Imaging findings of pelvic venous insufficiency in patients with postural orthostatic tachycardia syndrome

2020 ◽  
pp. 026835552094761
Author(s):  
Martha-Gracia Knuttinen ◽  
Kenneth S Zurcher ◽  
Neal Khurana ◽  
Indravadan Patel ◽  
Amy Foxx-Orenstein ◽  
...  
Keyword(s):  
Venous Insufficiency ◽  
Common Iliac Artery ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Outflow Obstruction ◽  
Venous Compression ◽  
Venous Outflow Obstruction ◽  
The Right ◽  
Pelvic Venous Insufficiency

Objectives Some patients with postural orthostatic tachycardia syndrome (POTS) demonstrate improved dysautonomic symptoms following treatment for pelvic venous insufficiency (PVI). This study assessed the prevalence of significant left common iliac vein (LCIV) compression in POTS patients. Methods Radiologists retrospectively reviewed CT images of pelvic veins for 216 women (191 with POTS and 25 age-comparable controls).Quantitative vascular analysis identified percent-diameter compression of the LCIV by the right common iliac artery. Significant LCIV compression was defined as >50%. Results Significant LCIV compression was found in 69% (131/191) of females with POTS versus 40% (10/25) in controls. The hypothesis that venous compression and presence of POTS are independent was rejected ( p = .005). Conclusions Significant LCIV compression was noted in a majority of female POTS patients, suggesting that incidence of iliac venous obstruction may be higher than the general population. Patients with POTS and symptoms of PVI may benefit from assessment for venous outflow obstruction.

scholarly journals Osteophytic Iliac Venous Compression: Technical Considerations for a Bony May-Thurner Syndrome Variant

2018 ◽  
Vol 02 (02) ◽  
pp. 095-100 ◽  
Author(s):  
David Shin ◽  
Mahati Mokkarala ◽  
Stephen Allison ◽  
Eric Monroe
Keyword(s):  
Common Iliac Artery ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Outflow Obstruction ◽  
Venous Outflow ◽  
Left Common Iliac Vein ◽  
Venous Compression ◽  
Venous Outflow Obstruction ◽  
Vertebral Osteophytes ◽  
Technical Considerations

AbstractMay-Thurner syndrome (MTS) results in compression of the left common iliac vein between the spine and right common iliac artery leading to symptomatic venous outflow obstruction. The authors depict a classic case of MTS followed by four variant cases in which the primary culprit lesions causing compression were degenerative vertebral osteophytes. The osteophytic variant of MTS poses distinct diagnostic and therapeutic challenges.

Iliocaval Compression Syndrome

1987 ◽  
Vol 2 (3) ◽  
pp. 173-179 ◽  
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.

Anomalous course of the left common iliac vein anterior to the right common iliac artery with resultant May-Thurner syndrome

2019 ◽  
Vol 7 (3) ◽  
pp. 450-451
Author(s):  
Arash Fereydooni ◽  
Christine Deyholos ◽  
Nariman Nezami ◽  
Joshua R. Feler ◽  
Hamid Mojibian ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Common Iliac Artery ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Left Common Iliac Vein ◽  
The Right

scholarly journals Treatment of acquired arteriovenous fistula with severe hemodynamic effects: therapeutic challenge

2014 ◽  
Vol 13 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Bruna Ferreira Pilan ◽  
Andréia Marques de Oliveira ◽  
Daniel Emílio Dalledone Siqueira ◽  
Ana Terezinha Guillaumon
Keyword(s):  
Arteriovenous Fistula ◽  
Common Iliac Artery ◽  
Severe Heart Failure ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
First Choice ◽  
Iatrogenic Vascular Injury ◽  
The Common ◽  
The Right ◽  
High Output

A 34-year-old female patient with severe heart failure and pulmonary hypertension was diagnosed late with a high-output acquired arteriovenous fistula between the right common iliac vein and artery. The most probable cause was an iatrogenic vascular injury inflicted during a prior laparoscopic cholecystectomy. Treatment was conducted by placement of an endoprosthesis in the common iliac artery, achieving total exclusion of the fistula and complete remission of symptoms. Considering the options available for treating this type of lesion, endovascular techniques are becoming ever more effective and are now the option of first-choice for management of this pathology.

scholarly journals Treatment of May–Thurner Syndrome in a Patient with an Iliac Artery Stent

2020 ◽  
Vol 3 ◽  
Author(s):  
Raleene Gatmaitan ◽  
Keagan Werner-Gibbings ◽  
Tommaso Donati ◽  
Prakash Saha ◽  
Stephen Black
Keyword(s):  
Surgical Management ◽  
Iliac Artery ◽  
Common Iliac Artery ◽  
Clinical Manifestations ◽  
Iliac Vein ◽  
Stent Insertion ◽  
Common Iliac Vein ◽  
Medical Implants ◽  
The Right ◽  
Venous Stents

