with excellent patency rates and a favorable safety profile.
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Affiliation(s)
- Frederic J Bertino
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
- Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory + Children's Pediatric Institute, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia.
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Grossman School of Medicine, 550 First Avenue Tisch Hospital Radiology- 2nd Floor, New York, NY, 10016, USA.
| | - C Matthew Hawkins
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
- Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory + Children's Pediatric Institute, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
| | - Gary M Woods
- Department of Hematology/Oncology/BMT, Children's Healthcare of Atlanta, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Jay H Shah
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
- Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory + Children's Pediatric Institute, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
| | - Darshan E Variyam
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
- Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory + Children's Pediatric Institute, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
| | - Kavita N Patel
- Department of Hematology/Oncology/BMT, Children's Healthcare of Atlanta, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatric Hematology and Oncology, The Woman's Hospital of Texas, Houston, TX, USA
| | - Anne E Gill
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
- Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory + Children's Pediatric Institute, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
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Malik MK, Humayun W, Darki A. "Complete Venous Shutdown:" A Rare Case of Combined Superior Vena Cava (SVC) and Inferior Vena Cava (IVC) Occlusion. Case Rep Vasc Med 2023; 2023:5590280. [PMID: 38143854 PMCID: PMC10746359 DOI: 10.1155/2023/5590280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/05/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023] Open
Abstract
Independently, superior vena cava (SVC) occlusion and inferior vena cava (IVC) occlusion are usually seen in the setting of SVC syndrome and iliocaval venous obstruction (ICVO), respectively. Concomitant occlusion of the SVC and IVC is rare and most commonly seen in the setting of malignancy or other hypercoagulable states. Venous hypertension can lead to the formation of "downhill" varices in the esophagus and can be a rare source of gastrointestinal bleeding. We present a rare case of combined SVC and IVC occlusion and its management.
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Affiliation(s)
- M. Kasim Malik
- Department of Internal Medicine, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL 60153, USA
| | - Wajahat Humayun
- Division of Cardiology, Department of Internal Medicine, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL 60153, USA
| | - Amir Darki
- Division of Cardiology, Department of Internal Medicine, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL 60153, USA
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MacDowell CJ, Idzikowski E, Saifuddin A, Kang F. Endovascular resolution of complete common iliac vein stenosis in a case of May-Thurner syndrome with underlying malignancy. Int J Surg Case Rep 2023; 112:108987. [PMID: 37939570 PMCID: PMC10667893 DOI: 10.1016/j.ijscr.2023.108987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE May-Thurner Syndrome (MTS) is an uncommon etiology of left common iliac vein thrombosis due to arterial compression. In this report, we describe a case of MTS with severe occlusion of the left common iliac vein in the context of a previously undiagnosed pancreatic cancer. We detail the endovascular resolution of the iliac vein compression and show long-term patency. CASE PRESENTATION A 33-year-old woman on oral contraceptive pills presented with extensive thrombosis of the left common iliac vein extending cephalad into the lower IVC and inferiorly to the femoral vein. The thrombus was refractory to therapeutic heparin. Mechanical thrombectomy removed the occluding thrombus. Intravenous ultrasound identified severe compression of the left common iliac vein by the right common iliac artery. Angioplasty and stenting provided complete resolution of the lesion. Imaging and hematologic workup revealed a pancreatic malignancy and concomitant hypercoagulable state that likely precipitated the patient's presentation. CLINICAL DISCUSSION Endovascular intervention provided complete resolution of severe iliac vein compression. Patency was maintained at 6-month follow-up. Research suggests that the anatomical lesion predisposing individuals to MTS is relatively common despite infrequent occurrence of the syndrome. This case highlights the importance of a high clinical suspicion for associated hypercoagulable states when MTS is discovered. CONCLUSION There is limited research exploring the relationship between severity of iliac vein compression and endovascular treatment outcome. This case documents endovascular resolution of a severe lesion with maintained patency.
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Affiliation(s)
| | - Emma Idzikowski
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Ali Saifuddin
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Francis Kang
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Kim JH, Lee SK, Kim JY. Iliac vein compression syndrome by lumbar degenerative changes is associated with deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:5833-5842. [PMID: 36799994 DOI: 10.1007/s00402-023-04811-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/04/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION This study aimed to identify whether iliac vein compression syndrome(IVCS) is associated with deep vein thrombosis(DVT) after total knee arthroplasty(TKA) and whether lower lumbar degenerative changes were risk factors for IVCS. MATERIALS AND METHODS A total of 259 consecutive patients who underwent TKA from January 2019 to March 2022 was retrospectively reviewed. Preoperative plain radiographs of lumbar spines and CT venography (CTV) for DVT diagnosis at postoperative 7 days were performed in all patients. Imaging findings of lower lumbar degenerative changes were analyzed on plain radiograph including lateral osteophytes, scoliosis, lateralolisthesis, retrolisthesis, anterolisthesis, and lower lumbar lordosis angle (LLLA). Percent compression at the left common iliac vein (LCIV) and right common iliac vein (RCIV) as well as DVT were evaluated on CTV. Moreover, IVCS was defined as greater than 50% of compression of the iliac vein on CTV. RESULTS DVT occurred in 79 patients (30.5%) after TKA. The overall occurrence of DVT was significantly higher in patients with IVCS of LCIV (52.8%) than those without (18.8%, P < 0.001). When DVT was further subdivided, compared to non-IVCS, IVCS of LCIV was significantly associated with bilateral DVT (P < 0.001, both), especially distal DVT (P < 0.001, both), and IVCS of RCIV was significantly associated with right-side DVT (P = 0.031), especially popliteal (P = 0.008) and distal DVT(P = 0.011). Female patients (OR: 3.945, P = 0.039), presence of left osteophyte (OR: 2.348, P = 0.006), and higher LLLA (OR: 1.082, P < 0.001) were significantly associated with IVCS of LCIV, and presence of right osteophyte (OR: 3.494, P = 0.017) was significantly associated with IVCS of RCIV. CONCLUSION IVCS was significantly associated with DVT after TKA and lumbar degenerative changes with lateral osteophytes and hyperlordosis were significant risk factors for IVCS.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, 05278, Seoul, Republic of Korea
| | - Seul Ki Lee
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 06591, Seoul, Republic of Korea.
