Trombose venosa profunda de veia ilíaca contralateral após stent venoso posicionado na confluência ilíaco-cava: um desafio terapêutico / Deep venous thrombosis of the contralateral iliac vein after stenting of the iliocaval confluence: a therapeutic challenge

Resumo O tratamento de escolha para pacientes com síndrome de compressão venosa sintomática é o implante de stent venoso. Entretanto, esse tratamento possui complicações bem documentadas e, embora rara, trombose venosa profunda contralateral é uma dessas complicações. Nosso objetivo é apresentar um caso de trombose venosa profunda da veia ilíaca contralateral como resultado do posicionamento do stent além do preconizado e o desafio terapêutico que é a recanalização da veia com reconstrução da confluência ilíaco-cava.

Abstract The treatment of choice for patients with symptomatic venous compression syndrome is venous stenting. However, this treatment has well-documented complications and, although rare, contralateral deep venous thrombosis is one of these complications. Our objective is to present a case of deep venous thrombosis of the contralateral iliac vein resulting from placement of the stent beyond the recommended position and the therapeutic challenge is to recanalize the vein with reconstruction of the iliocaval confluence.

Prevalência de compressão da veia ilíaca esquerda em imagens tomográficas de uma população / Prevalence of left iliac vein compression on computed tomography scans from a population

Resumo Contexto A síndrome de May-Thurner (SMT) é a compressão da veia ilíaca esquerda (VIE) entre a artéria ilíaca direita e o corpo vertebral associada à hipertensão venosa crônica unilateral no membro inferior esquerdo. Porém, o achado tomográfico da compressão não necessariamente se reflete em sintomas. Objetivos Avaliar o achado de compressão da veia ilíaca esquerda em tomografias realizadas por outros motivos. Métodos Angiotomografias ou tomografias computadorizadas (TCs) com fase venosa foram analisadas. Foram coletados os dados demográficos e o motivo do exame, quando presente, e foi analisada a relação do diâmetro da veia ilíaca esquerda no ponto de maior compressão com um ponto a montante. Resultados De janeiro a julho de 2016, 590 tomografias foram analisadas, sendo 357 de mulheres e 233 de homens. A compressão da VIE ocorreu em 87 (14,74%) pacientes, dos quais 74 (85,05%) eram mulheres e 13 (14,9%) homens. O diâmetro médio do ponto de maior compressão entre os pacientes que apresentavam VIE < 5 mm foi de 4,4 mm, variando de 2,67 mm a 4,97 mm. O diâmetro no ponto de maior compressão representou até metade do diâmetro na última imagem justaposta ao corpo vertebral (índice de 0,5) em 179 (30,3%) dos pacientes. Conclusões Nosso estudo sugere que a ocorrência de compressão da VIE em TC de pacientes aleatórios, sem conhecimento de insuficiência venosa crônica ou TVP em MIE, é comum. Isso mostra que o achado tomográfico de compressão não necessariamente resulta em sintomas e não deve ser a única razão para tratar um paciente.

Abstract Background May-Thurner syndrome (MTS) is defined as compression of the left iliac vein between the right iliac artery and the lumbar vertebral body in the presence of signs and symptoms of unilateral left chronic venous insufficiency. However, imaging findings of compression are not manifest in symptoms of the syndrome in all subjects. Objectives To evaluate findings of compression in an asymptomatic population. Methods Computed tomography angiographies or venous phase computed tomographies were analyzed. Demographic data and reason for the exam were recorded. Vein diameter was measured at the site of greatest compression and distal of the compression and the ratio between the two diameters was calculated. Results From January to July of 2016, 590 computed tomography scans were analyzed (357 women and 233 men). Left iliac compression was found in 14.74% of patients. Patients with a left iliac diameter below the 5mm threshold had a mean diameter at the site of greatest iliac vein compression of 4.4 mm (range: 2.67 mm-4.97 mm). The ratio between the two measurements was < 0.5 in 30% of patients. Conclusions Our study suggests that iliac vein compression is common among random patients who have had computed tomography for any other reason. This indicates that compression found on tomography images is not the only finding to consider when treating a patient.

