Anatomy of the great vessels by magnetic resonance in anterior lumbar interbody fusion / Anatomia dos grandes vasos por ressonância magnética na fusão intersomática lombar anterior / Anatomía de los grandes vasos por resonancia magnética en fusión intersomática lumbar anterior

ABSTRACT: Objective: To perform an analysis of the anatomy of the great vessels relevant to the access for anterior lumbar interbody fusion (ALIF), determining the level of their bifurcation, the distance between the iliac vessels at L5-S1, the morphological configuration of the left iliac vein and the presence of fatty tissue between the vessel and the disc. Methods: Two hundred magnetic resonance imaging (MRI) scans of the lumbar spine of patients (18-80 years old) were evaluated using axial, coronal, and sagittal cuts at levels L1-S1 in T2 weighting. The interiliac distance was defined as the measurement between the left iliac vein and the right iliac artery. The presence of fatty tissue was defined as the identification of space between the vessel and the disc. Vessel morphology was divided into oval and flat. Results: The population's average age was 49.6 years, with 52% being female. The average interiliac distance at L5-S1 was 27.48mm. The bifurcation of the aorta artery was identified at the level of L4 in 56.3%, as well as the confluence of the iliac veins (37.2%). The left iliac vein was identified as oval in 69% of patients and flat in 31% of patients. Fat tissue was evidenced in 60.5% of the exams. Conclusion: As a routine preoperative examination and surgical planning, lumbar MRI is fundamental in investigating the anatomy regarding anterior approach surgeries, allowing an effective assessment of the relationships between the great vessels and the lumbar spine. Level of Evidence IV; Retrospective Investigation.

RESUMO: Objetivo: Realizar uma análise da anatomia dos grandes vasos relevantes ao acesso para fusão intersomática lombar anterior (ALIF), determinando o nível de sua bifurcação, a distância entre os vasos ilíacos em L5-S1, a configuração morfológica da veia ilíaca esquerda e a presença de tecido gorduroso entre o vaso e o disco. Métodos: duzentos exames de ressonância magnética (RM) da coluna lombar de pacientes (18-80 anos) foram avaliados, utilizando cortes axiais, coronais e sagitais nos níveis L1-S1, na ponderação T2. A distância interilíaca foi definida como a medida entre a veia ilíaca esquerda e artéria ilíaca direita. A presença de tecido gorduroso foi definida como identificação de espaço entre o vaso e o disco. A morfologia do vaso foi dividida em oval e plana. Resultados: A idade média da população foi de 49,6 anos, sendo 52% mulheres. A distância média interilíacas em L5-S1 foi 27,48 mm. A bifurcação da artéria aorta foi identificada ao nível de L4 em 56,3%. A confluência das veias ilíacas também foi mais frequente ao nível de L4, representando 37,2%. A veia ilíaca esquerda foi identificada com o formato oval em 69% e plana em 31% dos pacientes. Tecido gorduroso foi evidenciado em 60,5% dos exames. Conclusão: Como rotina no exame pré-operatório e no planejamento cirúrgico, a RM lombar tem fundamental importância na investigação da anatomia visando cirurgias de abordagem anterior, pois permite uma avaliação eficaz das relações entre os grandes vasos e a coluna lombar. Nível de Evidência IV; Investigação Retrospectiva.

RESUMEN: Objetivo: Realizar un análisis de la anatomía de los grandes vasos relevantes para el acceso en artrodesis intersomática lumbar anterior (ALIF), determinando el nivel de su bifurcación, la distancia entre los vasos ilíacos en L5-S1, la configuración morfológica de la vena ilíaca izquierda y la presencia de tejido graso entre el vaso y el disco. Métodos: Se evaluaron 200 imágenes de resonancia magnética (RM) de la columna lumbar de pacientes (18-80 años) mediante cortes axiales, coronales y sagitales en los niveles L1-S1, en ponderación T2. La distancia interilíaca se definió como la medida entre la vena ilíaca izquierda y la arteria ilíaca derecha. La presencia de tejido graso se definió como la identificación de espacio entre el vaso y el disco. La morfología de los vasos se dividió en ovalados y planos. Resultados: La edad media de la población fue de 49,6 años, de los cuales 52% eran mujeres. La distancia interilíaca media en L5-S1 fue de 27,48 mm. La bifurcación de la arteria aorta se identificó a nivel de L4 en 56,3%, así como la confluencia de las venas ilíacas (37,2%). La vena ilíaca izquierda se identificó como ovalada en 69% y plana en 31%. Se evidenció tejido graso en 60,5% de los exámenes. Conclusión: Como rutina en examen preoperatorio, la RM lumbar es fundamental en la investigación de anatomía de cirugías de abordaje anterior, permitiendo una evaluación eficaz de las relaciones entre los grandes vasos y la columna lumbar. Nivel de Evidencia IV; Investigación Retrospectiva.