| | - Jee-Young Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 06591, Seoul, Republic of Korea
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Finkelstein ER, Crist TE, Shao T, Mella-Catinchi J, Xu KY. The utility of computed tomography venography in the routine evaluation of patients who present to a lymphedema center with lower extremity edema. J Vasc Surg Venous Lymphat Disord 2023; 11:1055-1062. [PMID: 37196921 DOI: 10.1016/j.jvsv.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/13/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Computed tomography venography (CTV) is not routinely used to screen patients presenting with a presumed lower extremity lymphedema diagnosis for left iliac vein obstruction (IVO) or May-Thurner syndrome (MTS). The objective of this study is to determine the utility of routine CTV screening for these patients by evaluating the proportion presenting with clinically significant CTV-identified left IVO. METHODS We retrospectively reviewed 121 patients who had presented to our lymphedema center with lower extremity edema between November 2020 and May 2022. Information regarding demographics, comorbidities, lymphedema characteristics, and imaging reports was collected. Cases of IVO present on CTV were reviewed by a multidisciplinary team to determine the clinical significance of the CTV findings. RESULTS Of the patients with complete imaging studies, 49% (n = 25) had abnormal lymphoscintigraphy findings, 45% (n = 46) had reflux on ultrasound, and 11.4% (n = 9) had IVO on CTV. Seven patients (6%) had CTV findings of IVO and edema of either the isolated left (n = 4) or bilateral (n = 3) lower extremities. Cases of IVO on CTV were determined by the multidisciplinary team to be the predominant cause of lower extremity edema for three of these seven cases (43%; or 2.5% of all 121 patients). CONCLUSIONS Six percent of patients presenting to a lymphedema center with lower extremity edema had left-sided IVO on CTV suggestive of MTS. However, the cases of IVO were determined to be clinically significant <50% of the time or for 2.5% of all patients. CTV should be reserved for patients with isolated left-sided or bilateral lower extremity edema with a greater left-sided component and a history of findings that raise clinical suspicion for MTS.
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Affiliation(s)
- Emily R Finkelstein
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Taylor E Crist
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Tony Shao
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Juan Mella-Catinchi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Kyle Y Xu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
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31
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Phillips-Smith BA, Jatana J, Carter E, Machani S, Wickel DJ. May-Thurner Syndrome: An Interesting Presentation of Recurrent, Unprovoked Deep Vein Thrombosis. Cureus 2023; 15:e43491. [PMID: 37719504 PMCID: PMC10499663 DOI: 10.7759/cureus.43491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/19/2023] Open
Abstract
May-Thurner Syndrome (MTS) is a unique condition characterized by the compression of the left iliac vein by the right common iliac artery, which causes venous outflow obstruction and a high risk of venous sequelae. May-Thurner Syndrome is a condition that is primarily observed in females and is an uncommon cause of deep vein thrombosis (DVT). The more common presentation of DVT is in the lower left extremity, although there have been cases of right-sided formation. In this case report, we present a patient with unprovoked, recurrent, left-sided deep vein thrombosis in a 70-year-old woman. The aim of this case report is to highlight this uncommon condition and to suggest consideration of MTS in the setting of a patient with recurrent unprovoked DVTs of the same extremity.
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Affiliation(s)
| | - Jazmin Jatana
- Family Medicine, West Virginia University School of Medicine, Wheeling, USA
| | - Emma Carter
- Family Medicine, West Virginia University School of Medicine, Wheeling, USA
| | | | - Dean J Wickel
- Vascular Surgery, West Virginia University School of Medicine, Wheeling, USA
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32
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Skeik N, Adamek A, Manunga J. Spontaneous iliac vein rupture and thrombosis in patients with May-Thurner syndrome: A narrative review. Vasc Med 2023; 28:361-367. [PMID: 37248994 DOI: 10.1177/1358863x231175697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Spontaneous iliac vein rupture (SIVR) is extremely rare and can lead to serious complications, including death. Etiologies include inflammatory processes and hormonal and mechanical triggers, with concomitant May-Thurner syndrome (MTS) being a rare cause. Management can be challenging due to the difficult balance between reducing thrombotic burden and life-threatening hemorrhage that can result from aggressive anticoagulation. Furthermore, surgical interventions are associated with high mortality, making conservative management more desirable. We report a case of SIVR with retroperitoneal hematoma and concurrent MTS that was successfully managed using conservative measures. We further provide a narrative review of the current literature addressing the diagnosis, management, and outcome of SIVR focusing on cases with concurrent MTS.