Compressões das veias renal e ilíaca comum esquerdas em tomografias computadorizadas: com que frequência são detectadas? / Compression of left renal vein and left common iliac vein on CT scans: how often are they detected?

Resumo Contexto As síndromes de nutcracker e May-Thurner são raras e, apesar de muitas vezes subdiagnosticadas, podem causar sintomas limitantes de gravidade variável. Frequentemente são consideradas diagnóstico de exclusão e não há consenso na literatura quanto a prevalência, incidência e critérios diagnósticos. Objetivos Estimar a frequência da compressão das veias ilíaca comum e renal esquerdas em tomografias computadorizadas de abdome e pelve. Métodos Estudo descritivo, quantitativo e transversal. Para veia renal esquerda, foram considerados como critérios de compressão a relação diâmetro hilar/aortomesentérico > 4 e o ângulo aortomesentérico < 39° e, para veia ilíaca comum esquerda, o diâmetro < 4 mm. Resultados Foram analisadas tomografias computadorizadas de 95 pacientes; destes, 61% eram mulheres e 39% eram homens. A compressão da veia renal esquerda foi encontrada em 24,2% da amostra, com idade média de 48,8 anos, ocorrendo em 27,6% das mulheres e 18,9% dos homens (p = 0,3366). A compressão da veia ilíaca comum esquerda foi detectada em 15,7% da amostra, com idade média de 45,9 anos, ocorrendo em 24,10% das mulheres e 2,7% dos homens (p = 0,0024). Em 7,4% dos pacientes, ambas compressões venosas foram detectadas. Conclusões A compressão da veia renal esquerda ocorreu em mulheres e homens com frequência semelhante, enquanto a compressão da veia ilíaca comum esquerda foi mais frequente em mulheres. Ambas as compressões venosas foram mais frequentemente encontradas em pacientes com idade entre 41 e 50 anos.

Abstract Background The nutcracker and May-Thurner syndromes are rare and, although often underdiagnosed, they can cause limiting symptoms. They are frequently considered only after exclusion of other diagnoses and there is no consensus in the literature on prevalence, incidence, or diagnostic criteria. Objectives To estimate the frequency of compression of the left common iliac vein and left renal vein in CT scans of the abdomen and pelvis. Methods Descriptive, quantitative, cross-sectional study. The criteria used to define compression of the left renal vein were a hilar/aortomesenteric diameter ratio > 4 and aortomesenteric angle < 39° and the criterion for compression of the left common iliac vein was a diameter < 4mm. Results CT scans of 95 patients were analyzed; 61% were women and 39% were men. Left renal vein compression was observed in 24.2% of the sample, with a mean age of 48.8 years, occurring in 27.6% of the women and 18.9% of the men (p = 0.3366). Compression of the left common iliac vein was detected in 15.7% of the sample, with a mean age of 45.9 years, occurring in 24.1% of the women and 2.7% of the men (p = 0.0024). Both veins were compressed in 7.4% of the patients. Conclusions Left renal vein compression was detected in women and men at similar frequencies, whereas left common iliac vein compression was more frequent in women. Both venous compressions were most frequently found in patients aged 41 to 50 years.

O caminho das pedras no diagnóstico e tratamento da síndrome obstrutiva ilíaca venosa crônica / Best practices in diagnosis and treatment of chronic iliac vein obstruction

Resumo A obstrução venosa ilíaca ocorre em 20% a 30% da população. Nos portadores de insuficiência venosa crônica grave, essa prevalência é ainda maior, podendo chegar a 50% a 90% dos pacientes, situação em que essa obstrução é investigada pelo ultrassom intravascular. Métodos diagnósticos menos invasivos, como o Doppler vascular, ou mesmo invasivos, como a flebografia, podem falhar em seu diagnóstico. O tratamento endovascular dessas obstruções tem se demonstrado eficaz, seguro e associado a excelente resultado clínico e de perviedade, desde que princípios anatômicos e técnicos fundamentais sejam considerados e aplicados.

Abstract Iliac vein obstruction occurs in 20-30% of the general population. In patients with severe chronic venous insufficiency, this prevalence can be even higher, reaching 50-90% when the obstruction is investigated using intravascular ultrasound. Less invasive methods, such as venous Duplex Scanning, and even invasive ones such as venography may fail to diagnose the condition. Endovascular treatment of these obstructions is effective, safe, and associated with excellent clinical outcomes and stent patency rates, provided that fundamental anatomical and technical principles are considered and applied.