Thrombectomy in a severe case of iliofemoral venous thrombosis involving the deep femoral vein via a single percutaneous access from the jugular vein: case report and description of the technique / Trombectomia em caso grave de trombose venosa iliofemoral afetando a veia femoral profunda pela técnica de punção e sessão única realizada pela veia jugular: relato de caso e descrição da técnica

ABSTRACT: Iliac vein thrombectomy is usually performed via access through veins located in the lower limbs, which makes it impossible to treat the deep femoral vein, which in turn is an important inflow route to the iliac vein stent. We describe a clinical case and the previously unpublished technique of percutaneous thrombectomy, angioplasty, and stent implantation performed in a single session and with a single access, obtained via the internal jugular vein.

RESUMO: A trombectomia mecânica venosa ilíaca geralmente é realizada por acesso em veias localizadas nos membros inferiores, o que impossibilita o tratamento da veia femoral profunda, que, por sua vez, é uma importante via de influxo ao stent venoso ilíaco. Descrevemos um caso clínico em que foi aplicada a técnica inédita de trombectomia percutânea, angioplastia e implante de stent, realizada por sessão e acesso único, obtido na veia jugular interna.

Identificação pela ultrassonografia vascular da compressão da veia ilíaca comum esquerda em mulheres assintomáticas: ortostatismo pode influenciar o diagnóstico? / Left common iliac vein compression identified by vascular ultrasonography in asymptomatic women: does standing position influence diagnosis?

Resumo Contexto A ultrassonografia vascular é o exame de imagem de escolha para rastreamento inicial da compressão na veia ilíaca comum esquerda, cujo achado assintomático pode ser encontrado em até 25% em algumas casuísticas. Objetivo Identificar, pela ultrassonografia vascular, se há diferença na avaliação da compressão na veia ilíaca comum esquerda em mulheres assintomáticas em decúbito dorsal e ao ortostatismo. Métodos Trata-se de um estudo observacional transversal em 50 mulheres voluntárias, sem sintomas de compressão venosa pélvica. Os parâmetros avaliados pela ultrassonografia vascular em decúbito dorsal e ao ortostatismo foram os diâmetros e as velocidades máximas na veia ilíaca comum esquerda no local do cruzamento com a artéria ilíaca comum direita e antes desse cruzamento, além dos índices de velocidade na veia ilíaca comum esquerda no local do cruzamento. Resultados Foram identificados oito casos de compressão significativa na veia ilíaca comum esquerda na avaliação em decúbito dorsal (16%) e somente dois casos (4%) ao ortostatismo. Os diâmetros na veia ilíaca comum esquerda foram estatisticamente maiores (p = 0,002) no local de cruzamento com a artéria ilíaca comum direita ao ortostatismo, e as velocidades e índices de velocidades foram estatisticamente maiores (p < 0,001) em decúbito dorsal. Não houve identificação de compressão significativa na veia ilíaca comum esquerda em ortostatismo quando os índices de velocidades estavam normais em decúbito dorsal. Conclusão Não houve diferença na detecção de compressão significativa da veia ilíaca comum esquerda ao ortostatismo em relação ao decúbito dorsal; no entanto, o estudo mostrou que pode haver menor compressão anatômica da veia ilíaca comum esquerda em posição ortostática.

Abstract Background Vascular ultrasonography is the imaging exam of choice for initial screening for left common iliac vein compression, which is an asymptomatic finding that can be detected in up to 25% of some patient samples. Objective To determine, using vascular ultrasonography, whether findings of left common iliac vein compression in asymptomatic women are different when assessed in the prone and standing positions. Methods This is a cross-sectional observational study of 50 adult female volunteers with no symptoms of pelvic venous compression. The parameters assessed with vascular ultrasonography in the prone and standing positions were diameters and maximum velocities of the left common iliac vein at the point at which it crosses behind the right common iliac artery and before this point, in addition to left common iliac vein velocity indices at the crossing. Results Eight cases of significant compression of the left common iliac vein were identified when assessed in prone position (16%) and just two cases (4%) were identified in the standing position. Left common iliac vein diameters were statistically larger (p = 0.002) at the point where it crosses behind the right common iliac artery in the standing position and velocities and velocity indices were statistically higher (p < 0.001) in the prone position. No significant compression of the left common iliac vein was identified in the standing position when velocity indices were normal in the prone position. Conclusions There was no difference in detection of significant compression of the left common iliac vein when assessed in the standing position in comparison with assessment in the prone position. However, the study showed that anatomic compression of the left common iliac vein may be reduced in the standing position.

