1
|
Joyce DP, Morris RI, Black SA, Desai KR, O'Sullivan GJ. Major Complications of Deep Venous Stenting. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03843-5. [PMID: 39214918 DOI: 10.1007/s00270-024-03843-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Deep venous stent placement has developed into a primary treatment modality for venous obstruction in recent decades. Reported rates of complications are low in the literature and are based mainly on case reports and single-centre cohorts. Interventionalists performing these procedures must be aware of the occurrence of complications associated with stent placement to counsel patients adequately and promote avoidance through optimal procedural approach. This study aims to determine the incidence of serious complications associated with iliocaval and iliofemoral stent placement in a cohort of patients from 3 major tertiary deep venous referral centres. METHODS Data were collated from January 2014 to September 2023. The following major complications were included in the analysis: death, major bleeding requiring transfusion, massive pulmonary embolism, any complication which required endovascular or open surgical intervention, vessel rupture, acute kidney injury requiring dialysis, stent crushing, fracture, migration, involution or erosion. RESULTS One thousand eight hundred fourteen (1814) patients were treated for acute or chronic deep venous pathology during the 9-year study period. Sixty-one patients (3.3%) experienced a major stent-related complication. The most frequently reported complication was stent crushing (n = 18, 29.5%), followed by stent fracture (n = 10, 16.4%) and erosion of the stent through the vessel wall (n = 8, 13.1%). Death was a rare event (0.2%). CONCLUSION Deep venous stent placement is a safe procedure with low rates of major complications. It is incumbent upon operators to be aware of the risks associated with these procedures, however, rare, so that they may obtain fully informed consent from patients.
Collapse
Affiliation(s)
- D P Joyce
- Department of Interventional Radiology, Galway University Hospital, Galway, Ireland.
| | - R I Morris
- Department of Vascular Surgery, St Thomas' Hospital, London, UK
| | - S A Black
- Department of Vascular Surgery, St Thomas' Hospital, London, UK
| | - K R Desai
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - G J O'Sullivan
- Department of Interventional Radiology, Galway University Hospital, Galway, Ireland
| |
Collapse
|
2
|
Skeik N, Adamek A, Manunga J. Spontaneous iliac vein rupture and thrombosis in patients with May-Thurner syndrome: A narrative review. Vasc Med 2023; 28:361-367. [PMID: 37248994 DOI: 10.1177/1358863x231175697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Spontaneous iliac vein rupture (SIVR) is extremely rare and can lead to serious complications, including death. Etiologies include inflammatory processes and hormonal and mechanical triggers, with concomitant May-Thurner syndrome (MTS) being a rare cause. Management can be challenging due to the difficult balance between reducing thrombotic burden and life-threatening hemorrhage that can result from aggressive anticoagulation. Furthermore, surgical interventions are associated with high mortality, making conservative management more desirable. We report a case of SIVR with retroperitoneal hematoma and concurrent MTS that was successfully managed using conservative measures. We further provide a narrative review of the current literature addressing the diagnosis, management, and outcome of SIVR focusing on cases with concurrent MTS.