Embolia cerebral como presentación atípica de síndrome de May Thurner

El síndrome de May-Thurner es una anormalidad anatómica que consiste en la comprensión cronica de la vena iliaca común izquierda, entre la arteria ilíaca común derecha y la columna vertebral, que puede predisponer a la trombosis venosa profunda. Es una entidad rara, y es infrecuente que provoque una embolia paradojal cerebral. Se presenta el caso de una isquemia cerebral de origen embólico, en un varón de 30 años, luego de actividad sexual. Los estudios realizados revelaron síndrome de May-Thurner asociado con un foramen oval permeable y una trombofilia por factor V de Leiden. Fue tratado con anticoagulantes orales y no ha presentado recurrencias.

May-Thurner syndrome is an anatomic abnormality that predisposes patients to increase risk of paradoxical embolism and stroke. It consists of chronic compression of the left common iliac vein by the overlying right common iliac artery and lumbar spine. This may lead to deep venous thrombosis and paradoxical embolism that could provoke cerebral ischemia in patients with a cardiac shunt from right-to-left. Embolic cerebral ischemic event is reported in a 30-year-old man after sexual intercourse. Further studies revea led suggestive findings of May-Thurner syndrome coupled with a patent foramen ovale and a factor V Leiden thrombophilia. He was placed on anticoagulation therapy and has not had any recurrent events.

Síndromes compresivos vasculares: un desafío diagnóstico / Vascular Compressive Syndromes: A Challenge Diagnosis

Resumen Los síndromes de compresión vascular constituyen un grupo de patologías poco frecuentes con prevalencia incierta, no solo por el desconocimiento que se tiene de estos, sino también por su presentación clínica inespecífica. Eso conlleva a que sean infradiagnosticados o detectados en etapas tardías, con secuelas a largo plazo. Su fisiopatología y clínica dependen del tipo de vaso comprometido, el sitio anatómico afectado y la causa subyacente que lo esté produciendo. La anamnesis, el examen físico dirigido y el uso de métodos complementarios como la ultrasonografía Doppler y la angiografía por tomografía computarizada (ATC) o angiografía por resonancia magnética (ARM), son herramientas vitales para su correcto diagnóstico, planificación terapéutica y seguimiento.

Abstract Vascular compression syndromes constitute a group of rare pathologies with uncertain prevalence not only because of their unawareness, but also for its nonspecific clinical presentation. This leads to their underdiagnosis, or detection in late stages with long-term sequelae. Its pathophysiology and presentation depends on the type of vessel involved, the affected anatomical site and the underlying cause producing it. Clinical history, physical examination and use of complementary methods such as Doppler ultrasonography, Computed Tomography Angiography (CTA) or Magnetic Resonance Angiography (MRA), are essential tools for its proper diagnosis, therapeutic planning and follow-up.

Progresses in etiology and imaging of iliac vein compression syndrome / 中国医学影像技术

Iliac vein compression syndrome is one of the most common clinical syndromes, which still lacks a consensus guideline. At present, imaging examinations play an important role in diagnosis of iliac vein compression syndrome, including ultrasonography, CT, MR and angiography. The progresses in etiology and imaging of iliac vein compression syndrome were reviewed in this article.

Clinical significance of antegrade lower limb venography in varicose veins of lower limbs / 中国医师杂志

Objective To investigate the clinical significance of antegrade lower limb venography in varicose veins of lower limbs.Methods The data of 230 cases of varicose veins of lower limb in Department of Vascular Surgery,Xiangyang Central Hospital from June 2018 to August 2019 were examined by antegrade lower limb venography.All patients were divided into simple varicose veins group (group A,67 cases) and secondary varicose veins group (group B,63 cases) according to the patency of deep veins.The data of sex,limb side,swelling and ulcer were analyzed respectively.Results There was no significant difference in the results of sex between the two groups (57.5％ vs 63.5％,P ＞ 0.05).The incidence of left side in group A was lower than that in group B (59.3％ vs 76.2％,P ＜ 0.05).And the incidence of swelling of lower extremities and ulcer in boot area in group A was lower than that in group B (31.1％ vs 49.2％,P＜0.05;18.6％ vs31.7％,P＜0.05 respectively).Conclusions Combined with swelling of lower extremities,ulcer in boot area or the varicose veins in left side had a higher incidence of secondary varicose veins.Anterogrede venography of lower extremities can accurately distinguish the classification of varicose veins of lower extremities and improve the diagnostic coincidence rate,which has significant clinical significance.