Tratamento endovascular de aneurisma sacular aórtico associado à doença de Adamantiades-Behçet / Endovascular treatment of aortic saccular aneurysms associated with Adamantiades-Behçet disease

Resumo A doença de Adamantiades-Behçet é uma desordem multissistêmica que se apresenta classicamente com úlceras orais e genitais e envolvimento ocular, podendo o acometimento vascular ocorrer em até 38% dos casos. O envolvimento aórtico é uma das manifestações mais severas e está associado a altas taxas de mortalidade, ocorrendo em 1,5 a 2,7% dos casos. Relatamos um caso de aneurisma sacular de aorta abdominal em um paciente de 49 anos com doença de Adamantiades-Behçet complicada, tratada por correção endovascular.

Abstract Adamantiades-Behçet disease is a multisystemic disorder that classically presents with oral and genital ulcers and ocular involvement, with vascular involvement in up to 38% of cases. Aortic involvement is one of the most serious manifestations and is associated with high mortality rates, occurring in 1.5 to 2.7% of cases. We report a case of a saccular abdominal aorta aneurysm in a 49-year-old male patient with complicated Adamantiades-Behçet disease that was treated with endovascular repair.

Trombo flutuante em veias profundas de membro inferior e síndrome de May-Thurner: relato de caso / Free-floating thrombus in lower limb deep veins and May-Thurner syndrome: case report

Resumo O trombo flutuante no sistema venoso profundo manifesta elevado potencial de embolização pulmonar. Pode também ser encontrado em pacientes com trombose venosa superficial (TVS) com extensão para uma veia profunda. Os tratamentos descritos na literatura, ainda sem critérios definidos, variam desde anticoagulação e tratamentos fibrinolíticos com implantes de filtros de veia cava, trombectomias abertas ou com dispositivos endovasculares até condutas mais invasivas como a interrupção cirúrgica com ligadura do sistema venoso. Apresentamos o caso de uma paciente com trombose venosa profunda extensa, acometendo o território ilíaco-fêmoro-poplíteo com um trombo flutuante estendendo-se da veia ilíaca comum esquerda até a veia cava inferior. O tratamento foi realizado com terapia fibrinolítica com um cateter multiperfurado, associado a anticoagulação com heparina e a controles angiográficos diários. Ao final do tratamento, foi identificada uma estenose significativa na veia ilíaca comum esquerda, sendo realizada angioplastia com implante de stent.

Abstract Free-floating thrombus in the deep venous system has a high potential to cause pulmonary embolization. It can also be found in patients with superficial venous thrombosis (SVT) that extends to a deep vein. There are still no defined criteria for treatments described in the literature, which range from anticoagulation and fibrinolytic treatments with vena cava filter implants, through open or endovascular thrombectomies, to more invasive procedures such as surgical interruption with ligation of the venous system. We present the case of a patient with extensive deep venous thrombosis affecting the iliofemoral-popliteal territory with a floating thrombus extending from the left common iliac vein to the inferior vena cava. Treatment was performed with fibrinolytic therapy delivered with a multiperforated catheter, supplemented with anticoagulation with heparin and daily control angiography. At the end of the treatment, a significant stenosis was identified in the left common iliac vein, and angioplasty was performed with stenting.

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.

Antithrombotic therapy after iliac vein stenting / 浙江大学学报·医学版

Stenting for iliac vein stenosis or compression has become a common therapeutic approach in recent years. The antithrombotic therapy after the stent deployment, however, reaches no consensus. Medications strategies and patients' prognoses differ in non-thrombotic, acute thrombotic and chronic thrombotic these three circumstances. Non-thrombotic patients usually possess satisfactory stent patency whatever antithrombotic therapy is used. Anticoagulant is the basic medication for acute thrombotic patients, benefits from additional antiplatelet drug remains to be clarified. In terms of chronic thrombotic patients, their prognoses are unsatisfactory under all antithrombotic therapies. In this review, we outlined the recent progress of antithrombotic therapy after iliac vein stenting, aiming to provide feasible medication plans for each circumstance.

