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Bai H, Kibrik P, Shaydakov ME, Singh M, Ting W. Indications, technical aspects, and outcomes of stent placement in chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord 2024:101904. [PMID: 38759753 DOI: 10.1016/j.jvsv.2024.101904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 04/13/2024] [Accepted: 04/22/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Iliofemoral Venous Stent Placement (IVS) has evolved to a well-established endovascular treatment modality for chronic iliofemoral venous obstruction (CIVO). Dedicated venous stents gained FDA approval in 2019 and solidified IVS as a defined intervention with clear indications, contraindications, risks, benefits, and procedural management principles. This review focuses on the indications, technical aspects and outcomes of stenting for CIVO. Other aspects pertaining to IVS are covered in manuscripts that are part of this series. METHODS This study conducted a literature search limited to English articles. Three search strategies were employed, and references were managed in Covidence software. Four investigators independently screened and evaluated articles, excluding meta-analyses, clinical trial protocols, and non-relevant studies. Eligible studies, focused on clinical outcomes and stent patencies, underwent thorough review. RESULTS The literature search yielded 1,704 studies, with 147 meeting eligibility criteria after screening and evaluation. Exclusions were based on duplicates, irrelevant content, and non-iliac vein stent placement. CONCLUSION Successful IVS for CIVO relies on meticulous patient selection, consistent use of IVUS during procedures, and attention to the technical details of IVS.
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Affiliation(s)
- Halbert Bai
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Pavel Kibrik
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maxim E Shaydakov
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mandeep Singh
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
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Bertino FJ, Hawkins CM, Woods GM, Shah JH, Variyam DE, Patel KN, Gill AE. Technical Feasibility and Clinical Efficacy of Iliac Vein Stent Placement in Adolescents and Young Adults with May-Thurner Syndrome. Cardiovasc Intervent Radiol 2024; 47:45-59. [PMID: 38097769 DOI: 10.1007/s00270-023-03628-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 11/19/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE To report technical feasibility and clinical efficacy of iliac vein stent placement in adolescent patients with May-Thurner Syndrome (MTS). MATERIALS AND METHODS Single-institution retrospective review of the medical record between 2014 and 2021 found 63 symptomatic patients (F = 40/63; mean age 16.1 years, 12-20 years) who underwent left common iliac vein (LCIV) stent placement for treatment of LCIV compression from an overriding right common iliac artery, or equivalent (n = 1, left IVC). 32/63 (50.7%) patients presented with non-thrombotic iliac vein lesions (NIVL). 31/63 (49.2%) patients presented with deep vein thrombosis of the lower extremity and required catheter-directed thrombolysis after stent placement (tMTS). Outcomes include technically successful stent placement with resolution of anatomic compression and symptom improvement. Stent patency was monitored with Kaplan-Meier analysis at 3, 6, 12, 24, and 36 months. Anticoagulation and antiplatelet (AC/AP) regimens were reported. RESULTS Technical success rate was 98.4%. 74 bare-metal self-expanding stents were placed in 63 patients. Primary patency at 12, and 24-months was 93.5%, and 88.9% for the NIVL group and 84.4% and 84.4% for the tMTS group for the same period. Overall patency for the same time intervals was 100%, and 95.4% for the NIVL group and 96.9%, and 96.9% for the tMTS group. Procedural complication rate was 3.2% (2/63) with no thrombolysis-related bleeding complications. Clinical success was achieved in 30/32 (93.8%) and 29/31 (93.5%) patients with tMTS and NIVL groups, respectively. CONCLUSION CIV stent placement in the setting of tMTS and NIVL is technically feasible and clinically efficacious in young patients with excellent patency rates and a favorable safety profile.
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Affiliation(s)
- Frederic J Bertino
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
- Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory + Children's Pediatric Institute, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia.