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Affiliation(s)
- Nedaa Skeik
- Section of Vascular & Endovascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Andrew Adamek
- Minneapolis Heart Institute Research Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Jesse Manunga
- Section of Vascular & Endovascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
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33
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Duncan R, Dickson S, Stewart M. To bleed or not to bleed: retroperitoneal haematoma and deep vein thrombosis. ANZ J Surg 2023; 93:2020-2021. [PMID: 37143303 DOI: 10.1111/ans.18503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Rebecca Duncan
- General Surgery, Nelson Hospital, Te Whatu Ora, Nelson, New Zealand
| | - Samuel Dickson
- General Surgery, Nelson Hospital, Te Whatu Ora, Nelson, New Zealand
| | - Mark Stewart
- General Surgery, Nelson Hospital, Te Whatu Ora, Nelson, New Zealand
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34
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Jeong J, Kim TE. CT Findings of May-Thurner Syndrome in Diffuse Idiopathic Skeletal Hyperostosis: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:941-945. [PMID: 37559815 PMCID: PMC10407060 DOI: 10.3348/jksr.2022.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/04/2022] [Accepted: 12/27/2022] [Indexed: 08/11/2023]
Abstract
May-Thurner syndrome (MTS) is a rare cause of deep vein thrombosis. Several cases of MTS because of various causes have been reported. However, MTS due to osteophytes in patients with underlying diffuse idiopathic skeletal hyperostosis (DISH) has not been reported in English literature, to the best of our knowledge. Here, we present the CT findings of MTS in patient with DISH.
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35
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Dix C, Clements W, Gibbs H, So J, A Tran H, D McFadyen J. Venous anomalies and thromboembolism. Thromb J 2023; 21:45. [PMID: 37081466 PMCID: PMC10116765 DOI: 10.1186/s12959-023-00484-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
Patients with venous anomalies are at increased risk of developing venous thromboembolism (VTE) and subsequent complications, but they are often under-recognised. While unprovoked VTE may trigger testing for inherited thrombophilias and malignancy screening, anatomic variants are considered less often. Venous anomalies increase the risk due to venous flow disturbance, resulting in hypertension, reduced flow velocity and turbulence. Recognition is important as endovascular or surgical intervention may be appropriate, these patients have a high rate of VTE recurrence if anticoagulation is ceased, and the anomalies can predispose to extensive VTE and severe post-thrombotic syndrome (PTS). In this case series, we present representative cases and radiological images of May-Thurner syndrome (MTS), inferior vena cava (IVC) variants and venous aneurysms, and review the available literature regarding optimal diagnosis and management in each condition.
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Affiliation(s)
- Caroline Dix
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, VIC, 3004, Australia.
| | - Warren Clements
- Department of Radiology, The Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Harry Gibbs
- Department of General Medicine, Alfred Health, Melbourne, VIC, 3004, Australia
| | - Joanne So
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Huyen A Tran
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, VIC, 3004, Australia
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Australia
| | - James D McFadyen
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, VIC, 3004, Australia
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Australia
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, 3004, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Australia
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36
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Love AN, Nasser GA, Yost C. A Not So Common Iliac Vein Anomaly: A Case Report. Cureus 2023; 15:e38145. [PMID: 37252602 PMCID: PMC10214882 DOI: 10.7759/cureus.38145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Arising from the external and internal iliac veins, the common iliac veins (CIVs) carry blood from the lower extremities and pelvic region into the inferior vena cava at the level of the fifth lumbar vertebra. It is sometimes common to observe slight anomalies in vascular anatomy in patients; however, anomalies of the CIVs are rare. We present a case of a patient with significant edema of the left lower extremity due to extrinsic compression (May-Thurner syndrome [MTS]) involving a duplicated left CIV found during vascular angiography. Anomalies in pelvic vasculature are well documented in the medical literature; however, documented cases of a duplicated CIV remain few and far between. These anomalies in pelvic vascular anatomy are essential to be aware of to avoid surgical complications and understand their implications in associated pathologies.
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Affiliation(s)
- Avery N Love
- Internal Medicine, A.T. Still University-School of Osteopathic Medicine in Arizona (ATSU-SOMA), Mesa, USA
| | - George A Nasser
- Cardiology, Nasser Cardiology and Vein Center, Woodlands, USA
| | - Connor Yost
- Internal Medicine, A.T. Still University-School of Osteopathic Medicine in Arizona (ATSU-SOMA), Mesa, USA
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37
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Qi HS, Kwan KJS, Li HL. Successful Management of Spontaneous Iliac Vein Rupture with Double Bare Stent Technique: A Case Report and Review of Literature. Vasc Endovascular Surg 2023; 57:257-263. [PMID: 36239775 DOI: 10.1177/15385744221130855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spontaneous rupture of the iliac vein is a rare cause of retroperitoneal hematoma. A misdiagnosis may delay the treatment and consequently put the patient in a life-threatening emergency. We report the case of a 73-year-old woman who presented with hemorrhagic shock from bleeding caused by a large left retroperitoneal hematoma. She was successfully treated with an endovascular approach by using a double bare stent technique. An extensive review of the literature was conducted and a total 44 articles with 50 patients were identified. Among these patients, 88.2% were women, 94.1% presented with a left-sided rupture, and the mortality rate was 13.7%. Spontaneous iliac vein rupture was more likely to occur in the left side in female patients. Conservative treatment was an option in hemodynamically stable patients. Exploratory laparotomy and surgical iliac vein repair was necessitated in most patients. Endovascular treatment including placement of covered stent and coil embolization had been widely used to treat spontaneous vein rupture since 2003. Double bare stent technique was also an effective alternative if a suitable covered stent was unavailable.
