Venous Compression Syndromes

2017 ◽  
Vol 51 (3) ◽  
pp. 155-168 ◽  
Author(s):  
Joseph M. White ◽  
Anthony J. Comerota
Keyword(s):  
Left Renal Vein ◽  
Iliac Vein ◽  
Venous Hypertension ◽  
Diagnostic Methods ◽  
Common Iliac Vein ◽  
Management Options ◽  
Venous Compression ◽  
Extrinsic Compression ◽  
Venous Compression Syndromes ◽  
Compression Syndromes

Venous compression syndromes occur due to extrinsic compression causing complications of venous hypertension or venous thrombosis. This review focuses on 4 venous compression syndromes involving the left common iliac vein, subclavian vein, left renal vein, and popliteal vein. Clinical presentation, diagnostic methods, and management options are reviewed. When properly diagnosed and treated, long-term consequences can be avoided.

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.

Nonhealing Venous Ulcers and Chronic Venous Outflow Obstruction

2015 ◽  
Vol 105 (6) ◽  
pp. 541-549
Author(s):  
Jonathan Labovitz ◽  
Paul Gagne ◽  
Keith Penera ◽  
Sandra Wainwright
Keyword(s):  
Ulcer Healing ◽  
Iliac Vein ◽  
Venous Ulcer ◽  
Venous Disease ◽  
Ulcer Recurrence ◽  
Outflow Obstruction ◽  
Venous Compression ◽  
Venous Ulcers ◽  
Venous Compression Syndromes ◽  
Compression Syndromes

The etiology of chronic venous insufficiency is typically neglected or misunderstood when treating lower-extremity edema and venous ulcerations. Despite the high prevalence of venous compression syndromes, it is rarely considered when treating venous ulcers and unresolved venous disease. We report a case of bilateral iliac vein outflow obstruction that prohibited venous ulcer healing until properly treated. This case highlights the importance of properly identifying and treating venous compression syndromes to enhance ulcer healing and decrease the risk of venous ulcer recurrence.

scholarly journals Recurrent Varicocele Associated With Congestion Pelvic Syndrome

2019 ◽  
Vol 4 (9) ◽  
Keyword(s):  
Surgical Technique ◽  
Renal Vein ◽  
Left Renal Vein ◽  
Left Kidney ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Venous Compression ◽  
Low Body Mass Index ◽  
Technique Failure ◽  
Pelvic Congestion

Left Renal Vein compression, entitled as Nutcracker Syndrome, usually is described as cause of Pelvic Congestion once the difficult of drainage of the left kidney deviate vein flow to Gonadal vein developing Pelvic varices in women, and Varicocele in men. Recurrence of Varicocele is described to be between 1 to 35%, dependent on the surgical technique used to repair it. Among the cause of recurrent varicocele, include surgical technique failure, low Body Mass Index, venous plexus variation (persistence of branched spermatic veins), and venous compression. In this study, the authors present 2 cases of recurrent varicocele in young men caused by pelvic congestion due to the Left Renal Vein (LRV) and Left Common Iliac Vein (LCIV) compression, treated by endovascular techniques with good results. In the Literature there are few papers relating the association of both syndromes. Authors discuss of the association of recurrent varicocele and pelvic congestion, and also suggest a routine investigation of it in this recurrence.

scholarly journals A rare case of May-Thurner-like syndrome in an elderly lady

2014 ◽  
Vol 1 (2) ◽  
pp. 19
Author(s):  
Kapil Sahnan ◽  
Chris Pui Yan Yee ◽  
Robert Hywel Thomas ◽  
Kaji Sritharan
Keyword(s):  
Iliac Artery ◽  
Common Iliac Artery ◽  
Imaging Modality ◽  
Lumbar Vertebrae ◽  
Kidney Injury ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Left Common Iliac Vein ◽  
Extrinsic Compression ◽  
Duplex Imaging

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. 

scholarly journals Late-Onset Nonthrombotic Left Common Iliac Vein Compression Secondary to Degenerative Lumbar Disc: A Case Report of May-Thurner Variant

2018 ◽  
Vol 53 (1) ◽  
pp. 62-65 ◽  
Author(s):  
Salman Khalid ◽  
Young Jin Youn ◽  
Michael Azrin ◽  
Juyong Lee
Keyword(s):  
Iliac Artery ◽  
Common Iliac Artery ◽  
Late Onset ◽  
Multimodality Imaging ◽  
Lumbar Disc ◽  
Lumbar Vertebrae ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Left Common Iliac Vein ◽  
Extrinsic Compression

May-Thurner syndrome (MTS) refers to venous outflow obstruction caused by extrinsic compression of the left common iliac vein (LCIV) by the overlying pulsatile right common iliac artery against lumbar vertebrae. The classic clinical presentation is acute unilateral left leg painful swelling due to deep venous thrombosis in a young woman in the second or third decade of life. We present a case of a 66-year-old woman who presented with late-onset left leg swelling caused by nonthrombotic venous hypertension due to degenerative lumbar disc bulge leading to LCIV compression against the left common iliac artery which was confirmed by computed tomography and intravascular ultrasound. Our case highlights the importance of high index of suspicion for MTS in elderly patients with unilateral leg swelling and the importance of multimodality imaging for understanding the mechanism and appropriate treatment of MTS.

Nutcracker Syndrome: Case Report on the Management of Recurrent Stenosis After Stenting

2017 ◽  
Vol 51 (4) ◽  
pp. 203-208 ◽  
Author(s):  
Natasha Hansraj ◽  
Abdul Hamdi ◽  
Ali Khalifeh ◽  
Eric Wise ◽  
Rajabrata Sarkar ◽  
...  
Keyword(s):  
Renal Vein ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Stent Migration ◽  
Venous Hypertension ◽  
Intractable Pain ◽  
Nutcracker Syndrome ◽  
Extrinsic Compression ◽  
Vein Bypass ◽  
Renal Venous Hypertension

Nutcracker syndrome is a clinical entity leading to renal venous hypertension due to extrinsic compression of the left renal vein by the superior mesenteric artery. Current surgical therapy involves placement of an oversized renal vein stent with partial protrusion into the inferior vena cava (IVC) to relieve stenosis and prevent stent migration. Here, we present a patient with intractable pain and hematuria secondary to nutcracker syndrome who underwent left renal vein stent placement and developed recurrent symptoms due to flow-limiting kinking at the left renal hilum, with partial obstruction of the IVC from pseudointimal hyperplasia. This was treated with stent excision and construction of a left neorenal vein bypass. Thus, given these complications, we should perhaps revisit the recommendations for oversizing of the stent.

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

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.

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