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.

Study on mechanical properties of nitinol iliac vein stent and animal test under different release scales / 生物医学工程学杂志

The mechanical properties of nitinol iliac vein stent (NIVS) have been studied by many scholars at home and abroad, but the study on the mechanical properties of iliac vein stent under different release scales has not been reported yet. Based on the finite element analysis method, the mechanical properties of three self-developed NIVS were studied to reveal the influence of stent diameters (12, 14, 16 mm) and different release scales (80%, 90%) on its strength, fatigue life and vein wall biomechanical properties. With an increases in the release scales, the equivalent elastic strain, fatigue strength safety factors, and vessel wall equivalent stress exhibited a downward trend, while the most stressed cross-section coincided with the arc of stent-connecting rods. Through 30, 60 and 90 days' animal test, a narrowed vascular model was established in the iliac veins of 12 pigs, and the developed iliac vein stents were implanted to comprehensively evaluate the safety and effectiveness of the stent, and at the same time the mechanical properties of stents were verified to provide important reference for the type inspection and clinical trials of follow-up products.

An Unusual Case of Bilateral Peripheral Edema in a Male with Undiagnosed Type 2 Diabetes Mellitus / 임상당뇨병

The present article demonstrates an unusual case of bilateral lower extremity edema caused by neurogenic areflexic bladder as the first physical symptom of diabetes. A 52-year-old man presented to the emergency department because of massive edema of his lower limbs. The edema had been present for 2 weeks, was symmetrical, and was progressively covering the lower limbs up to the inguinal area, scrotal bag, and penis and was accompanied by dysuria and an interrupted urine stream. Laboratory findings revealed a serum glucose level of 657 mg/dL and glycated hemoglobin (HbA1c) level of 15.6%. Computed tomography (CT) of the abdomen and pelvis revealed marked enlargement of the bladder with bilateral hydronephrosis and hydroureter. In addition, CT demonstrated bilateral compression of the iliac veins caused by the enlarged bladder. This case highlights the importance of a broad differential diagnosis for patients with diabetes and extensive peripheral edema. Neurogenic bladder should be considered in the differential diagnosis, even in newly diagnosed diabetic patients.

Dangerous twisted communications between external and internal iliac veins which might rupture during catheterization / 대한해부학회지

In this report, four unusual communications between external and internal iliac veins of the left side have been presented. The lowest communication was the narrowest measuring about 2 mm in diameter, the second measured 6 mm, the third had a diameter of 7 mm and the last communication measured 5 mm in breadth. The upper three communications were twisted in a helical manner. The internal iliac vein had its normal tributaries except that the iliolumbar vein drained into the external iliac vein at the level of the third communication. The external iliac vein was slightly dilated just below the level of lowest communication.

Catheter directed thrombolysis in treatment of acute iliofemoral deep venous thrombosis: determinants of outcome

Background: Acute deep vein thrombosis [DVT] of the lower limbs occurs in about 1.0 person per 1000 population per year and is associated with substantial morbidity. Although anticoagulation effectively prevents thrombus extension, pulmonary embolism, death, and recurrence may occur. Moreover, many patients develop venous dysfunction resulting in post-thrombotic syndrome [PTS]. PTS is associated with reduced individual health-related quality of life and a substantially increased economic burden. Hence, additional and more aggressive treatment, including systemic thrombolysis, thrombectomy, and catheter- directed thrombolysis [CDT], has been introduced to accelerate thrombus removal. Numerous studies suggest that additional CDT may provide highly effective clot lysis. There is little doubt that the overall benefit of thrombolysis depends on multiple factors, including predisposing risks, symptom duration, thrombus extension, and technical approaches and interventional success

Aim of the Work: This study aimed to define predictors of immediate and mid-long-term anatomic and clinical failures to guide patient selection and to set a standard for patient and physician expectations

Patients and Methods: This is a prospective observational cohort study that enrolled 20 patients [22 limbs] who presented to the Ain Shams University hospitals in the period from 7/2015 to 7/2017 with acute iliofemoral deep venous thrombosis [IFDVT] and fulfilled the inclusion criteria [mentioned below]. Intrathrombus catheter directed thrombolysis [CDT] was done. Assessments of predictors of immediate periprocedural success was based on degree of clot lysis and resolution of symptoms and signs. Incidence of postthrombotic syndrome [PTS] was calculated at 6 months postoperative using Villalta score [>/=5 vs <5]