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Affiliation(s)
- Hao-Shan Qi
- Division of Vascular Surgery, Department of Surgery, 12648Qingdao Municipal Hospital, China
| | | | - Hai-Lei Li
- Division of Vascular Surgery, Department of Surgery, 444333University of Hong Kong - Shenzhen Hospital, China
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38
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Rosenthal J, Kilburn T, Jackson W, Lune PV, Nutting A, Pacheco L. Double Trouble: A Young Female with Extensive Deep Venous Thrombosis. Am J Med 2023; 136:e113-e114. [PMID: 36828208 DOI: 10.1016/j.amjmed.2023.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Jeffrey Rosenthal
- Brookwood Baptist Health, Department of Internal Medicine, Birmingham, Ala.
| | - Tyler Kilburn
- Brookwood Baptist Health, Department of Internal Medicine, Birmingham, Ala
| | - Will Jackson
- Brookwood Baptist Health, Department of Internal Medicine, Birmingham, Ala
| | | | - Andrew Nutting
- Brookwood Baptist Health, Department of Internal Medicine, Birmingham, Ala
| | - Lauren Pacheco
- Brookwood Baptist Health, Department of Internal Medicine, Birmingham, Ala
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Muacevic A, Adler JR, Awan B, Borz-Baba C. May-Thurner Syndrome: A Suspicion That Led to an Incidental Discovery. Cureus 2023; 15:e33862. [PMID: 36819452 PMCID: PMC9933148 DOI: 10.7759/cureus.33862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
May-Thurner syndrome (MTS)/Iliac vein compression syndrome is characterized by left iliac vein stenosis secondary to compression by the right common iliac artery against the fifth-lumbar vertebra. It increases the incidence of deep venous thrombosis (DVT). We had a 43-year-old female presenting with left leg swelling and was found to have extensive DVT provoked by a long history of travel. Because of the extension of her thrombus, a catheter-guided thrombectomy (CDT) was planned and findings of MTS were identified incidentally. She had an endovascular stent placed and was discharged on long-term anticoagulation.
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Schrufer-Poland TL, Florio K, Grodzinsky A, Borsa JJ, Schmidt L. Management of May Thurner Syndrome in Pregnant Patients. J Cardiovasc Dev Dis 2022; 9:jcdd9120410. [PMID: 36547407 PMCID: PMC9784684 DOI: 10.3390/jcdd9120410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022] Open
Abstract
May Thurner Syndrome contributes to thromboembolic disease and can cause significant morbidity in pregnant patients secondary to exaggerated anatomic relationships and physiologic changes in the hematologic system favoring thrombogenesis. Because this condition is both underrecognized and underreported, management in pregnant and postpartum patients is based on expert opinion without any formal evidence-based guidance. Herein, we review five pregnancies in four patients with May Thurner Syndrome and general management strategies. Through collaborative and multidisciplinary care, patients with May Thurner Syndrome can be safely and successfully managed during pregnancy and the postpartum period with appropriate anticoagulation.
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Affiliation(s)
- Tabitha L. Schrufer-Poland
- Maternal and Fetal Medicine, Saint Luke’s Health System, Kansas City, MO 64111, USA
- Cardiovascular Outcomes Research Department, Saint Luke’s Health System, Kansas City, MO 64111, USA
- Correspondence:
| | - Karen Florio
- Maternal and Fetal Medicine, Saint Luke’s Health System, Kansas City, MO 64111, USA
- Cardiovascular Outcomes Research Department, Saint Luke’s Health System, Kansas City, MO 64111, USA
| | - Anna Grodzinsky
- Cardiovascular Outcomes Research Department, Saint Luke’s Health System, Kansas City, MO 64111, USA
| | - John J. Borsa
- Department of Radiology, Saint Luke’s Health System, Kansas City, MO 64111, USA
- Department of Radiology, University of Missouri Kansas City, Kansas City, MO 64108, USA
| | - Laura Schmidt
- Cardiovascular Outcomes Research Department, Saint Luke’s Health System, Kansas City, MO 64111, USA
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Seely KD, Arreola HJ, Paul LK, Higgs JA, Brooks B, Anderson RC. Seizures, deep vein thrombosis, and pulmonary emboli in a severe case of May–Thurner syndrome: a case report. J Med Case Rep 2022; 16:411. [DOI: 10.1186/s13256-022-03639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/08/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
May–Thurner syndrome is a vascular disorder caused by the right common iliac artery compressing the left common iliac vein against the lumbar spine, causing distal venous stasis and potentially leading to fibrous change in the venous wall structure. Although May–Thurner syndrome is most commonly discovered in females upon investigation of new-onset deep vein thrombosis, we present the case of an otherwise healthy 29-year-old male with severe May–Thurner syndrome who presented with seizures, bilateral deep vein thrombosis, and diffuse pulmonary emboli. Seizures constituted the earliest presenting symptoms for the patient. Although it is difficult to prove that the patient’s seizures were related to the May–Thurner syndrome, this possible association renders this case extraordinary.