Clinical significance of antegrade lower limb venography in varicose veins of lower limbs / 中国医师杂志

Objective@#To investigate the clinical significance of antegrade lower limb venography in varicose veins of lower limbs.@*Methods@#The data of 230 cases of varicose veins of lower limb in Department of Vascular Surgery, Xiangyang Central Hospital from June 2018 to August 2019 were examined by antegrade lower limb venography. All patients were divided into simple varicose veins group (group A, 67 cases) and secondary varicose veins group (group B, 63 cases) according to the patency of deep veins. The data of sex, limb side, swelling and ulcer were analyzed respectively.@*Results@#There was no significant difference in the results of sex between the two groups (57.5% vs 63.5%, P>0.05). The incidence of left side in group A was lower than that in group B (59.3% vs 76.2%, P<0.05). And the incidence of swelling of lower extremities and ulcer in boot area in group A was lower than that in group B (31.1% vs 49.2%, P<0.05; 18.6% vs 31.7%, P<0.05 respectively).@*Conclusions@#Combined with swelling of lower extremities, ulcer in boot area or the varicose veins in left side had a higher incidence of secondary varicose veins. Anterograde venography of lower extremities can accurately distinguish the classification of varicose veins of lower extremities and improve the diagnostic coincidence rate, which has significant clinical significance.

Endovenous Intervention of May-Thurner Syndrome with Thrombus beyond Iliac Vein Stenosis

PURPOSE: With the increase in the incidence of venous thrombosis, interest in May-Thurner syndrome (MTS) accompanying iliac vein compression has increased. Some patients with MTS have inferior vena cava thrombosis or thrombosis beyond iliac vein stenosis (TBIVS). This study aimed to identify the characteristics of MTS with TBIVS including pulmonary embolism (PE) and post-thrombotic syndrome (PTS) compared to those of MTS without TBIVS. MATERIALS AND METHODS: Thirty-five patients with deep vein thrombosis associated with MTS were treated between March 2012 and February 2016. Demographic data, medical history, computed tomography findings (iliac vein size of stenosis and stenotic ratio compared with the other side), and clinical outcomes (preoperative PE and PTS) were retrospectively collected and reviewed by dividing into groups with or without TBIVS. RESULTS: Eight of the 35 patients with MTS had TBIVS. The group with TBIVS had a statistically significantly greater iliac vein size (P<0.001) and ratio (P=0.001). PE was more prevalent in the group with TBIVS (63% vs. 15%, P=0.007). However, no statistically significant intergroup difference in PTS prevalence was found. CONCLUSION: The presence of mild iliac vein stenosis in MTS can be used to predict TBIVS and the requirement for more attention to PE.

Síndrome de May Thurner con accidente cerebrovascular isquémico y foramen oval permeable / May Thurner syndrome with ischemic cerebrovascular accident and permeable oval foramen

La asociación de accidente cerebral isquémico con foramen oval permeable, no ha sido extensamente estudiada, y frecuentemente el sitio de origen de la embolia no se detecta a pesar de los estudios de rutina. Se presenta el caso de un paciente joven con accidente cerebral vascular isquémico y foramen oval permeable en el contexto de síndrome de May Thurner. El síndrome de May Thurner es una entidad poco estudiada en la literatura médica y además se lo ha relacionado poco con accidente cerebral vascular isquémico, pero en pacientes con foramen oval permeable sin evidencia de la fuente embolígena, es interesante descartarlo como causa de embolia paradojal.

The association of cerebral ischemic attack with patent foramen ovale has not been extensively studied, and frequently the site of origin of embolism is not detected despite routine studies. We present the case of a young patient with ischemic stroke and permeable oval foramen in the context of May Thurner syndrome. The May Thurner syndrome is an entity scarcely studied in the medical literature and it has also been infrequently related to ischemic vascular cerebral accident, but in patients with permeable oval foramen without evidence of the emboligen source, it is interesting to rule it out as a cause of paradoxical embolism.