Results: During the study duration, 20 patients [22 limbs] were recruited. The mean age was 40.95 +/- 12.35 years old, 11 patients [12 limbs] were women. The indication for CDT was severe progressive pain/swelling [18 limbs], and phlegmasia cerulea dolens [4 limbs]. 5 patients [7 limbs] had IVC thrombosis at the initial venography. 5 limbs had balloon dilatation only while iliac stenting was done in 12 limbs. 15 patients received CDT for 48 hours while 5 patients [7 limbs] received CDT for 24 hours [mean duration of CDT was 1.68 days]. As regards bleeding, only 2 cases of those who had CDT for 24 hours had bleeding, while bleeding occurred in 12 cases of those who had CDT for 48 hours. There were no recurrent DVT, intra or postoperative pulmonary embolism nor death within the study population till the end of the follow up period [6months]. 6 months post intervention, 7 limbs were free of PTS [Villalta score < 5], 15 limbs had mild to moderate PTS, and no patients had severe PTS. The mean Villalta score was 5.14 +/- 1.859

Conclusion: In our study, determinants of outcome following CDT for acute IFDVT were: 1] access site, 2] dose of thrombolytic agent used, 3] duration of thrombolysis, and 4] thrombus score at the end of the procedure. More studies should be done comparing not only the effect of CDT on incidence of PTS but also its effect on its severity [e.g. Villalta score] on short and long term

Presentación atípica de síndrome infrecuente: absceso como inicio de síndrome de May-Thurner / Atypical presentation in an uncommon syndrome: abscess as debut of May-Thurner syndrome

Resumen Objetivo Presentar un caso de inicio atípico de síndrome de May-Thurner, enfermedad vascular poco frecuente. Caso clínico Se reporta el caso de una paciente de 23 años con absceso de pie izquierdo y extenso edema de dicha extremidad. El dímero D y la ecotomografía doppler color venosa descartan evento trombótico agudo. El estudio complementario con angioTC objetiva compresión del origen de la vena ilíaca común izquierda, presencia de venas colaterales y diferente grado de insuficiencia venosa en dicha extremidad, hallazgos compatibles con el síndrome de May-Thurner. Conclusión El síndrome de May-Thurner representa una causa inusual y de presentación variable en enfermedad venosa de extremidad inferior izquierda en mujeres jóvenes.

ABSTRACT Aim To present a case of an atypical debut of May-Thurner syndrome, uncommon vascular disease. Case report We report a case of a 23 year old female with an abscess of the left foot and extensive edema of the left lower limb. D-Dimmer test and Venous Doppler ultrasound discards an acute trombotic event. Further studies with CT angiogram concludes the compression in the origin of the left common iliac vein compatible with May-Thurner syndrome. Conclusion May-Thurner syndrome represent an uncommon and variable cause of venous disease of the left lower limb in young female patients.

Comparison of mechanical thrombectomy with transcatheter thrombolysis for acute iliac femoral venous thrombosis / 浙江大学学报·医学版

OBJECTIVE@#To compare the efficacy of mechanical thrombectomy with transcatheter thrombolysis in the treatment of acute iliac femoral venous thrombosis.@*METHODS@#The clinical data of 170 patients with acute iliac venous thrombosis treated in Ningbo No.2 Hospital from September 2015 to September 2017 were retrospectively reviewed. Among them, 94 cases were treated with AngioJet mechanical thrombolysis or additional thrombolysis for residual thrombus (PMT group) and 76 cases were treated with catheter-directed thrombolysis(CDT group). After thrombolytic treatment if there was stenosis of iliac vein, the transluminal angioplasty was also performed. The clearance of thrombus and safety were evaluated and compared between two groups.@*RESULTS@#In PMT group there were 86 cases (91.5%) with grade Ⅲ, 5 cases (5.3%) with grade Ⅱ, 3 cases (3.2%) with grade Ⅰ clearance of thrombus; while in CDT group, there were 63 cases (82.9%) with grade Ⅲ, 7 cases (9.2%) with grade Ⅱ and 6 cases (7.9%) with grade Ⅰ clearance of thrombus (>0.05). The differences of diameter of two lower extremities 15 cm above knee after treatment in PMT and CDT groups were (2.3±0.9) cm and (2.5±1.1) cm, respectively (>0.05). The time of thrombolysis in group PMT was significantly shorter than that in group CDT[(2.6±1.2) d vs. (5.3±1.5) d, 0.05).@*CONCLUSIONS@#Both PMT and CDT have good thrombus clearance effect in the treatment of acute iliac femoral venous thrombosis, however, PMT has the advantages of short thrombolytic time and less urokinase.

