A Rare Variation of Retroaortic Left Renal Vein Draining into Left Common Iliac Vein

A 24-year-old woman without underlying disease presented with right lower abdominal pain for a day. The patient’s clinical symptoms were suspected acute appendicitis and underwent multidetector computed tomography. There is diffuse enlarged appendix with diffuse wall thickening and enhancement as well as minimal surrounding fat stranding. Mild thickened peritoneum is also observed. There is no fluid collection or free air. The radiologist diagnosed acute appendicitis without complication. Incidentally, the patient was found a rare anatomical variation of the retroaortic left renal vein draining into left common iliac vein. Patient underwent appendectomy. We would like to present a characteristic imaging of the renal vein variations.

Childhood Varicose Veins–An Unusual Visceral “May–Thurner” Like Compression

We report the case of 8-year-old girl with left lower limb edema due to superficial venous incompetence and varicosities. Color Doppler demonstrated compression of the left common iliac vein by an ectopic left kidney, which was partly relieved in right lateral decubitus position. CT demonstrated ectopic malrotated pelvic kidney, compressing the left common iliac vein against the L5 vertebra. A “May–Thurner” like syndrome due to visceral compression needs to be suspected in children with unilateral left lower limb varicosities.

Case Report: Rare Iliac Vein Compression (May–Thurner) Syndrome in a Pediatric Patient

Iliac vein compression syndrome (IVCS) or May–Thurner syndrome occurs predominantly in young to middle-aged women. Here we reported a case of IVCS in a 5-year-old boy. The child was admitted to our vasculocardiology department with left lower extremity that had been swollen for 1 month. Blood tests revealed coagulation routine and platelets in the normal ranges. Computer tomography angiography (CTA) and magnetic resonance imaging (MRI) showed the left common iliac vein had become narrow before it entered the right common iliac vein. To further clarify, we performed angiography, which clearly showed the stenosis and the blood return of the left common iliac vein. So IVCS was diagnosed. What is more, we found the aorta descended to the right of the spine, and this may be the reason for the apparent compression of the left common iliac vein. Given the young age and mild symptoms of the child, the treatment was conservative mainly including elevation of the affected limb, wearing medical elastic socks, and short-term oral aspirin for anticoagulation. Meanwhile, the boy is being followed up closely. If the swelling of the left lower extremity significantly increases, stent placement may need to be considered in the future.

Our clinical experiences of vascular injuries due to lumbar disc surgeries

Objectives We aimed to evaluate emergency vascular complications of the lumbar disc reconstructive surgery in this study. Method Between March 2006 and February 2020, nine patients (six males and three females; mean age: 53.4 ± 9.6 years; range: 38–64 years) who underwent emergent vascular intervention during lumbar spinal disc reconstructive surgery in our clinic were included in this retrospective study. Result The left common iliac artery injury, the left common iliac artery and left common iliac vein injuries, bilateral common iliac artery and abdominal aortic injuries, and vena cava inferior injury with left common iliac vein and right common iliac vein injuries were detected in two, three, two, and two patients, respectively. In addition, 16 mm Dacron tube graft interposition and graft patch plasty were performed in one and two patients who had an abdominal aortic injury, respectively. Also, 8 mm polytetrafluoroethylene straight graft interposition was performed in two patients with left common iliac artery injury, and lateral wall repair was performed in other patients. Graft patch plasty and 8 mm polytetrafluoroethylene graft interposition were performed in one patient with vena cava inferior injury and left common iliac vein injury, respectively. Also, lateral wall repair was performed in other patients with venous injuries. Deep venous thrombosis had developed in three patients, and one patient of these had a pulmonary embolism. Conclusion The incidence of vascular injury after the lumbar disc surgery is relatively low; however, the emergency vascular operation should be performed as soon as possible.