Tratamento endovascular de trombose venosa profunda associada à Síndrome de May-Thurner / Endovascular treatment of deep venous thrombosis related to May-Thurner syndrome

A trombose venosa profunda (TVP) é a causa mais frequente e mais evitável de óbitos intra-hospitalares em todo o mundo. Descreve-se, neste relato, paciente feminina, de 43 anos de idade, que desenvolveu TVP em membro inferior esquerdo sem, aparentemente, fatores de risco associados. O diagnóstico de TVP aguda em mulher adulta ou adulta-jovem, sobretudo à esquerda, inclui a possibilidade de se associar com a variação anatômica da Síndrome de May-Thurner, o que torna menos adequado o seu tratamento isolado e conservador com anticoagulantes, uma vez que não aborda a sua causa base. Nesta situação clinico-cirúrgica, é necessária intervenção cirúrgica para retirar a compressão mecânica extrínseca da veia ilíaca comum esquerda pela artéria ilíaca comum direita, como revelada neste relato, por intermédio da angioplastia transluminal percutânea com colocação de stent auto-expansível. Este relato alerta para a importância da busca de diagnóstico etiopatogênico correto para a decisão terapêutica apropriada, o que permite a abordagem mais efetiva e condizente com a melhor recuperação e retorno à higidez. (AU)

Deep venous thrombosis (DVT) is the most frequent and most preventable cause of in-hospital deaths worldwide. We described in this report a 43-year-old female patient who developed DVT in the lower left limb without apparently associated risk factors. The diagnosis of acute DVT in an adult or young adult woman, especially on the left, includes the possibility of being associated with the anatomical variation of the May-Thurner Syndrome, which makes her isolated and conservative treatment with anticoagulants less suitable, because does not address its underlying cause. In this clinical-surgical situation, surgical intervention is required to remove the extrinsic mechanical compression of the left common iliac vein by the common iliac artery, as revealed in this report, through percutaneous transluminal angioplasty with selfexpanding stent placement. This report alerts to the importance of the correct etiopathogenic diagnostic search for the appropriate therapeutic decision, which allows the most effective approach, consistent with the best recovery and return to health. (AU)

Pyoderma gangrenosum associated with left iliac vein compression syndrome: presentation of difficult diagnosis

Abstract: Pyoderma gangrenosum is a rare neutrophilic dermatosis of unknown etiology, of which the most frequent clinical manifestations are ulcers. The diagnosis difficulty is, among other things, to rule out other causes of ulcers, since it is considered a diagnosis of exclusion. Skin ulcerations may also occur in the iliac vein compression syndrome, which, like pyoderma gangrenosum, mainly affects young women. Because they have such similar characteristics, the presence of vascular disease may hinder the diagnosis of concurrent pyoderma gangrenosum. Because of the clinical relevance of ulcerated lesions and scars, the early diagnosis and treatment of this condition is considered extremely important. We report a case in which the two diseases were associated, hampering the diagnosis of pyoderma gangrenosum.

A Case of May-Thurner Syndrome with Extensive Deep Vein Thrombosis and Extraperitoneal Hematoma from Spontaneous Utero-ovarian Vein Rupture

May-Thurner syndrome, also known as iliac vein compression syndrome, is an anatomically variable condition that is characterized by left common iliac vein compression by the right common iliac artery and the lumbar vertebra. This chronic and pulsatile venous compression by the right common iliac artery can cause local intimal injury, inflammation, scarring, and fibrosis, leading to venous outflow obstruction and increased intraluminal pressure. This can cause several complications, such as venous insufficiency, venous claudication, deep vein thrombosis, and very rarely extraperitoneal hematoma due to spontaneous iliac vein rupture. In particular, in middle aged women, hormonal imbalance coupled with these mechanical and inflammatory factors can cause further weakening of the venous wall integrity and develop spontaneous and potentially lethal venous rupture. This paper reports an extremely rare case of a 58-year-old woman with May-Thurner syndrome with acute and extensive deep vein thrombosis of the left lower extremity and a spontaneous extraperitoneal hematoma caused by utero-ovarian vein rupture.

