A new treatment paradigm for phlegmasia cerulea dolen: Single stage endovascular pharmacomechanical thrombectomy with venoplasty and stenting

2020 ◽  
pp. 026835552097727
Author(s):  
GuangMing Tan ◽  
Bryan PY Yan
Keyword(s):  
Clinical Success ◽  
Treatment Algorithm ◽  
Clinical Success Rate ◽  
Iliac Vein ◽  
Single Stage ◽  
Bleeding Complications ◽  
Common Iliac Vein ◽  
Period 2 ◽  
Treatment Paradigm ◽  
Iliac Vein Compression

Background Phlegmasia Cerulae Dolen (PCD) is potentially a lethal disease but there is currently no established treatment algorithm for it. The aim of this study was to assess the safety and effectiveness of single stage endovascular pharmacomechanical thrombectomy with venoplasty and stenting in the treatment of PCD. Method This was a retrospective single centre observational study of consecutive patients who underwent endovascular intervention for the treatment of PCD between June 2016 and March 2020. Clinical and procedural details were recorded. Procedural and clinical success rate, procedural complications, and 30 days mortality were reported. Result 11 patients were treated during the study period. 2 (18.2%) had active malignancy. 63.6% were uncomplicated PCD on presentation. Common iliac vein compression or stenosis were demonstrated in all patients. Venous stents were implanted in all cases and procedures were successful in all cases. All patients had symptoms improvement at 72 hours post procedure. Other than 2 major bleeding complications, there was no other adverse event. The 30 days mortality was 18.2%. Active malignancy and the presence of anaemia were significantly associated with major complications. Conclusion Single stage endovascular thrombectomy and stenting was effective and safe in the treatment of patients with PCD. Common Iliac vein compression was a common underlying cause of PCD.

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.

scholarly journals Left Common Iliac Vein Compression Is Not Uncommon CT Finding

2012 ◽  
Vol 55 (1) ◽  
pp. 298
Author(s):  
M. Nazzal ◽  
M. Elfedaly ◽  
W. Qu ◽  
v. Kazan ◽  
J. Abbas ◽  
...  
Keyword(s):  
Iliac Vein ◽  
Common Iliac Vein ◽  
Left Common Iliac Vein ◽  
Iliac Vein Compression ◽  
Ct Finding

scholarly journals Iliac vein compression syndrome: literature review

2015 ◽  
Vol 14 (1) ◽  
pp. 78-83 ◽  
Author(s):  
Leonardo Pessoa Cavalcante ◽  
José Emerson dos Santos Souza ◽  
Raquel Magalhães Pereira ◽  
Marcos Velludo Bernardes ◽  
Alan Maurice da Silva Amanajás ◽  
...  
Keyword(s):  
Color Doppler ◽  
Iliac Vein ◽  
Surgical Reconstruction ◽  
Diagnostic Tools ◽  
Screening Methods ◽  
Common Iliac Vein ◽  
Noninvasive Methods ◽  
Compression Syndrome ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome

Iliac vein compression syndrome is a clinical condition in which the right common iliac artery extrinsically compresses the left common iliac vein. The syndrome predominantly affects young women between their 2nd and 4th decades of life. In view of the syndrome's potential complications, it should be recognized/diagnosed and treated in symptomatic patients before it causes irreversible damage to patients' venous systems. Noninvasive methods, such as venous color Doppler US are reasonable screening methods, but angiotomography and magnetic resonance angiography are more reliable diagnostic tools and the method of choice for confirmation of diagnosis remains multi-plane phlebography with measurement of pressure gradients. Endovascular treatment (angioplasty with placement of self-expanding stents) is safe and effective and can replace open surgical reconstruction and/or anticoagulation alone.

scholarly journals Patency and Clinical Outcomes of a Dedicated, Self-Expanding, Hybrid Oblique Stent Used in the Treatment of Common Iliac Vein Compression

2016 ◽  
Vol 24 (1) ◽  
pp. 159-166 ◽  
Author(s):  
Anna K. Stuck ◽  
Samuel Kunz ◽  
Iris Baumgartner ◽  
Nils Kucher
Keyword(s):  
Clinical Outcomes ◽  
Treatment Success ◽  
Iliac Vein ◽  
Primary Treatment ◽  
Clinical Severity ◽  
Common Iliac Vein ◽  
Nitinol Stent ◽  
Venous Clinical Severity Score ◽  
Iliac Vein Compression