Collapse
Affiliation(s)
- Nedaa Skeik
- Section of Vascular & Endovascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Andrew Adamek
- Minneapolis Heart Institute Research Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Jesse Manunga
- Section of Vascular & Endovascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| |
Collapse
|
3
|
Zhui L, Yangyang F, Miao W, Hong C, Qiu Z, Wen H, Wei R, Yu Z. Clinical characteristics and treatment outcomes of 68 patients with spontaneous iliac vein rupture: A case report and systematic review. Heliyon 2023; 9:e16382. [PMID: 37255985 PMCID: PMC10225893 DOI: 10.1016/j.heliyon.2023.e16382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023] Open
Abstract
Objective Spontaneous iliac vein rupture (SIVR) is a rare but life-threatening condition with limited understanding regarding its clinical presentation, pathogenesis, diagnosis, management, and risk factors for mortality. This study aims to address this gap by providing comprehensive insights into SIVR through personal case reports and a systematic review of previous cases. Methods We detail a case of right SIVR caused by inappropriate positioning of the stent in the inferior vena cava and systematically reviewed previous cases. Logistic regression analysis was used to identify risk factors for mortality. Results Our SIVR case was successfully managed with percutaneous mechanical thrombectomy and covered stent placement. In the systematic review, 68 patients were included in the analysis with an average age of 62.01 ± 13.25 years; 86.76% were female, 91.17% had left iliac vein rupture, 55.88% presented hemodynamic instability, 76.47% had lower abdomen or iliac fossa pain, 67.64% had deep venous thrombosis (DVT), and 32.35% had May‒Thurner syndrome (MTS). The mortality rates of conservative treatment and open surgery were 2.94% and 17.65%, respectively. All 12 patients receiving endovascular treatment survived. The factors associated with a worse outcome were younger age (52.86 ± 12.96 years, OR: 1.085, 95% CI: 1.002-1.174) and SIVR patients without DVT (OR:10.111, 95% CI: 1.637-62.443). Conclusion This first systematic review on SIVR shows that SIVR should be highly suspected in elderly females who develop lower extremity DVT and concurrent lower abdominal pain, particularly those with a retroperitoneal mass and unstable hemodynamics. Thrombosis secondary to MTS may be the main cause of SIVR. Angiography and endovascular therapy should be prioritized for DVT patients with unexplained retroperitoneal hematoma. This study classifies SIVR into two types: iliac vein rupture alone and iliac vein rupture with DVT. These findings provide critical insights for clinicians to accurately diagnose and manage SIVR, thereby improving patient outcomes.
Collapse
Affiliation(s)
- Li Zhui
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Yangyang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Miao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cui Hong
- Department of Anesthesia, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zeng Qiu
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huang Wen
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ren Wei
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhao Yu
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
4
|
Qi HS, Kwan KJS, Li HL. Successful Management of Spontaneous Iliac Vein Rupture with Double Bare Stent Technique: A Case Report and Review of Literature. Vasc Endovascular Surg 2023; 57:257-263. [PMID: 36239775 DOI: 10.1177/15385744221130855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spontaneous rupture of the iliac vein is a rare cause of retroperitoneal hematoma. A misdiagnosis may delay the treatment and consequently put the patient in a life-threatening emergency. We report the case of a 73-year-old woman who presented with hemorrhagic shock from bleeding caused by a large left retroperitoneal hematoma. She was successfully treated with an endovascular approach by using a double bare stent technique. An extensive review of the literature was conducted and a total 44 articles with 50 patients were identified. Among these patients, 88.2% were women, 94.1% presented with a left-sided rupture, and the mortality rate was 13.7%. Spontaneous iliac vein rupture was more likely to occur in the left side in female patients. Conservative treatment was an option in hemodynamically stable patients. Exploratory laparotomy and surgical iliac vein repair was necessitated in most patients. Endovascular treatment including placement of covered stent and coil embolization had been widely used to treat spontaneous vein rupture since 2003. Double bare stent technique was also an effective alternative if a suitable covered stent was unavailable.