Síndrome de May-Thurner como diagnóstico diferencial en trombosis a repetición / May-Thurner syndrome as a differential diagnosis in recurrent thrombosis

El síndrome de May-Thurner es una anomalía anatómica que genera insuficiencia venosa y episodios trombóticos recurrentes de los miembros inferiores. Se presenta el caso de una paciente de 29 años, con cuadro de trombosis venosas profundas en miembros inferiores a repetición desde los 20 años, sin factores de riesgo identificados, en quien se realizan estudios de extensión para neoplasia y trombofilia con resultados negativos, además de estudios para patología reumatológica con anticuerpos antinucleares (ANAS) positivo a títulos bajos como único hallazgo, con lo que se hace diagnóstico de enfermedad del tejido conectivo no diferenciado y se instaura manejo con anticoagulación plena; sin embargo, ante la persistencia de eventos trombóticos se realiza angio-TAC, la cual reporta obstrucción de la vena ilíaca izquierda, por lo cual se realiza una venografía más cavografía documentándose obstrucción de la vena ilíaca externa izquierda y la común estableciéndose el diagnóstico de síndrome de May-Thurner, el cual debe considerarse dentro de los diagnósticos diferenciales de los episodios trombóticos recurrentes.(Acta Med Colomb 2016; 41: 67-70).

The May-Thurner syndrome is an anatomic abnormality generating venous insufficiency and recurrent thrombotic episodes of lower limbs. The case of a 29 years old patient with clinical picture of recurrent deep venous thrombosis in lower limbs since the age of 20 years is presented. No risk factors were identified; extension studies for neoplasia and thrombophilia were performed with negative results, as well as studies for rheumatic disease with positive anti-nuclear antibodies (ANAs) at low titers as unique finding, being diagnosed as undifferentiated connective tissue disease and management with full anticoagulation is established. However, at the persistence of thrombotic events, an angio-CT which reports obstruction of the left iliac vein and the common vein is performed whereby a venography and cavography are done establishing the diagnosis of May Thurner syndrome, which should be considered within the differential diagnosis of recurrent thrombotic events. (Acta Med Colomb 2016; 41: 67-70).

Iliac vein compression syndrome: literature review / Síndrome de compressão da veia ilíaca: revisão de literatura

Iliac vein compression syndrome is a clinical condition in which the right common iliac artery extrinsically compresses the left common iliac vein. The syndrome predominantly affects young women between their 2nd and 4th decades of life. In view of the syndrome's potential complications, it should be recognized/diagnosed and treated in symptomatic patients before it causes irreversible damage to patients' venous systems. Noninvasive methods, such as venous color Doppler US are reasonable screening methods, but angiotomography and magnetic resonance angiography are more reliable diagnostic tools and the method of choice for confirmation of diagnosis remains multi-plane phlebography with measurement of pressure gradients. Endovascular treatment (angioplasty with placement of self-expanding stents) is safe and effective and can replace open surgical reconstruction and/or anticoagulation alone...

A Síndrome de Compressão da Veia Ilíaca (SCVI) é uma situação clínica na qual a artéria ilíaca comum direita comprime extrinsecamente a veia ilíaca comum esquerda. Há uma predominância em mulheres jovens, entre a segunda e a quarta décadas de vida. Levando-se em consideração as complicações potenciais da síndrome, esta deve ser reconhecida/diagnosticada e tratada, em pacientes sintomáticos, antes que cause alterações irreversíveis no sistema venoso do paciente. Métodos não invasivos, como o US-Doppler colorido, quando realizados por examinadores experientes, são métodos de triagem razoáveis; porém, a angiotomografia e a angiorressonância são mais fidedignas. O método de escolha para a confirmação diagnóstica consiste na flebografia, em múltiplas incidências, com aferição de gradientes pressóricos. O tratamento endovascular (angioplastia com colocação de stent autoexpansível) é seguro e efetivo, podendo substituir a reconstrução cirúrgica aberta e/ou a anticoagulação isolada...