Selection of retroperitoneal access during intervertebral disc endoprosthesis in lumbar spine

The morphometric parameters and surgical areas of risk of retroperitoneal approach were studied for endoprosthetics of intervertebral discs in the lumbar spine to reduce trauma and reduce the risk of complications. The study included 110 patients operated on in the period from 2017 to 2020 (72 men, 38 women) in the neurosurgical department of the 1586 Military Clinical Hospital. The average age of the patients was 44.9 15.4 years. According to the localization of access to the lumbar spine, the patients were distributed as follows: LIIILIV 8 (7.3%), LIVLV 46 (41.7%), LVSI 56 (51%). It was found that, for the intervertebral disc LV SI, the length of the skin incision was 92.5 (80; 100) mm, the length of the surgical wound was 80 (80; 110) mm, the thickness of the subcutaneous fat layer was 30 (15; 40) mm, the depth of the wound was to the spine 85 (70; 120) mm, the depth of the wound to the spinal canal 125 (107.5; 152.5) mm, the angle of operation in the horizontal plane at the level of the spine 52 (47; 59.5) degrees. On the basis of the anthropometric data of patients, the optimal length of the skin incision was determined for performing the retroperitoneal approach (120 mm for level LIIILIV, 100 mm for level LIVLV). Three variants of the inferior vena cava bifurcation have been identified for different levels of intervertebral discs in the lumbar spine: high bifurcation, left common iliac vein mainly overlaps the left half of the LIVLV intervertebral disc and does not overlap the LVSI intervertebral disc; middle bifurcation, left common iliac vein overlaps the central part of the intervertebral discs LIVLV and LVSI; low bifurcation, inferior vena cava overlaps the right side of the intervertebral disc LIVLV, inferior vena cava and left common iliac vein completely overlap the intervertebral disc LVSI. The data obtained can be used when planning retroperitoneal access to the lumbar spine in order to reduce the trauma of the operation.

Nonnegligible causes of symptoms of acute lower extremities——3 cases of May-Thurner syndrome with deep vein thrombosis

Background May-Thurner syndrome is a kind of disease caused by the compression of the left common iliac vein. It is one of the causes of incomplete venous valves and superficial varicose veins in lower limbs, and is also a potential factor of acute deep vein thrombosis (DVT). Method Here 3 cases are diagnosed as May-Thurner syndrome at different ages. Case presentations 1. A 35-year-old female patient was hospitalized with swelling of the left lower limb for 1 week. Computed tomography (CT) showed compression of the left common iliac vein with thrombosis. May-Thurner syndrome was diagnosed and catheter-directed thrombolysis was performed. 2. A 37-year-old male patient came to our hospital due to sudden swelling of the right lower extremity and pain for 3 days. Computed tomography showed compression of the left common iliac vein and deep venous thrombosis (DVT) of the right iliac vein. May-Thurner syndrome was diagnosed. The patient was performed with inferior vena cava (IVC) filter implantation, catheter-directed thrombolysis and balloon angioplasty for right iliac vein. And the patient recovered well; 3. A 55-year-old female patient came to our hospital with swelling and discomfort in the left lower extremity for 3 days. Computed tomography showed stenosis of the left common iliac vein with deep vein thrombosis. May-Thurner syndrome was diagnosed, balloon dilation and stent implantation were performed. During 3 years of follow-up, there was no swelling or new thrombosis in her lower limbs. Conclusion When encountering unexplained deep vein thrombosis, iliac vein compression syndrome should be considered and treated in time to prevent the recurrence of thrombosis. Catheter-directed thrombolysis can relieve symptoms and stenting placement is the optimal way to relieve stenosis, supplemented by long-term anticoagulation therapy and graduated compression stockings.

A RARE CASE OF MAY- THURNER SYNDROME

May-Thurner syndrome (MTS) is a venous outow 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.We report a unique case of a 25 -year-old male who presented with MTS-related multiple varicosities in left lower limb.

May-Thurner syndrome: modern methods of diagnosis and treatment

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.

Successful treatment of acquired arteriovenous fistula following iliac vein thrombosis

Objectives Cases of arteriovenous fistula following iliac vein thrombosis are uncommon. The pathogenesis of its formation remains unclear. We present the efficacy of left common iliac vein recanalization in acquired arteriovenous fistula treatment. Methods A 71-year-old man presented with severe lower left limb edema and was diagnosed with acquired arteriovenous fistula following iliac vein thrombosis. Treatment by recanalizing the left common iliac vein with bare stents was selected over embolizing the arteriovenous fistula, leading to an excellent clinical outcome. Results and Conclusions: Acquired arteriovenous fistula should be considered in some patients with post-thrombotic syndrome. Endovascular recanalization without embolization of the arteriovenous fistula can effectively treat iliac vein thrombosis associated with arteriovenous fistula.