Collapse
Affiliation(s)
- Hao-Shan Qi
- Division of Vascular Surgery, Department of Surgery, 12648Qingdao Municipal Hospital, China
| | | | - Hai-Lei Li
- Division of Vascular Surgery, Department of Surgery, 444333University of Hong Kong - Shenzhen Hospital, China
| |
Collapse
|
5
|
Kooiman AL, Bakas JM, van Fessem JMK, Boellaard WPA, Cornelissen SAP, van Rijn MJE. Spontaneous Iliac Vein Ruptures: A Systematic Review. Vasc Endovascular Surg 2023:15385744231163707. [PMID: 36913198 DOI: 10.1177/15385744231163707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Spontaneous iliac vein rupture is a rare, but frequently lethal condition. It is important to timely recognize its clinical features and immediately start adequate treatment. We aimed to increase awareness to clinical features, specific diagnostics, and treatment strategies of spontaneous iliac vein rupture by evaluating the current literature. METHODS A systematic search was conducted in EMBASE, Ovid MEDLINE, Cochrane, Web of Science, and Google Scholar from inception until January 23, 2023, without any restrictions. Two reviewers independently screened for eligibility and selected studies describing a spontaneous iliac vein rupture. Patient characteristics, clinical features, diagnostics, treatment strategies, and survival outcomes were collected from included studies. RESULTS We included 76 cases (64 studies) from the literature, mostly presenting with left-sided spontaneous iliac vein rupture (96.1%). Patients were predominantly female (84.2%), had a mean age of 61 years, and frequently presented with a concomitant deep vein thrombosis (DVT) (84.2%). After various follow-up times, 77.6% of the patients survived, either after conservative, endovascular, or open treatment. Endovenous or hybrid procedures were frequently performed if the diagnose was made before treatment, and almost all survived. Open treatment was common if the venous rupture was missed, for some cases leading to death. CONCLUSION Spontaneous iliac vein rupture is rare and easily missed. The diagnose should at least be considered for middle-aged and elderly females presenting with hemorrhagic shock and concomitant left-sided DVT. There are various treatment strategies for spontaneous iliac vein rupture. An early diagnose brings options for endovenous treatment, which seems to have good survival outcomes based on previously described cases.
Collapse
Affiliation(s)
- Alexander L Kooiman
- Department of Vascular Surgery, 273243Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jay M Bakas
- Department of Vascular Surgery, 273243Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joris M K van Fessem
- Department of Anesthesiology, 273243Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem P A Boellaard
- Department of Urology, 273243Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sandra A P Cornelissen
- Department of Radiology and Nuclear Medicine, 273243Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marie Josee E van Rijn
- Department of Vascular Surgery, 273243Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
6
|
McCready RA, Kiell CS, Webb TH. Spontaneous iliac vein rupture: An uncommon, but frequently lethal, event. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:558-562. [PMID: 34485778 PMCID: PMC8403535 DOI: 10.1016/j.jvscit.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/12/2021] [Indexed: 11/03/2022]
Abstract
Spontaneous rupture of the iliac veins is a distinctly uncommon problem often misdiagnosed as an arterial rupture because of significant retroperitoneal bleeding. It often occurs with acute left-sided deep vein thrombosis and physical activities that exacerbate acute venous hypertension. A significant number of these patients will have anatomy associated with May-Thurner syndrome. Delayed imaging on computed tomography scanning might suggest a venous etiology for a retroperitoneal hematoma rather than arterial bleeding. We found 53 previously reported cases of iliac vein rupture Our report details two additional cases and the treatment options and outcomes.
Collapse
Affiliation(s)
- Robert A McCready
- Department of Vascular Surgery, Franciscan Alliance, Indianapolis, Ind
| | - Charles S Kiell
- Department of Vascular Surgery, Franciscan Alliance, Indianapolis, Ind
| | - Thomas H Webb
- Department of Vascular Surgery, Franciscan Alliance, Indianapolis, Ind
| |
Collapse
|
7
|
Endovascular Repair of Spontaneous Iliac Vein Rupture. Ann Vasc Surg 2020; 73:510.e25-510.e28. [PMID: 33373771 DOI: 10.1016/j.avsg.2020.11.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/09/2020] [Accepted: 11/24/2020] [Indexed: 11/20/2022]
Abstract
Spontaneous iliac vein rupture is a relatively rare but fatal disease. Herein, 2 cases are reported. The two middle-aged and elderly females complaining of abdominal pain were admitted without any history of trauma. The computed tomography image both showed one huge hematoma in the lower abdominal cavity and the left external iliac venous thrombus. Venogram showed ruptures of the left external iliac vein and stenosis of the left common iliac vein after percutaneous mechanical thrombectomy. Stent grafts were implanted by endovascular technique. Favorable outcomes were achieved in both cases.
