Symptomatic compression of right iliac vein after right iliac artery stent placement

An elderly lady presented with decreased mobility, sputum production and intermittent confusion. She was treated for chest sepsis, fast atrial fibrillation, and acute kidney injury, and also noted to have a swollen left leg. Venous duplex imaging showed extensive thrombus within the left common iliac, left external iliac and left common femoral veins. A CT Venogram showed compression of the left common iliac vein between an osteophyte at L5 and a calcified ipsilateral common iliac artery. It also showed a pelvic kidney with an extra renal pelvis and large renal cyst which was indirectly contributing to venous compression by splinting the left iliac artery. A decision was made after discussion at the Vascular MDT that the patient was not fit enough for surgery and to manage her medically with anticoagulation. Discussion: Proximal DVT’s are rarer than distal thrombosis, but have similar causes. One of the rarer causes of proximal DVT is May-Thurner syndrome and its variants known collectively as non-thrombotic iliac vein lesions. May-Thurner originally described DVT formation caused by extrinsic compression of the left common iliac vein between the overriding contralateral (right) common iliac artery and adjacent lumbar vertebrae. The best imaging modality is a CT Venogram. Duplex ultrasonography can be used, although it can be difficult to visualize the iliac veins. The mainstay of management is surgical thrombectomy, or thrombolysis, followed by stenting of the affected vessel. However, if intervention is not appropriate, then it can be managed medically with anticoagulation.

Download Full-text

Anatomical variation of obturator vessels and its practical risk: a case report from an anatomic study

Jornal Vascular Brasileiro ◽

10.1590/s1677-54492008000300015 ◽

2008 ◽

Vol 7 (3) ◽

pp. 275-277 ◽

Cited By ~ 2

Author(s):

Somayaji Nagabhooshana ◽

Venkata Ramana Vollala ◽

Vincent Rodrigues ◽

Seetharama Bhat ◽

Narendra Pamidi ◽

...

Keyword(s):

Iliac Artery ◽

Anatomical Variation ◽

External Iliac Artery ◽

Iliac Vein ◽

Inferior Epigastric Artery ◽

Undergraduate Medical Students ◽

Obturator Artery ◽

External Iliac Vein ◽

Epigastric Artery ◽

Internal Iliac

Obturator artery is frequently a branch of anterior division of the internal iliac artery. It has drawn attention of pelvic surgeons, anatomists and radiologists because of the high frequency of variations in its course and origin. The obturator vein is usually described as a tributary of the internal iliac vein. During routine dissection classes to undergraduate medical students we have observed obturator artery arising from external iliac artery, obturator vein draining into external iliac vein, communicating vein between obturator vein and external iliac vein and inferior epigastric artery arising from the obturator artery. The anomalous obturator vessels and inferior epigastric artery in the present case may be in a dangerous situation in pelvic surgeries that require dissection or suturing along the pelvic rim. Developmental reasons and clinical significances of the variations are discussed.

Download Full-text

Transvenous Embolization and Stent Placement for an Internal Iliac Arteriovenous Fistula with Central Iliac Vein Occlusion

Journal of Vascular and Interventional Radiology ◽

10.1097/01.rvi.0000121404.46920.ce ◽

2004 ◽

Vol 15 (4) ◽

pp. 399-404 ◽

Cited By ~ 11

Author(s):

Saim Yılmaz ◽

Abdullah Erdoğan ◽

Ersin Lüleci

Keyword(s):

Arteriovenous Fistula ◽

Stent Placement ◽

Iliac Vein ◽

Transvenous Embolization ◽

Vein Occlusion ◽

Internal Iliac ◽

Iliac Vein Occlusion

Download Full-text

Iliocaval Compression Syndrome

Phlebology The Journal of Venous Disease ◽

10.1177/026835558700200310 ◽

1987 ◽

Vol 2 (3) ◽

pp. 173-179 ◽

Cited By ~ 5

Author(s):

Syde A. Taheri ◽

Paul Nowakowski ◽

David Pendergast ◽

Julie Cullen ◽

Steve Pisano ◽

...

