Endovenous Iliocaval Revascularization for Transplant Kidney Salvage

Purpose: We report the case of a venous iliocaval recanalization to preserve a transplant kidney. Case Report: A young patient with a nephrotic syndrome caused by focal segmental glomerulosclerosis (FSGS) underwent a robot-assisted living-donor kidney transplant. The postoperative course was uneventful; serum creatinine at discharge was 1.51 mg/dL (normal range = 0.72–1.17 mg/dL). In the course of the following months, the patient was readmitted repeatedly due to acute kidney failure not related to rejection, recurrent FSGS, or anastomotic stenosis. All episodes started after prolonged standing and renal function improved after bed rest. Several hospital admissions and investigations later, phlebography revealed an occlusion of the inferior vena cava (IVC) and both common iliac veins with large collateral vessels through the azygos system. An endovenous recanalization of the iliocaval tract was performed, with subsequent normalization of transplant kidney function. Conclusion: Vascular complications after renal transplantation are an important cause of graft loss. We present an endovenous treatment option for a chronic occlusion of the IVC and common iliac vein with intermittent venous congestion as a cause of transplant failure.

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

Modified Sling Technique for Difficult Filter Retrieval

Surgical Technology Online ◽

10.52198/21.sti.39.cv1506 ◽

2021 ◽

Vol 39 ◽

Author(s):

Pasquale Grillo ◽

◽

Giuseppe Granata ◽

Anna Savoldi ◽

Giovanni Rodà ◽

...

Keyword(s):

Vena Cava ◽

Iliac Vein ◽

Common Iliac Vein ◽

Vein Thrombosis ◽

Filter Retrieval ◽

Ivc Filters ◽

The Common ◽

Deep Vein ◽

Removal Technique ◽

Loop Snare

Caval filters are placed in the inferior vena cava (IVC) to prevent pulmonary thromboembolism in patients with deep vein thrombosis. If there is no indication for thrombo-embolic risk prevention, the filter can be removed to reduce potential filter-related complications. Advanced endovascular techniques are frequently used to retrieve IVC filters. We describe an alternative filter-removal technique for use when standard techniques are not practicable. In our method, the filter hook is embedded within the IVC wall. To retrieve it, a long introducer is inserted; a guidewire and the "loop snare" retrieval system are then advanced through it with a coaxial system and positioned below the filter at the level of the common iliac vein confluence. The guidewire is then passed through the loop, creating a "sling" around the filter which allows the application of traction from the bottom upwards, releasing the hook from the wall. The loop is then held under tension with the filter aligned in the IVC lumen, and the introducer is advanced distally to completely cover the filter, allowing complete retrieval of the filter without damaging the vessel walls. This modified Sling technique is a safe and feasible method for complicated IVC filter retrieval.

Download Full-text

Morphological and Histological Study of an ‘Iliac Venous Ladder’ Associated with Very Short Common Iliac Arteries

Journal of Morphological Sciences ◽

10.1055/s-0039-1697009 ◽

2019 ◽

Vol 36 (04) ◽

pp. 255-260

Author(s):

Satheesha B. Nayak ◽

Sudarshan Surendran ◽

Venu Madhav Nelluri ◽

Prakashchandra Shetty

Keyword(s):