Case presentation
This report describes the case of a 29-year-old previously healthy white male with a severe case of left-sided May–Thurner syndrome that required extensive medical and interventional treatment. The patient experienced two seizures, one month apart, both of which occurred while residing at high altitude. The patient had no prior history of seizures, and epilepsy was ruled out. Three weeks after the second seizure, he presented to the emergency room with hemoptysis, dyspnea, and severe leg pain. Sites of thrombus were confirmed in both legs and diffusely in the lungs. Etiological work-up after treatment with intravenous tissue plasminogen activator revealed May–Thurner syndrome. Hematology workup including genetic testing showed no evidence of coagulopathy. Bilateral common iliac venous stents were placed to attempt definitive treatment. Despite stenting, the patient had another thrombotic event with associated sequelae after discontinuation of anticoagulation. The patient has not had another seizure since the stents were placed. Despite the negative testing, the patient remains on lifelong chemoprophylaxis in the event of an undiscovered hypercoagulopathy.
Conclusions
The care team theorizes that the seizures resulted from hypoxia due to May–Thurner syndrome-induced hemostasis and associated thrombotic events, the high-altitude location of his residence at the time he experienced the seizures, and shallow breathing during sleep. For patients with lower limb venous thrombosis, May–Thurner syndrome should be considered in the differential diagnosis. Endovascular treatment followed by extended prophylactic anticoagulation therapy until the patient is determined to be no longer at risk for thrombosis is recommended. Post-venoplasty thrombosis is a common complication of endovascular treatment of May–Thurner syndrome and should be carefully monitored.
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Vasan V, Bai H, Chen J, Storch J, Kim J, Dionne E, Cho LD, Gonzalez C, Cooke PV, Kang Y, Rao A, Ting W. Iliac vein stenting outcomes for patients with superficial venous insufficiency concurrent with deep venous disease. J Vasc Surg Venous Lymphat Disord 2022; 10:1215-1220.e1. [PMID: 35952955 DOI: 10.1016/j.jvsv.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/12/2022] [Accepted: 06/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Many patients will present with chronic proximal venous outflow obstruction (PVOO) and superficial venous insufficiency (SVI) at the time of iliac vein stenting. In the present study, we aimed to determine whether differences in outcomes were present for patients receiving an iliac vein stent according to whether concurrent SVI was present. METHODS A registry of 553 patients who had undergone iliac vein stent placement for chronic PVOO from 2011 to 2021 was retrospectively analyzed. Two groups of patients were followed for ≤6 years after initial vein stent placement: group 1 (n = 178; 32.2%) had not had SVI before or after stent placement and group 2 (n = 375; 67.8%) had had SVI at initial iliac vein stent procedure. The patients' symptoms were evaluated using the venous clinical severity score (VCSS). Postoperative procedures after initial stent placement were recorded. Postoperative procedures included any operation performed after the index iliac vein stent procedure. Endovenous thermal ablation was classified as a minor postoperative procedure, and any intervention with venography was classified as a major postoperative reintervention. Multivariate regression models were used to determine the odds of a major reintervention or minor procedure postoperatively. RESULTS Across the two groups, the mean age (group 1, 65.3 years; group 2, 59.9 years; P < .001), body mass index (27.6 vs 26.1 kg/m2; P = .004), diabetes (32.6% vs 17.6%; P < .001), arterial hypertension (68.5% vs 42.1%; P < .001), and coronary artery disease (16.9% vs 9.6%; P = .048) differed significantly. The time to follow-up was similar between the two groups (P = .915). Longitudinally, both groups had had similar improvements in the composite VCSSs. After multivariable adjustment, group 2 was more likely than group 1 (odds ratio, 5.26; 95% confidence interval, 3.33-8.59; P < .001) to have required a postoperative minor procedure, but not a major reintervention. Group 2 had also averaged a shorter interval from the index procedure to a postoperative procedure than group 1 (525.7 days vs 258.1 days; P < .001). CONCLUSIONS Compared with patients without SVI, those with SVI and chronic PVOO were younger, had had fewer comorbidities, and fared similarly in the change in the composite VCSSs but were more likely to have required a minor procedure and less likely to have required a major reintervention after the index iliac vein stent procedure.
