Chronic Venous Insufficiency

Iatrogenic Venous Compression Syndrome Following Bilateral Hip Arthroplasty: A Unique Case of Bilateral Femoral Vein Compression in a Patient With May-Thurner Syndrome

Iatrogenic venous compression syndrome is defined by extrinsic vein compression due to medical hardware, particularly relevant after joint replacement surgeries. Inserting medical hardware can lead to immediate risks such as deep vein thrombosis and pulmonary embolisms due to local tissue inflammation. The long-term issues include venous insufficiency due to chronic vessel irritation, subsequently causing intimal proliferation and thickening. Despite the existing knowledge of venous compression syndromes, iatrogenic cases are severely underreported. Here, we present a unique case of bilateral common femoral vein compression in a patient with May-Thurner syndrome and prior bilateral hip arthroplasty. An 85-year-old man with a history of venous insufficiency and bilateral hip arthroplasty for osteoarthritis presented with bilateral leg edema. Unsuccessful sclerotherapy and radiofrequency ablation led to a referral to a vascular specialist for venous duplex scans, venograms, and intravascular ultrasound. May-Thurner syndrome was revealed in the left common iliac vein, prompting the deployment of an 18 mm × 16 mm stent. Subsequently, during a venogram, what initially appeared to be a vasospasm in the left common femoral vein was diagnosed as extrinsic iatrogenic venous compression due to acetabular hip screws. This was found after two IV injections of 400 mg nitrogen and one balloon angioplasty could not resolve the compression. After advancement over a 0.35" microwire and accurate positioning over the center of the left common femoral vein lesion, a 16 mm × 90 mm stent was deployed. The venogram and intravascular ultrasound also showed a similar compression in the right common femoral vein. Another 400 mg IV nitrogen did not expand the lesion, so it was concluded that there was similarly an iatrogenic venous compression of the right common femoral vein, also due to acetabular hip screws in the right femur. A follow-up was scheduled a couple of weeks later to address the issue in the right common femoral vein. The underreported issue of iatrogenic venous compression following joint replacements highlights the need for better recognition and management of vascular complications due to inflammation and intimal proliferation. This is especially the case in high-risk patients, such as those with May-Thurner syndrome.

Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management

Chronic venous disease (CVD) is a multifactorial condition affecting an important percentage of the global population. It ranges from mild clinical signs, such as telangiectasias or reticular veins, to severe manifestations, such as venous ulcerations. However, varicose veins (VVs) are the most common manifestation of CVD. The explicit mechanisms of the disease are not well-understood. It seems that genetics and a plethora of environmental agents play an important role in the development and progression of CVD. The exposure to these factors leads to altered hemodynamics of the venous system, described as ambulatory venous hypertension, therefore promoting microcirculatory changes, inflammatory responses, hypoxia, venous wall remodeling, and epigenetic variations, even with important systemic implications. Thus, a proper clinical management of patients with CVD is essential to prevent potential harms of the disease, which also entails a significant loss of the quality of life in these individuals. Hence, the aim of the present review is to collect the current knowledge of CVD, including its epidemiology, etiology, and risk factors, but emphasizing the pathophysiology and medical care of these patients, including clinical manifestations, diagnosis, and treatments. Furthermore, future directions will also be covered in this work in order to provide potential fields to explore in the context of CVD.