Purpose: To investigate the clinical outcomes of a dedicated hybrid oblique nitinol stent that has been specifically designed to treat common iliac vein compression. Methods: The Bern Venous Stent Registry database was interrogated to identify all patients who had at least 6-month follow-up after treatment with the sinus-Obliquus hybrid stent for common iliac vein compression. The search identified 24 patients (mean age 39±18 years; 20 women) who matched the search criteria. Ten patients had postthrombotic syndrome (PTS), another 10 patients had acute iliofemoral thrombosis after catheter-directed therapy, and 4 patients had nonthrombotic iliac vein compression. Primary treatment success was defined as antegrade flow and stenosis <30% on venography and evidence of a spontaneous Doppler signal in the treated segment. Stent patency was assessed using duplex ultrasound. Clinical outcomes were evaluated using a clinical symptom score (Villalta) and the revised venous clinical severity score (rVCSS) at 3, 6, and 12 months in follow-up. Results: Primary treatment success was achieved in all patients. Mean follow-up was 10±3 months. Primary patency estimates by Kaplan-Meier analysis were 92% at 6 months [95% confidence interval (CI) 71% to 98%] and 83% (95% CI 54% to 95%) at 10 months. Three symptomatic patients underwent reintervention for early and late stent thromboses and the third for in-stent restenosis, resulting in secondary patency of 100%. Overall, all patients had clinical improvement at the latest follow-up; 50% reported complete resolution of symptoms. In patients with PTS, the Villalta score decreased by 6±6 points (p=0.02) and the rVCSS score by 3±1 points (p=0.05). Among deep vein thrombosis patients, none developed PTS. Conclusion: In patients with common iliac vein compression, the oblique hybrid nitinol stent appears to provide excellent early patency and clinical outcomes.

May-Thurner syndrome: diagnosis and management

VASA ◽  
2013 ◽  
Vol 42 (2) ◽  
pp. 96-105 ◽  
Author(s):  
Nicholas F. Brazeau ◽  
Harlan B. Harvey ◽  
Erique G. Pinto ◽  
Amy Deipolyi ◽  
Richard L. Hesketh ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Management ◽  
Young Patients ◽  
Diagnostic Errors ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Endovascular Management ◽  
Left Common Iliac Vein ◽  
Syndrome Diagnosis ◽  
Iliac Vein Compression

For over fifty years, the pathogenesis of May-Thurner syndrome (MTS) has been associated with chronic left common iliac vein compression resulting in the formation of intraluminal, permanent obstructive lesions. However, despite this association, the mechanism by which compression produces these lesions is unknown. Diagnostic accuracy of MTS is critical since it often afflicts young patients requiring endovascular management. This review will focus on the historical, embryological and evolutionary description of MTS and examine its development, diagnosis, clinical management and potential diagnostic errors.

scholarly journals Presentation and management of IVC and iliac vein encroachment by lumbar pedicle screws: a case-report

2020 ◽  
Vol 2020 (3) ◽  
Author(s):  
Keith George ◽  
Shane Burke ◽  
Sandra Park ◽  
Luis Suarez ◽  
Ron Riesenburger
Keyword(s):  
Multidisciplinary Approach ◽  
Treatment Algorithm ◽  
Vena Cava ◽  
Pedicle Screws ◽  
Operative Management ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vascular Integrity ◽  
The Right ◽  
Case Basis

Abstract Pedicle screws are commonly used in spinal surgeries and are relatively safe, with venous complications occurring rarely. We report a patient with imaging following a L4–5 fusion that showed indentation of the inferior vena cava and right common iliac vein by the right L4 and L5 pedicle screws. She underwent revision surgery in which the hardware was removed and no bleeding was observed. Intraoperative venogram confirmed vascular integrity and absence of indentation on the venous structures following screw removal. The patient recovered without complications. Venous contact by pedicle screws should be treated on a case-by-case basis in a multidisciplinary approach with vascular surgery. We discuss a treatment algorithm for the operative management of this problem.

scholarly journals Decreased incidence of left common iliac vein compression in patients with abdominal aortic aneurysms

2006 ◽  
Vol 44 (3) ◽  
pp. 595-600 ◽  
Author(s):  
Natalie C. Moreland ◽  
Michael Ujiki ◽  
Jon S. Matsumura ◽  
Mark D. Morasch ◽  
Mark K. Eskandari ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysms ◽  
Iliac Vein ◽  
Aortic Aneurysms ◽  
Common Iliac Vein ◽  
Left Common Iliac Vein ◽  
Abdominal Aortic ◽  
Iliac Vein Compression
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