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Affiliation(s)
- Vikram Vasan
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Halbert Bai
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jenny Chen
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Jason Storch
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jinseo Kim
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elyssa Dionne
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Logan D Cho
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Peter V Cooke
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yeju Kang
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ajit Rao
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Windsor Ting
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Wei WC, Hsin CH, Yang HT, Su TW, Su IH, Chu SY, Ko PJ, Yu SY, Lee CH. Clinical outcomes of AngioJet rheolytic thrombectomy in the treatment of May-Thurner syndrome-related deep venous thrombosis. J Int Med Res 2022; 50:3000605221100134. [PMID: 35650686 PMCID: PMC9168862 DOI: 10.1177/03000605221100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective May–Thurner syndrome (MTS) is an anatomic stenotic variation associated with
deep vein thrombosis (DVT) of the left leg. The classical DVT treatment
strategy is medical treatment without thrombus removal. This study was
performed to assess the clinical outcomes of the combination of AngioJet™
rheolytic thrombectomy and stenting for treatment of MTS-related DVT. Methods We conducted a retrospective cohort study of patients treated for MTS-related
DVT from January 2017 to June 2020 at a single institution. Results Fourteen patients (nine women) underwent AngioJet™ rheolytic thrombectomy for
MTS-related DVT during the study period. The median DVT onset time was 8
days (interquartile range (IQR), 3–21 days). The median procedure time was
130 minutes (IQR, 91–189 minutes), and the median hospital stay was 7 days
(IQR, 5–26 days). One patient had a residual thrombus and occluded iliac
stent and underwent adjuvant catheter-directed thrombolysis for
revascularization. The primary patency rate for the iliac stent was 92.9% at
12 months. Conclusion Concomitant AngioJet™ rheolytic thrombectomy and stenting of MTS-induced
lesions may be beneficial for patients with MTS-related DVT.
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Affiliation(s)
- Wen-Cheng Wei
- Department of Cardiovascular Surgery, Kang-Ning General Hospital, Taipei, Taiwan
| | - Chun-Hsien Hsin
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Hsuan-Tzu Yang
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Ta-Wei Su
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - I-Hao Su
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Sung-Yu Chu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Ko
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Yueh Yu
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hui Lee
- Department of Anesthesiology, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
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May-Thurner Syndrome and Lymphedema Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4377. [PMID: 35702363 PMCID: PMC9187167 DOI: 10.1097/gox.0000000000004377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022]
Abstract
May-Thurner syndrome (MTS) is an anatomical variant that results in compression of the left common iliac vein by the right common iliac artery. Although often asymptomatic, lower extremity swelling/edema, deep venous thrombosis, post-thrombotic syndrome, and eventual lymphedema (due to long-standing venous obstruction) can develop. The clinical management of patients presenting for lymphedema surgery with concomitant or undiagnosed MTS is not well described. Methods This review investigates two patients who were evaluated for unilateral lower extremity lymphedema, both of whom were subsequently diagnosed with MTS. Standard imaging (including lymphoscintigraphy, indocyanine green lymphangiography, and magnetic resonance venography) were performed to identify proximal venous obstruction. Treatment was accomplished using vascular surgical management, including stenting of the iliac vein before lymphedema reconstruction with vascularized lymph node transfer and multiple lymphovenous bypass. Results Both patients we examined in this review had improvement of lymphedema with vascular surgical management. Literature review reveals that MTS has an incidence as high as 20% in the population, although commonly unidentified due to lack of symptomatology. Conclusions There are no studies documenting the incidence of MTS in patients referred for lymphedema surgical management. Routine studies should be obtained to screen for proximal venous obstruction in patients presenting for surgical management of lower extremity lymphedema. Additional research is needed regarding the approach to managing patients with both MTS and lymphedema. Careful observational and prospective studies may elucidate the appropriate time interval between venous stenting and lymphedema microsurgical reconstruction.
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Han Y, Tian Y, Gao L, Tang J, Fan P, Cong L, Dong J, Yang L. Clinical outcomes of different endovenous procedures among patients with varicose veins and iliac vein compression: A retrospective cohort study. Int J Surg 2022; 101:106641. [PMID: 35490951 DOI: 10.1016/j.ijsu.2022.106641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to investigate the short-term outcomes of three endovenous procedures in patients with varicose veins (VVs) and severe iliac vein compression syndrome (IVCS). METHODS A total of 158 consecutive patients were included in this multicenter retrospective study from May 2017 to December 2019; 54 patients underwent endovenous laser ablation (EVLA) alone, 47 patients underwent EVLA and balloon angioplasty (BA), and 57 patients underwent EVLA and stenting angioplasty (SA). Clinical outcomes and complications were assessed at one and twelve months post-surgery. The Quality of life (QoL) was assessed by the venous clinical severity score (VCSS) and Aberdeen Varicose Vein Questionnaire (AVVQ). RESULTS Patients who underwent the SA procedure were older (P < 0.05). Incidence of laser ablation complications was similar among the three procedures; closure rates of the great saphenous vein were 96.8%, 98.0%, and 98.4%, respectively, at 12 months. Reflux times in the SA procedure were lower than those in the EVLA and BA procedures at 12 months, while ulcer healing time was faster with the SA procedure (P < 0.05) than with the other procedures. The VCSS and AVVQ values were significantly improved post-procedure (P < 0.05), with lower AVVQ scores in the SA procedure than in the EVLA and BA procedures at 12 months post-surgery. The EVLA and BA procedures (stenosis >70%) caused a significantly higher symptom recurrence than the SA procedure, with an odds ratios of 14.04 (95% confidence interval (CI), 1.99-99.18) and 10.50 (95% CI, 1.26-87.15), respectively. CONCLUSIONS Our results demonstrate that EVLA and SA procedures relieve symptoms, improve the QoL, and decrease symptom recurrence in patients with VVs and severe IVCS (stenosis >70%).
