Venous cystic adventitial disease: to cure or manage? A case series

Venous cystic adventitial disease is a rare vascular condition that can have significant effects on a patient’s quality of life. The clinical presentation of venous cystic adventitial disease is variable, and there are no established guidelines on investigation or treatment of the disease. We present a series of three patients with venous cystic adventitial disease of the common femoral vein, treated within a single vascular surgery unit. Each of the three patients presented within 18 months of each other, despite the rarity of the disease. These are the only known cases treated within this vascular surgery unit. The investigation, management and treatment of each patient are individualised, with a management focus on quality of life.

Stenting in the common femoral vein does not increase posthrombotic syndrome or rethrombosis

Background In lower limbs deep venous thrombosis (DVT) scenario there is evidence that favours catheter guided invasive treatment. The treatment with stenting in the common femoral vein could be related with a diminished permeability in the inflow of the deep femoral vein. There is scarce data of the clinical follow up of this treatment. Purpose To analize and compare clinical and procedural outcomes in endovenous interventions that required stent placement in the common femoral vein because of residual lesion vs interventions that did no require such treatment. Methods From May 2010 to December 2020, 122 endovenous interventions were performed, within these 74 were DVT compromising the iliofemoral territory. Two groups were defined: Group A 28 (38%) that required stent placement in the common femoral vein and Group B 46 (62%) that did not required such treatment. Results Baseline characteristics were Group A vs Group B n (%) respectively: Median age 41.1±16.7 vs 40.5±18.8; female 23 (82) vs 27 (58); smoking 7 (25) vs 14 (30); cancer 1 (4) vs 7 (15); prior prolonged rest 7 (25) vs 14 (30); concomitant diagnosis of pulmonary embolism 7 (25) vs 17 (37). Within the female population 2 (7) vs 1 (2) were in puerperium; 6 (21) vs 6 (13) were under contraceptive therapy. Regarding the diagnosis of DVT 21 (75) vs 37 (80) were acute; 7 (25) vs 9 (19) were chronic. Compromised vessels were primitive iliac vein 21 (75) vs 38 (82); external iliac vein 6 (21) vs 18 (39); superficial femoral vein 11 (39) vs 8 (17); May-Thurner syndrome 14 (50) vs 20 (43). As regards the aspects of the intervention 15 (53) vs 34 (74) had a filter implanted in the inferior vena cava; thrombolytics were infused in 20 (71) vs 32 (70); manual thrombectomy was performed in 8 (27) vs 17 (37); mechanical thrombectomy 11 (39) vs 19 (41); pre dilation with balloon was performed in 22 (79) vs 39 (85); dedicated venous stents were implanted in 22 (78) vs 39 (85); not dedicated venous stents in 13 (46) vs 11 (24). Technique success was achieved in 28 (100) vs 45 (98) p=1; major bleeding occurred 0 vs 2 (4) p=0.5; rethrombosis 3 (10) vs 9 (20) p=0.25; intrahospital death 1 (4) vs 2 (4) p=1; early reintervention was needed 1 (4) vs 2 (4) p=1, radiation dose (min) 35.4±20.2 vs 30.1±17.0 p=0.2; Contrast (ml) 216.5±76.8 vs 217.3±90.8 p=0.9. During follow up (34.1±31.5 vs 22.3±16.4) image control was performed in 27 (96) vs 39 (85) p=0.23 with either doppler or chest computed tomography angiography. Post thrombotic syndrome (PTS) symptoms were classified with Villalta Score assuming that 0–4 points had no PTS, 5–9 points presented mild PTS, 10–14 points moderate PTS, >14 points severe PTS, in Group A 1 (4) presented mild PTS vs Group B 2 (4) mild PTS p=1, 1 (2) moderate PTS. Conclusions Endovenous treatment with stent placement in the common femoral vein did not required more reinterventions nor had more complications nor had more PTS that the interventions without stent placement. FUNDunding Acknowledgement Type of funding sources: None. Table 1. Basal Characteristics Table 2. Outcomes

Extraskeletal mesenchymal chondrosarcoma mimicking a thrombosed venous aneurysm with femoral vein involvement: A case report

Introduction/Objective Mesenchymal chondrosarcoma is a high-grade primitive mesenchymal tumor, which accounts for <5% of all chondrosarcomas and commonly affects young adults (peak incidence in second to third decade of life). The tumor has a widespread anatomic distribution, frequently involving the craniofacial bones as well as extraskeletal sites. The clinical presentation of an inguinal mass mimicking a thrombosed venous aneurysm is unusual and represents a potential diagnostic pitfall. Methods/Case Report A 42-year-old female with hypertension and obesity initially presented with a two-week history of left lower leg swelling. Venous doppler revealed presumed venous thrombosis, and she was prescribed apixaban while no history of coagulopathy, immobility, or recent surgery was noted. Two months later, she had residual swelling. Follow-up CT scan favored a large, peripherally thrombosed venous aneurysm arising from the left common femoral vein, while MRI showed a lobulated, inguinal soft tissue mass abutting the vein. Biopsy of the mass demonstrated a spindle cell mesenchymal neoplasm; subsequent resection revealed a pink-to-tan, well-circumscribed, and encapsulated mass (5.2 cm) with focal left common femoral vein invasion. Microscopically, the lesion demonstrated poorly-differentiated, oval-to-spindle cells with prominent staghorn vasculature interspersed were focal areas of well-differentiated hyaline cartilage. Immunohistochemical stains showed that the lesional cells were negative for cytokeratin cocktail, EMA, SMA, desmin, S100 protein, SOX10, STAT6, MUC4, MDM2, and ER. Next-generation sequencing (NGS) revealed a HEY1-NCOA2 gene fusion, confirming the diagnosis of extraskeletal mesenchymal chondrosarcoma. Results (if a Case Study enter NA) N/A Conclusion Extraskeletal mesenchymal chondrosarcoma can rarely present as an inguinal soft tissue mass with vascular invasion, mimicking a thrombosed venous aneurysm. Molecular confirmation of HEY1-NCOA2 gene fusion can help confirm the diagnosis in unusual clinical presentations.