Keyword(s):

Iliac Artery ◽

Common Iliac Artery ◽

Vena Cava ◽

Signs And Symptoms ◽

Iliac Vein ◽

Venous Hypertension ◽

Common Iliac Vein ◽

Compression Syndrome ◽

Extrinsic Compression ◽

The Right

The iliocaval compression syndrome is a disorder, frequently found in young women, in which extrinsic compression of the left iliocaval junction produces signs and symptoms of lower extremity venous insufficiency. The anatomic variant which gives rise to this syndrome consists of compression of the left common iliac vein by the overlying right common iliac artery, near its junction with the vena cava. Additional reduction of outflow results from intraluminal venous webs and tight adhesions between the iliac artery and vein. Pain, swelling, pigmentation, and venous claudication characterize this syndrome, which affects predominantly the left leg. The syndrome may progress to iliofemoral thrombosis, phlegmasia cerulea dolens, and venous gangrene. Longstanding iliocaval stenosis may produce valvular incompetence. Exercise plethysmography is a non-invasive test useful in screening patients for iliocaval compression. The definitive diagnosis is made by venography, both ascending and descending, to determine the degree of outflow stenosis. Iliocaval patch angioplasty with retrocaval positioning of the right iliac artery, decreases venous hypertension and leads to improvement in the clinical condition. To date, we have performed iliocaval angioplasty, with retrocaval repositioning of the right common iliac artery, on 18 patients. Of these, 83% have had good results as determined by hemodynamic and clinical assessment.

Download Full-text

A RARE CASE OF MAY- THURNER SYNDROME

10.36106/gjra/8100743 ◽

2021 ◽

pp. 17-19

Author(s):

B. Santhi ◽

Manigandan Manigandan ◽

Nishok Nishok

Keyword(s):

Iliac Artery ◽

Lower Limb ◽

Rare Case ◽

Common Iliac Artery ◽

Iliac Vein ◽

Common Iliac Vein ◽

Middle Aged ◽

Unique Case ◽

Left Common Iliac Vein ◽

Left Lower Limb

May-Thurner syndrome (MTS) is a venous outow obstruction disorder characterized by compression of the left common iliac vein by an overriding right common iliac artery. MTS primarily affects young to middle-aged women, although many patients remain entirely asymptomatic.We report a unique case of a 25 -year-old male who presented with MTS-related multiple varicosities in left lower limb.

Download Full-text

A Rare Cause of May-Thurner Syndrome Postarterial Intervention

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0039-1693630 ◽

2019 ◽

Vol 03 (03) ◽

pp. 180-184 ◽

Cited By ~ 1

Author(s):

Hiok Yang Chan ◽

Edward Tieng Chek Choke ◽

Tjun Yip Tang ◽

Chandramohan Sivanathan ◽

Chua Ming Er Jasmine ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Iliac Artery ◽

Lower Limb ◽

Unusual Case ◽

Anatomical Variation ◽

Iliac Vein ◽

Team Approach ◽

Left Lower Limb ◽

Iliac Vein Compression

AbstractMay-Thurner syndrome (MTS) is rare condition thought to occur due to an anatomical variation. In MTS, there is left iliac vein compression by the right iliac artery and lumbar spine resulting in left lower limb deep venous thrombosis. The authors report a rare cause of MTS postarterial intervention. They describe the unusual case of an Asian man who presented with acute left lower limb deep venous thrombosis 5 days following left common iliac artery angioplasty and stent insertion. Computed tomographic (CT) venogram demonstrated the left iliac vein compression by the left iliac artery stent. Successful recanalization of the thrombosed iliac vein was achieved with a combination of pulse spray thrombolysis and rheolytic mechanical thrombectomy, followed by angioplasty and stent placement in the iliac vein. There was rapid and complete resolution of symptoms. This report illustrates the use of complementary imaging modalities and a multidisciplinary team approach to achieve a successful technical and clinical outcome following an unusual case of MTS postarterial intervention and the subsequent successful endovascular management.

Download Full-text