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Affiliation(s)
- Yang Han
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ye Tian
- Department of Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Lu Gao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingdong Tang
- Department of Vascular Surgery, Pudong Hospital of Fudan University, Shanghai, China
| | - Pengcheng Fan
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Longlong Cong
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian Dong
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lin Yang
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Bai H, Cho LD, Cooke PV, Ting W. Endovascular Intervention for May-Thurner Syndrome in a Pregnant Patient with a Patent Foramen Ovale and Paradoxical Embolism. Vasc Endovascular Surg 2022; 56:517-520. [PMID: 35354415 DOI: 10.1177/15385744221086135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
May-Thurner syndrome (MTS) is a known structural risk factor for deep vein thrombosis (DVT) and embolism. In patients with a patent foramen ovale (PFO), emboli originating from the deep veins are able to paradoxically reach the systemic circulation via the PFO, consequently resulting in transient ischemic attacks (TIA) or stroke.We report the case of a 31-year-old pregnant woman, with a recent history of TIA, who presented with chronic bilateral numbness, pain, and swelling in the lower extremities. On imaging, she was found to have a PFO and MTS. Her pregnancy was subsequently terminated. This decision was made independently by the patient. Her care team did not advise her to terminate her pregnancy as there was no specific medical reason to do so. However, the patient was in significant physical pain and distress and ultimately was not comfortable continuing with the pregnancy. This highlights the complex, multifactorial decision-making process that pregnant patients with comorbid health conditions undertake. The patient then underwent transcatheter PFO closure and stents were placed bilaterally in the left and right common iliac veins. Following the stent procedure, lower extremity symptoms swiftly resolved, allowing the patient to significantly improve her ability to ambulate. There have been no signs of TIA since her procedures, and her venous symptoms have been stable.In patients with TIA or stroke from a paradoxical embolism, MTS should be considered as a potential etiology. Endovascular intervention to treat the underlying MTS should also be considered to decrease the risk of recurrent DVT and embolism.
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Affiliation(s)
- Halbert Bai
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Logan D Cho
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter V Cooke
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kim DH, Boudier-Revéret M, Sung DH, Chang MC. Deep vein thrombosis of the common iliac vein caused by neurogenic heterotopic ossification in the anterior lower lumbar spine of a patient with complete paraplegia due to radiation-induced myelopathy. J Spinal Cord Med 2022; 45:316-319. [PMID: 32808906 PMCID: PMC8986183 DOI: 10.1080/10790268.2020.1807767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Context: Deep vein thrombosis (DVT), a frequent complication of spinal cord injury, is occasionally caused by neurogenic heterotopic ossification (NHO). In most cases of NHO, the hip joint is affected. Herein, we present a case of paraplegia following radiation-induced myelopathy that presented with left leg swelling due to DVT in the common iliac vein (CIV) caused by venous compression by NHO on the anterior lower lumbar spine.Findings: A 28-year-old man with complete paraplegia due to radiation-induced myelopathy presented with left lower extremity swelling 6 years after the onset of paraplegia. DVT in the left CIV was observed on computed tomography venography. The left CIV was significantly compressed between the NHO at the anterior longitudinal ligament of the lumbar spine and the right common iliac artery, suggestive of May-Thurner syndrome. Slightly distal to that compressed area, the left CIV was significantly compressed by the large NHO at the anterior longitudinal ligament of the lumbar spine.Conclusions: We believe that such compression of the left CIV would have contributed to the development of DVT. This case shows that DVT might be caused by NHO at the anterior aspect of the lumbar vertebral body, and this may help clinicians identify the main cause of DVT in the leg.
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Affiliation(s)
- Du Hwan Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - Duk Hyun Sung
- Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Farina R, Foti PV, Pennisi I, Vasile T, Clemenza M, Rosa GL, Crimi L, Catalano M, Vacirca F, Basile A. Vascular compression syndromes: a pictorial review. Ultrasonography 2022; 41:444-461. [PMID: 35644605 PMCID: PMC9262661 DOI: 10.14366/usg.21233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/23/2022] [Indexed: 12/01/2022] Open
Abstract
Vascular compression syndromes include a group of rare vascular changes due to extrinsic compression of veins or arteries by surrounding structures. These pathologies are often underestimated due to their rarity, clinicians’ poor level of knowledge, and the non-specificity of their symptoms. The best known are Eagle syndrome, thoracic outlet syndrome, nutcracker syndrome, May-Thurner syndrome, Dunbar syndrome, and popliteal entrapment syndrome. This work summarizes the main ultrasonographic characteristics, symptoms, and treatments of choice for these syndromes. Knowledge of these conditions’ characteristic signs is essential for the differential diagnosis. Failure to diagnose these rare diseases can expose patients to serious complications and risks to their health.
