scholarly journals Association of Dunbar, May-Thurner and Nutcracker Compression Syndromes in One Patient

2020 ◽  
Vol 74 (2) ◽  
pp. 150-155
Author(s):  
Poļina Zalizko ◽  
Evija Tropina ◽  
Thomas Scholbach ◽  
Aldis Puķītis
Keyword(s):  
Left Renal Vein ◽  
Vena Cava ◽  
Iliac Vein ◽  
Celiac Artery ◽  
Vascular Compression ◽  
Nutcracker Syndrome ◽  
Compression Syndrome ◽  
Extrinsic Compression ◽  
Dunbar Syndrome ◽  
Iliac Vein Compression Syndrome

AbstractWe report a case of Dunbar syndrome, May–Thurner syndrome and Nutcracker syndrome diagnosed in one patient with clinical presentation and imaging findings on Doppler ultrasonography. Dunbar syndrome or truncus coeliacus compression syndrome is an under-diagnosed vascular compression syndrome with a lot of controversy around it because of insufficient differentiation from celiac artery stenosis. May–Thurner syndrome or iliac vein compression syndrome is an anatomically variable condition of venous outflow obstruction caused by extrinsic compression by the right common iliac artery as it crosses the iliac vein anteriorly. In Nutcracker syndrome due to compression the outflow from the left renal vein into the inferior vena cava is obstructed. The combination of all these syndromes in one patient was not described before.

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.

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.

scholarly journals Case report of gross hematuria in the nutcracker syndrome resolved by renocaval reimplantation

2016 ◽  
Vol 73 (12) ◽  
pp. 1178-1180
Author(s):  
Igor Banzic ◽  
Nikola Fatic ◽  
Sinisa Pejkic ◽  
Lazar Davidovic ◽  
Milos Sladojevic ◽  
...  
Keyword(s):  
Case Report ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Signs And Symptoms ◽  
Nutcracker Syndrome ◽  
Gross Hematuria ◽  
Extrinsic Compression ◽  
Clinical Center ◽  
Urethral Orifice ◽  
Ventral Aorta

Introduction. Nutcracker syndrome is defined as a set of signs and symptoms secondary to compression of the left renal vein (LRV) in the acute anatomic angle between the aorta and its superior mesenteric branch. Case report. A 38-year old woman with asymptomatic and ?idiopathic? gross hematuria came to the Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia in Belgrade. Hematuria was documented by cystoscopy and was found to be unilateral, located to the left urethral orifice. The contrast-enhanced multidetector computed tomography (MDCT) scan showed a stenotic LRV due to the extrinsic compression in the angle formed by the ventral aorta and superior mesenteric artery (MSA), with a jet of contrast through the lumen. Considering the negative investigations for more common causes of hematuria, its incapacitating nature, and above mentioned imaging findings suggestive of the nutcracker syndrome, an indication for the open surgical correction of the LRV entrapment was established. The patient underwent reimplantation of the LRV into the more distal inferior vena cava (IVC), to relocate it out of the constrictive aortomesenteric space. Intraoperative findings were notable for blood flow turbulence in the LRV and hypertrophy of its tributaries, which were ligated. We presented the first published case in the Serbian literature on nutcracker syndrome with hematuria resolved by renocaval reimplantation. Conclusion. This case report demonstrates that renocaval reimplantation, as the open surgery technique, could be the adequate method for resolving gross hematuria in patients with nutcracker syndrome.

scholarly journals Iliac Vein Compression Syndrome due to Bladder Distention Caused by Urethral Calculi

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Akiko Ikegami ◽  
Takeshi Kondo ◽  
Tomoko Tsukamoto ◽  
Yoshiyuki Ohira ◽  
Masatomi Ikusaka
Keyword(s):  
Vena Cava ◽  
Iliac Vein ◽  
Compression Syndrome ◽  
Bladder Distention ◽  
Distended Bladder ◽  
Urethral Calculus ◽  
Iliac Vein Compression ◽  
Leg Edema ◽  
Iliac Vein Compression Syndrome ◽  
The Right

We report a rare case of iliac vein compression syndrome caused by urethral calculus. A 71-year-old man had a history of urethral stenosis. He complained of bilateral leg edema and dysuria for 1 week. Physical examination revealed bilateral distention of the superficial epigastric veins, so obstruction of both common iliac veins or the inferior vena cava was suspected. Plain abdominal computed tomography showed a calculus in the pendulous urethra, distention of the bladder (as well as the right renal pelvis and ureter), and compression of the bilateral common iliac veins by the distended bladder. Iliac vein compression syndrome was diagnosed. Bilateral iliac vein compression due to bladder distention (secondary to neurogenic bladder, benign prostatic hyperplasia, or urethral calculus as in this case) is an infrequent cause of acute bilateral leg edema. Detecting distention of the superficial epigastric veins provides a clue for diagnosis of this syndrome.

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 The role of ultrasound imaging in vascular compression syndromes

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Renato Farina ◽  
Pietro Valerio Foti ◽  
Andrea Conti ◽  
Francesco Aldo Iannace ◽  
Isabella Pennisi ◽  
...  
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Clinical Signs ◽  
Vascular Compression ◽  
Nutcracker Syndrome ◽  
Vascular Changes ◽  
False Negatives ◽  
Dunbar Syndrome ◽  
Level Method ◽  
Compression Syndromes

AbstractVascular compression syndromes are rare alterations that have in common the compression of an arterial and/or venous vessel by contiguous structures and can be congenital or acquired. The best known are the Thoracic Outlet Syndrome, Nutcracker Syndrome, May–Thurner Syndrome, and Dunbar Syndrome. The incidence of these pathologies is certainly underestimated due to the non-specific clinical signs and their frequent asymptomaticity. Being a first-level method, Ultrasound plays a very important role in identifying these alterations, almost always allowing a complete diagnostic classification. If in expert hands, this method can significantly contribute to the reduction of false negatives, especially in the asymptomatic population, where the finding of the aforementioned pathologies often happens randomly following routine checks. In this review, we briefly discuss the best known vascular changes, the corresponding ultrasound anatomy, and typical ultrasound patterns.

Dunbar (Or Median Arcuate Ligament) Syndrome: A Case Series

2021 ◽  
Vol 23 (09) ◽  
pp. 450-459
Author(s):  
Dr Praveen K Sharma, MD RD ◽  
◽  
Dr. Pavankumar mathapati ◽  
Dr. Dinesh babu J ◽  
Dr. Keerthi vatsan ◽  
...  
Keyword(s):  
Case Series ◽  
Vascular Reconstruction ◽  
Vascular Compression ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Non Invasive ◽  
Compression Syndrome ◽  
Axis Compression ◽  
Arcuate Ligament ◽  
Dunbar Syndrome

Dunbar syndrome (DS) (or Median arcuate ligament syndrome) is a rare entity of the vascular compression syndrome, where there is focal proximal coeliac axis compression by Median arcuate ligament (MAL). It results in an insufficient supply of blood to the respective organs of the gastrointestinal tract (GIT). Multi-detector computed tomography (MDCT) is a very convenient non-invasive modality in diagnosing this condition and helpful in distinguishing it from other conditions, such as atherosclerotic disease. DS can further be treated disorder surgically by relieving the compression and sometimes may need vascular reconstruction. We present five cases of the DS.

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