Deep Vein Thrombosis Associated with May-Thurner Syndrome in an Amyotrophic Lateral Sclerosis Patient: A Case Report

There have been a few reports on deep vein thrombosis (DVT) associated with compression of the left common iliac vein by the right common iliac artery, referred to as May-Thurner syndrome (MTS). However, there have been no reports on DVT associated with MTS in amyotrophic lateral sclerosis (ALS) patients exhibiting similar clinical features to paraplegic spinal cord injury patients. We hereby report a case of DVT associated with MTS in an ALS patient, who was treated successfully.

Impact of Distance from the Right Iliac Artery to the Lumbar Vertebra in Left Side Deep Venous Thrombosis / 대한혈관외과학회지

PURPOSE: The aim of this study is to evaluate how much influence iliac vein compression exerts on the clinical feature of deep venous thrombosis (DVT). METHODS: One hundred five cases of lower extremity DVT were enrolled. The cases were grouped by location of the thrombus, left/right and inferior vena cava, iliac vein (IV), femoral vein (FV), popliteal vein, and calf vein. The estimated frequency was calculated by means of that the numbers of each goup were divided by the group's mean of DVT risk score. The minor distance from the right iliac artery to the fifth lumbar vertebral body overlying the left iliac vein was measured in computed tomography. Correlation of the severity and the minor distance was evaluated. RESULTS: Left, right, and bilateral DVT were represented in 66, 26, and 13 cases, respectively. Estimated frequencies were 2, 6.47, 5.47, 2.08, and 0.96 in the left side and 2, 1.44, 2.5, 1.33, and 1 in the right, respectively. Statistics significance was seen at the IV and FV levels. The means of minor distances in millimeters were 4.88, 3.98, 6.13, 6.20, and 4.20 in the left and 2.50, 7.00, 5.20, 7.33, and 6.50 in the right, respectively. Significance was seen only at the IV level. DVT severity and the minor distance could not be correlated with statistical significance. CONCLUSION: We consider that May-Thurner's anatomical changes impacts the DVT prevalence only at the proximal vein. We also suggest that the compression of the left iliac vein might be a contributing factor for developing DVT but not for severity of the DVT.

Perioperative Management for the Patient with May-Thurner Syndrome: A Case Report / 대한구급학회지

May-Thurner syndrome is an anatomic variant in which the left common iliac vein is compressed by the right common iliac artery. The most frequent clinical presentation is deep vein thrombosis of the left lower extremity. We report the perioperative management in a patient with May-Thurner syndrome undergoing an open reduction of a tibia fracture. The patient developed deep vein thrombosis of the left lower extremity and had an endovascular stent placed approximately 1 year earlier. An important aspect of the perioperative management in a patient with May-Thurner syndrome is to prevent deep vein thrombosis. We monitored the activated clotting time during the intraoperative period.

May-Thurner Syndrome in Lung Cancer

May-Thurner syndrome is deep vein thrombosis (DVT) of the iliofemoral vein due to compression of the left common iliac vein (CIV) by the overlying right common iliac artery (CIA). In contrast to the right CIV, which ascends almost vertically to the inferior vena cava (IVC), the left CIV follows a more transverse course. Along this course, it underlies the right CIA, which may compress it against the lumbar spine. A 69-year-old man with squamous cell lung cancer presented with acute onset painful left leg swelling. He had been undergoing chemotherapy with gemcitabine and cisplatin as a 2nd line treatment after concurrent chemoradiation. Physical examination revealed left leg edema with tenderness and warmth. The D-dimer level was elevated and a lower extremity computed tomographic angiogram (CTA) showed a DVT involving the left infrapopliteal vein to the common iliac vein with collapsed junction between the CIV and IVC. Systemic anticoagulation with low molecular weight heparin (LMWH) and an IVC filter insertion was performed to prevent further thrombosis, such as a PTE. After IVC filter placement, mechanical thrombectomy was performed on the left femoral vein and left CIV. A vascular stent was then deployed in the left CIV. Left leg swelling seemed to be improved after heparinization, but he had a 2nd episode one week later. Therefore, he underwent a 2nd mechanical thrombectomy and stent deployment of the left external iliac vein. His leg swelling was gradually relieved. He has received LMWH for 3 months, and has received 2 cycles of pemetrexed followed by erlotinib