May–Thurner syndrome (MTS) is caused by compression of the left iliac vein by the right iliac artery, leading to clinical manifestations of outflow obstruction in the lower limb and deep vein thrombosis. There have been increasing reports of iatrogenic MTS caused by medical implants. The authors report the case of a 60-year-old man who developed MTS after stenting of the right common iliac artery. Due to the debilitating nature of the patient’s symptoms of venous congestion in the left leg, he proceeded with endovascular venoplasty and venous stent insertion with concurrent intra-arterial balloon angioplasty of the existing right common iliac artery stent. Technical success and primary patency of arterial and venous stents were achieved. The patient remained asymptomatic at 6 weeks and 3 months follow-up and arterial and venous stents were found to be patent on duplex ultrasound. Surgical management of MTS may include thrombolysis, thrombectomy, venoplasty and stenting of the left common iliac vein. Care must be taken to preserve existing medical implants during treatment of MTS. The authors demonstrate that concurrent angioplasty of the right common iliac artery during treatment of the vein is an effective method of preventing arterial stent disruption during surgical management of MTS.

Unusual cases of right-sided and left-sided May–Thurner syndrome

2014 ◽  
Vol 25 (4) ◽  
pp. 797-799 ◽  
Author(s):  
I. B. Vijayalakshmi ◽  
H. S. Natraj Setty ◽  
Chitra Narasimhan
Keyword(s):  
Aortic Stenosis ◽  
Rare Case ◽  
Common Iliac Artery ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Rare Clinical Entity ◽  
Venous Obstruction ◽  
Left Common Iliac Vein ◽  
Left Lower Extremity ◽  
The Right

AbstractMay–Thurner syndrome is a rare clinical entity involving venous obstruction of the left lower extremity. The May–Thurner syndrome is a phenomenon commonly described as an acquired stenosis of the left common iliac vein secondary to compression of the left common iliac vein between the right common iliac artery and the underlying vertebral body. We report one case of May–Thurner syndrome, and another rare case of reverse May–Thurner syndrome, incidently detected during intervention, in a case of aortic stenosis and mitral stenosis with dextrocardia and situs inversus.

scholarly journals Evolving Concepts in the Diagnosis and Management of May–Thurner Syndrome

2017 ◽  
Vol 01 (01) ◽  
pp. 023-030 ◽  
Author(s):  
Murthy Chamarthy ◽  
Patrick Sutphin ◽  
Matthew Anderson ◽  
Mark Reddick ◽  
Sanjeeva Kalva
Keyword(s):  
Venous Thrombosis ◽  
Dynamic Compression ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Left Lower Extremity ◽  
Venous Compression ◽  
High Clinical Suspicion ◽  
The Right ◽  
Computed Tomography Venography

AbstractMay–Thurner syndrome is a common cause of left lower extremity venous thrombosis resulting from repetitive and dynamic compression of the left common iliac vein by the right common iliac artery, commonly seen in young to middle-aged women. The diagnosis requires high clinical suspicion. Computed tomography venography and magnetic resonance venography depict the extent of venous thrombosis and iliac venous compression in patients with underlying thrombotic and nonthrombotic pathologies, respectively. Contrast venography allows detection of acute and chronic thrombus, associated venous obstruction, and collaterals but is of limited value to evaluate the early venous wall abnormalities. Endovascular ultrasound is highly useful to detect early mural changes and accurately quantify venous narrowing. Endovascular intervention with balloon dilatation and stenting with or without pharmacomechanical thrombectomy followed by long-term anticoagulation is the preferred treatment with excellent technical and clinical outcomes. This review focuses on the current understanding of the pathology, clinical presentation, and endovascular management of May–Thurner syndrome.

Confluence of the right internal iliac vein into a compressed left common iliac vein

2015 ◽  
Vol 31 (2) ◽  
pp. 145-146
Author(s):  
Alberto Caggiati ◽  
Miguel Amore ◽  
Pietro Sedati
Keyword(s):  
Iliac Artery ◽  
Common Iliac Artery ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Left Common Iliac Vein ◽  
Internal Iliac Vein ◽  
Internal Iliac ◽  
The Right

The authors describe the abnormal confluence of the right internal iliac vein into a left common iliac vein compressed by the overlying right common iliac artery. The prevalence of this combination of abnormalities, evaluated in cadavers and in living subjects by CT, was 0.9%. The possible obstacle to venous pelvic return by these anomalies is pointed out.

May-Thurner syndrome – Are we aware enough?

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 381-388 ◽  
Author(s):  
Katalin Mako ◽  
Attila Puskas
Keyword(s):  
Contraceptive Use ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Compression Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

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