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Affiliation(s)
- Renato Farina
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Pietro Valerio Foti
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Isabella Pennisi
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Tiziana Vasile
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Mariangela Clemenza
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Giuliana La Rosa
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Luca Crimi
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Marco Catalano
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Francesco Vacirca
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Antonio Basile
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
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Investigating the Source of Fatal Pulmonary Thromboembolism in a Coronial Postmortem Population. Am J Forensic Med Pathol 2022; 43:117-120. [PMID: 35102008 DOI: 10.1097/paf.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The incidence of how often a deep vein thrombosis is found in the calves of the legs at coronial postmortem examination is unclear. This study retrospectively examined postmortem examination reports from Australian Coronial investigations of sudden death resulting from pulmonary thromboembolism to determine the likelihood of dissection of the deep veins of calves of the legs revealing the source of a pulmonary thromboembolism. From 450 cases taken from the National Coronial Information System (NCIS) for 2016, the postmortem reports of 327 cases were reviewed to provide demographic details of victims of sudden death from pulmonary thromboembolism. In 235 cases, it was possible to determine in 76.6% a thrombus had been found in the deep veins of the calves of the legs after dissection. In 141 cases, it was documented that both sides had been examined. From these, it was determined there was no statistically significant difference in the prevalence of thrombus in either side. However, it was shown that the presence of an abnormality of a lower limb (such as leg or hip infection, burns, surgery and nonoperated fractures, or a larger circumference) increased the likelihood that a deep vein thrombus would be found on that side.
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50
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Cheng Z, Wang H, Lin S, Yin L, Su J, Lei Y, Lan Y, Yan J, Han T, Ma M, Xie G. Black-blood Venous Imaging (BBVI): A Contrast-Free and High-Resolution Magnetic Resonance Approach for Diagnosing IVCS - a Proof of Concept Study. Clin Appl Thromb Hemost 2022; 28:10760296221127275. [PMID: 36124369 PMCID: PMC9490483 DOI: 10.1177/10760296221127275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Iliac vein compression syndrome (IVCS) diagnosis heavily relies on an imaging test. However, non-invasive and contrast-free imaging test for the diagnosis of IVCS remains a big challenge. To address this issue, this prospective study aimed to assess the image quality and diagnostic performance of a magnetic resonance imaging technique, black-blood venous imaging (BBVI), in detecting IVCS by comparing it with contrast-enhanced computed tomography venography (CTV) and using invasive digital subtraction angiography (DSA) as the reference. Methods We enrolled 105 patients, and all patients underwent BBVI, CTV, and DSA examinations. We compared the consistency of CTV and BBVI image quality and their consistency in diagnosing the rate of iliac vein stenosis in IVCS patients. Using the consensus DSA as a reference, the sensitivity, specificity, positive and negative predictive values, and accuracy of BBVI and CTV and their diagnostic agreement with DSA were calculated. Results BBVI demonstrated high sensitivity, specificity, and accuracy for the diagnosis of IVCS, without contrast agents. BBVI and CTV are quite in diagnosis IVCS. Quite SE (67.8% vs 68.3%), SP (94.8% vs 94.8%), PPV (98.0% vs 98.0%), NPV (46.2% vs 46.9%) and ACC (75.3% vs 75.7%) were obtained by BBVI in comparison with CTV. Conclusion BBVI has comparable diagnostic performance with CTV. It may be a viable alternative to CTV techniques in screening the IVCS without contrast agents and free of ionizing radiation.
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Affiliation(s)
- Zhangbo Cheng
- Department of Cardiovascular Surgery, Fujian Provincial Clinical College of Fujian Medical University, 117861Fujian Provincial Hospital, Fuzhou, China
| | - Hang Wang
- Department of Cardiovascular Surgery, Fujian Provincial Clinical College of Fujian Medical University, 117861Fujian Provincial Hospital, Fuzhou, China
| | - Shengmei Lin
- Department of Radiology, Fujian Provincial Clinical College of Fujian Medical University, 117861Fujian Provincial Hospital, Fuzhou, China
| | - Lei Yin
- Department of Radiology, Fujian Provincial Clinical College of Fujian Medical University, 117861Fujian Provincial Hospital, Fuzhou, China
| | - Jiawei Su
- Department of Radiology, Fujian Provincial Clinical College of Fujian Medical University, 117861Fujian Provincial Hospital, Fuzhou, China
| | - Yunhong Lei
- Department of Cardiovascular Surgery, Fujian Provincial Clinical College of Fujian Medical University, 117861Fujian Provincial Hospital, Fuzhou, China
| | - Yongrong Lan
- Department of Cardiovascular Surgery, Fujian Provincial Clinical College of Fujian Medical University, 117861Fujian Provincial Hospital, Fuzhou, China
| | - Jun Yan
- Department of Cardiovascular Surgery, Fujian Provincial Clinical College of Fujian Medical University, 117861Fujian Provincial Hospital, Fuzhou, China
| | - Tao Han
- Department of Cardiovascular Surgery, Fujian Provincial Clinical College of Fujian Medical University, 117861Fujian Provincial Hospital, Fuzhou, China
| | - Mingping Ma
- Department of Radiology, Fujian Provincial Clinical College of Fujian Medical University, 117861Fujian Provincial Hospital, Fuzhou, China
| | - Guoxi Xie
- Department of Biomedical Engineering of Basic Medical School, 26468Guangzhou Medical University, Guangzhou, China
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