Developmental Process ◽

Present Report ◽

Histological Study ◽

Vena Cava ◽

Iliac Vein ◽

Histological Structure ◽

Common Iliac Vein ◽

Structural Variations ◽

Surgical Interventions ◽

The Common

Abstract Introduction Communications between iliac veins in the pelvis are reported to be rare occurrences, which are mostly due to developmental abnormalities. The common iliac vein is formed by the joining of the internal and external iliac veins. Here, we present a detailed morphological and histological study of a rare communication found between the internal and external iliac veins, which would prove to be of substantial value to the knowledge of vessels in the pelvis, both for clinicians and surgeons. Materials and Methods In the present study, we came across a rare communication in the form of a ladder, between the left internal and external iliac veins in a 70-year-old male cadaver. There were two communications (named upper and lower communications) between the external and internal iliac veins, before they joined to form the common iliac vein. On naked eye observation, the lumen of the right common iliac vein appeared to be wider than on the left side. The lengths of these communications and the distance between each of their attachments have been measured and tabulated. The walls of these veins, their microscopic sections and their communication involved in the case were taken. The possible causes for these variations were congenital, owing to the complicated nature of the developmental process involved in the formation of the inferior vena cava and the venous system of the lower limb. Results The structure of all the veins involved in this case and the communications were seen to be normal. The thickness of these walls were measured and tabulated for uniformity around the circumference of the wall of these veins. All the measurements from the structural variations and from the histological observations are tabulated in our results. Conclusion The complicated development sequence of these veins could have possibly led to the persistence of these communications. Such a developmental variation does not seem to pose any threat until unless encountered under clinical or surgical interventions, as the histological structure of the walls of the communications as well as the major channels connected appeared to be normal and well-developed. The detailed morphological and histological features of these structures involved in the variation along with the possible complications have been presented in the present report. Knowledge of these variations and complications due to injury plays a key role in a clinical setup.

Download Full-text

May-Thurner Syndrome with Large Abdominal Varicosity, Treated Successfully Using Multiple Approaches

Case Reports in Vascular Medicine ◽

10.1155/2019/7079307 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Lori Jia ◽

Jason Alexander ◽

Nedaa Skeik

Keyword(s):

Vena Cava ◽

Iliac Vein ◽

Postthrombotic Syndrome ◽

Common Iliac Vein ◽

Filter Placement ◽

Vein Thrombosis ◽

Left Common Iliac Vein ◽

Venous Outflow Obstruction ◽

Angioplasty And Stenting ◽

Deep Vein

May-Thurner syndrome (MTS) is a venous outflow 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. Anatomic variations of MTS, while uncommon, have been described. Treatment usually involves endovascular management, including thrombolysis and/or thrombectomy with or without inferior vena cava filter placement, followed by angioplasty and stenting of the left common iliac vein. We report a unique case of a 31-year-old woman who presented with MTS-related deep vein thrombosis accompanied by symptomatic abdominal and pelvic varicosities. The varicosities were treated successfully using multiple procedures, resulting in complete resolution of all symptoms. Our case discusses a treatment approach for an unusual presentation of MTS-related postthrombotic syndrome, and provides a brief literature review of MTS complications and management.

Download Full-text

May-Thurner syndrome: modern methods of diagnosis and treatment

Complex Issues of Cardiovascular Diseases ◽

10.17802/2306-1278-2021-10-1-89-96 ◽

2021 ◽

Vol 10 (1) ◽

pp. 89-96

Author(s):

D. G. Gitelson ◽

A. G. Faibushevich ◽

D. A. Maximkin ◽

G. I. Veretnik ◽

V. Yu. Baranovich ◽

...

Keyword(s):

Turner Syndrome ◽

Intravascular Ultrasound ◽

Vena Cava ◽

Clinical Manifestations ◽

Iliac Vein ◽

Diagnosis And Treatment ◽

Common Iliac Vein ◽

Promising Alternative ◽

Left Common Iliac Vein ◽

Modern Methods

May-Turner syndrome is a condition where the left common iliac vein is compressed between the lumbar spine and the overlying right common iliac artery. Left iliac vein compression is common (up to 24%) in the general population, but clinical manifestations occur in a few patients. This syndrome should be considered in case of unexplained edema of the left lower extremity since routine duplex ultrasound does not possess optimal sensitivity and specificity in the study of the iliac veins and the inferior vena cava. Intravascular ultrasound is the most accurate diagnostic method. However, the advent of computed tomography angiography and magnetic resonance angiography providing high-quality images of the vasculature have become a promising alternative to invasive intravascular ultrasound. Treatment for May-Turner syndrome usually involves stenting of the left common iliac vein along with medical therapy, including antithrombotic (anticoagulant and antiplatelet) therapy combined with phlebotonics. Our review reports modern methods of diagnosis and treatment of May-Turner syndrome.