Long-term efficacy of percutaneous mechanical thrombectomy combined with stent implantation in treatment of acute iliofemoral venous thrombosis / 浙江大学学报·医学版

OBJECTIVE@#To evaluate the long-term efficacy of percutaneous mechanical thrombectomy (PMT) combined with stent implantation in treatment of acute iliofemoral vein thrombosis.@*METHODS@#Seventy patients with acute iliac vein thrombosis were treated with PMT combined stent implantation in Ningbo No.2 Hospital from November 2015 to November 2017. During the follow-up, the improvement of blood flow was evaluated, the occurrence of post-thrombotic syndrome was assessed by the Villalta rating scale, and the stent patency was examined with lower extremity ultrasound or angiography.@*RESULTS@#The blood flow was significantly improved after procedure in all 70 patients, including 62 cases (88.6%) of grade Ⅲ clearance, 5 cases (7.1%) of grade Ⅱ clearance, and 3 cases (4.3%) of grade Ⅰ clearance. No significant complications occurred during the treatment. The patients were followed up for (15.0±2.5) months. During the follow-up, 64 patients (91.4%) had unobstructed stents, and 9 patients (12.8%) had post-thrombotic syndrome.@*CONCLUSIONS@#PMT combined with stent implantation is effective in the treatment of acute iliac vein thrombosis with a high medium-and long-term stent patency rate.

Left Common Femoral to Right Common Iliac Venous Bypass Through a Retroperitoneal Exposure

The endovascular recanalization of the iliocaval system has replaced venous surgical reconstructions as the primary treatment option in severe post-thrombotic syndrome (PTS). We herein present a 51-year-old female with previous deep venous thrombosis, complicated with PTS with a large and complex circumferential calf ulcer measuring 25 cm of length in the left lower extremity. Venogram revealed a complete and extensive occlusion in the left iliofemoral system. A surgical bypass from the left common femoral vein to the right common iliac vein was performed. Patient recovered well and after 12 months postoperation her large wound is healing favorably with a clean and well granulated bed. Iliofemoral venous bypass is a feasible treatment for non-healing ulcer of lower extremity.

Iliac Vein Compression Syndrome in an Asymptomatic Patient Population: A Prospective Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Iliac vein compression syndrome (IVCS) is an important cause of deep vein thrombosis, but the incidence of IVCS is still unclear. The purpose of this prospective study was to determine the incidence of IVCS in an asymptomatic patient population and to evaluate the risk factors in patients with and without IVCS.</p><p><b>METHODS</b>From October 2011 to November 2012, a total of 500 patients (228 women and 272 men; mean age of 55.4 ± 14.7 years) with no vascular-related symptoms were enrolled in this study. Computed tomography was performed to evaluate all patients. The degree of venous compression was calculated as the diameter of the common iliac vein at the site of maximal compression divided by the mean diameter of the uncompressed proximal and caudal left common iliac vein (LCIV). We compared the stenosis rate of the common iliac vein in women and men according to age and followed up patients to evaluate outcomes.</p><p><b>RESULTS</b>The mean compression degree of the LCIV was 16% (4%, 36%); 37.8% of patients had a compression degree ≥25% and 9.8% had a compression degree ≥50%. There was a significant difference between men and women in the LCIV compression degree (9% [3%, 30%] vs. 24% [8%, 42%]; U = 4.66, P< 0.01). In addition, the LCIV compression degree among younger women (≤40 years) was significantly different compared with that in older women (>40 years) (42% [31%, 50%] vs. 19% [5%, 39%]; U = 5.14, P< 0.001). Follow-up was completed in 367 patients with a mean follow-up of 39.5 months (range, 6-56 months). The incidence of IVCS in the follow-up period was 1.6%. Stenosis rate and the diameter of the site of maximal compression correlated with the incidence of IVCS. Multivariable Cox regression analysis showed that the stenosis rate was an independent risk factor of IVCS (Wald χ2 = 8.84, hazard ratio = 1.13, P< 0.001).</p><p><b>CONCLUSIONS</b>The incidence of IVCS was low and correlated with the stenosis rate of iliac vein. Preventative therapy may be warranted for common iliac vein compression in patients at an increased risk of venous thromboembolism, especially patients with a higher iliac vein compression degree.</p>