Collapse
|
8
|
Chen YC, Huang CL, Huang JW. Endovascular Stent Can Be the Treatment of Choice for Spontaneous Iliac Vein Rupture: A Case Report. Vasc Endovascular Surg 2017; 52:131-134. [PMID: 29187071 DOI: 10.1177/1538574417739090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Spontaneous iliac vein rupture is a rare but lethal disease. Most patients suffer from shock status in the emergency department. Until now, open laparotomy combined with primary suture is the most common treatment of iliac vein rupture. However, there is high mortality and morbidity in the patients who underwent open laparotomy. CASE PRESENTATION A 71-year-old woman denied trauma history and sustained hypovolemic shock. The abdominal computed tomography showed one huge retroperitoneal hematoma. The emergency angiography revealed one obvious rupture point on the left external iliac vein. We repaired the lesion with endovascular stent and open laparotomy for abdominal decompression. The patient progressed well and was discharged. CONCLUSION Endovascular repair is an effective and safe treatment. Compared with open laparotomy and primary suture, stent leads to fewer complications and a lower mortality rate.
Collapse
Affiliation(s)
- Yen-Cheng Chen
- 1 Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chien-Lin Huang
- 2 Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jiann-Woei Huang
- 2 Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| |
Collapse
|
9
|
May-Thurner syndrome presenting as spontaneous left iliac vein rupture. J Vasc Surg Venous Lymphat Disord 2016; 4:479-81. [DOI: 10.1016/j.jvsv.2016.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 03/23/2016] [Indexed: 11/17/2022]
|
10
|
Sadaghianloo N, Jean-Baptiste E, Haudebourg P, Declemy S, Mousnier A, Hassen-Khodja R. Successful treatment of a spontaneous rupture of the left external iliac vein in a man. Vascular 2013; 22:68-70. [DOI: 10.1177/1708538112474255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Spontaneous rupture of the external iliac vein associated with a May–Thurner syndrome is infrequent, particularly in men. We report a case of previously healthy 73-year-old man with a left iliac vein thrombosis, who presented a large lower left abdominal hematoma of sudden-unset. Emergent laparotomy revealed a 3-cm longitudinal tear in the left external iliac vein, which was repaired primarily. Patient's recovery was uneventful. Possible etiological factors have been identified as venous hypertension due to iliac vein thrombosis associated with Cockett syndrome, as well as inflammatory venous wall. Some other estrogenic factors could explain female preponderance of the event.
Collapse
Affiliation(s)
- Nirvana Sadaghianloo
- Université de Nice Sophia Antipolis, Nice, France
- Service de chirurgie vasculaire, Pôle cardio-vasculaire, thoracique et métabolique du Haut Pasteur, CHU de Nice, Nice, France
| | - Elixène Jean-Baptiste
- Université de Nice Sophia Antipolis, Nice, France
- Service de chirurgie vasculaire, Pôle cardio-vasculaire, thoracique et métabolique du Haut Pasteur, CHU de Nice, Nice, France
| | | | - Serge Declemy
- Université de Nice Sophia Antipolis, Nice, France
- Service de chirurgie vasculaire, Pôle cardio-vasculaire, thoracique et métabolique du Haut Pasteur, CHU de Nice, Nice, France
| | - Aurélien Mousnier
- Université de Nice Sophia Antipolis, Nice, France
- Service de chirurgie vasculaire, Pôle cardio-vasculaire, thoracique et métabolique du Haut Pasteur, CHU de Nice, Nice, France
| | - Réda Hassen-Khodja
- Université de Nice Sophia Antipolis, Nice, France
- Service de chirurgie vasculaire, Pôle cardio-vasculaire, thoracique et métabolique du Haut Pasteur, CHU de Nice, Nice, France
| |
Collapse
|