Download Full-text

Management of Phlegmasia Cerulea Dolens Caused by a Giant Leiomyoma

10.21203/rs.3.rs-892622/v1 ◽

2021 ◽

Author(s):

Elisabeth Ekkel ◽

Tara Chandran ◽

Ryan Qasawa ◽

Michael Trpkovski ◽

Sachinder Hans

Keyword(s):

Uterine Leiomyoma ◽

Inferior Vena ◽

Mechanical Thrombectomy ◽

Vena Cava ◽

Iliac Vein ◽

Young Female ◽

Common Iliac Vein ◽

Venous Obstruction ◽

Recurrent Thrombosis ◽

Phlegmasia Cerulea Dolens

Abstract This case is of a young female with a large uterine leiomyoma causing phlegmasia cerulea dolens with thrombosis of the left common and left external iliac veins. She underwent mechanical thrombectomy to temporize the condition until she could be evaluated by gynecology-oncologist to remove the cause of venous obstruction. Prior to hysterectomy, suprarenal inferior vena cava filter was placed. Less than 12 hours post hysterectomy she developed recurrent thrombosis involving the left common and external iliac veins. She underwent repeat mechanical thrombectomy with wall stent placement in the left common iliac vein with resolution of her symptoms.

Download Full-text

Horseshoes Are Not Always Lucky: A Rare Cause of Varicose Veins

Journal for Vascular Ultrasound ◽

10.1177/154431670903300108 ◽

2009 ◽

Vol 33 (1) ◽

pp. 36-39

Author(s):

Kathryn Busch ◽

Judith Doyle ◽

Martin Forbes ◽

Geoffrey White ◽

John Harris ◽

...

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Varicose Veins ◽

Vena Cava ◽

Horseshoe Kidney ◽

Duplex Ultrasound ◽

Iliac Vein ◽

Venous Hypertension ◽

Common Iliac Vein ◽

True Nature

Introduction Color duplex ultrasound (CDU) assessment for patients with varicose veins has increased in prevalence as new techniques for treatment continue to emerge. Occasionally, patients present with atypical varicosities that warrant the typical study to be extended to unveil the true underlying cause of the condition. Clinical Details A 41 year old man presented to our laboratory for assessment of bilateral varicose veins. He had recently developed venous eczema. Examination of the patient revealed large varicose veins associated with the long saphenous system, especially prominent on the left side. Methods Using a standard venous incompetence study protocol, CDU was performed with a Philips IU22 machine. The lower-extremity deep and superficial venous systems were assessed for patency and competency. Measurements of incompetent venous junctions and noteworthy vessel diameters were included. The examination was extended to include the pelvic and abdominal veins on the basis of unusual findings during the CDU imaging of the legs. Results Superficial venous insufficiency was detected involving the saphenofemoral junctions (SFJs), long saphenous veins (LSVs), and tributaries bilaterally. Bilateral incompetent calf perforators were identified. On the left, two large SFJs were identified and the LSV measured up to 2.1 cm in diameter. On both sides, an incompetent superficial pelvic vein arising from the SFJ was identified tracking proximally. Examination of the iliac veins revealed normal right iliac veins. On the left, the common iliac vein was extrinsically compressed as was the inferior vena cava. Further examination revealed a horseshoe kidney. The confluence of the lower poles of the kidneys were anterior to the aorta, inferior vena cava, and left common iliac vein, compressing the venous vasculature, accounting for the venous hypertension and left sided prominence. Further management included confirmatory radiological imaging and intervention. Conclusion Atypical varicose veins may be a result of a plethora of causes. It is crucial to the patient's outcome to reveal the true nature of the underlying cause. Abdominal sources of venous incompetence need appropriately tailored intervention to prevent recurrence and potential worsening of symptoms.

Download Full-text