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Grossman School of Medicine, 550 First Avenue Tisch Hospital Radiology- 2nd Floor, New York, NY, 10016, USA.
| | - C Matthew Hawkins
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
- Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory + Children's Pediatric Institute, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
| | - Gary M Woods
- Department of Hematology/Oncology/BMT, Children's Healthcare of Atlanta, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Jay H Shah
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
- Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory + Children's Pediatric Institute, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
| | - Darshan E Variyam
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
- Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory + Children's Pediatric Institute, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
| | - Kavita N Patel
- Department of Hematology/Oncology/BMT, Children's Healthcare of Atlanta, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatric Hematology and Oncology, The Woman's Hospital of Texas, Houston, TX, USA
| | - Anne E Gill
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
- Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory + Children's Pediatric Institute, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
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Faĭbushevich AG, Akulova AA, Shugushev ZK, Lobastov KV, Taranenko OV, Chaban AS, Maksimkin DA, Baranovich VI. [Diagnosis of arteriovenous compression in small pelvic varicose veins]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:68-76. [PMID: 34528590 DOI: 10.33529/angio2021302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM The study was aimed at assessing the incidence of arteriovenous compression in women with chronic venous insufficiency of the inferior vena cava and at developing an optimal diagnostic algorithm. PATIENTS AND METHODS During the period 2019-2020, we performed a cross-sectional study including a total of sixty-six 18-to-55-year-old (mean 33.5±5.0) women with clinical manifestations of chronic venous insufficiency of the basin of the inferior vena cava. A diagnostic algorithm included questionnaire, transvaginal ultrasound examination, multislice computed tomography, direct phlebography in combination with phlebotonometry. RESULTS Chronic venous insufficiency of lower limbs was diagnosed in 66 (100%) cases and was presented by the following clinical classes according to the CEAP classification: C0 - 4.5%, C1 - 60.6%, C2 - 27.2%, C3 - 3%. Symptoms of pelvic venous plethora were revealed in 36 (55.5%) examined patients. Arteriovenous compression syndrome according to the findings of multislice computed tomography was verified in 16 (24%) women, including May-Turner syndrome in 5 (7.6%), aortomesenteric compression syndrome in 8 (12%) women, with a combination of both syndromes observed in 3 cases; the frequency of their detection did not differ statistically in subgroups of women with and without clinical signs pelvic varicose veins. Direct phlebography in combination with phlebotonometry was performed in 9 women, the diagnosis of arteriovenous compression (May-Thurner syndrome) was confirmed in 1 case only. CONCLUSION In women with signs of chronic venous insufficiency in the system of the inferior vena cava the frequency of detecting arteriovenous compression on multislice computed tomography may reach 24% and does not depend on the presence of symptoms of pelvic venous plethora. The proportion of arteriovenous compression according to the findings of direct phlebography and phlebotonometry in the structure of causes of the development of pelvic varicose veins did not exceed 11%. An algorithm for diagnosing arteriovenous compression syndromes should obligatorily include multislice computed tomography, direct phlebography and phlebotonometry.
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Affiliation(s)
- A G Faĭbushevich
- Department of Hospital Surgery with a Course of Paediatric Surgery, Peoples' Friendship University of Russia, Moscow, Russia
| | - A A Akulova
- Department of Hospital Surgery with a Course of Paediatric Surgery, Peoples' Friendship University of Russia, Moscow, Russia
| | - Z Kh Shugushev
- Department of Cardiovascular Surgery of the Faculty of Continuing Medical Education, Peoples' Friendship University of Russia, Moscow, Russia
| | - K V Lobastov
- Department of General Surgery and Radiodiagnosis, N.I. Pirogov Russian National Research Medical University of the RF Ministry of Public Health, Moscow, Russia
| | - O V Taranenko
- Therapeutic Department, Scientific Centre of Obstetrics, Gynaecology and Perinatology named after Academician V.I. Kulakov, Moscow, Russia
| | - A S Chaban
- Joint-Stock Company 'Family Physician', Moscow, Russia
| | - D A Maksimkin
- Department of Hospital Surgery with a Course of Paediatric Surgery, Peoples' Friendship University of Russia, Moscow, Russia; Department of Cardiovascular Surgery of the Faculty of Continuing Medical Education, Peoples' Friendship University of Russia, Moscow, Russia
| | - V Iu Baranovich
- Department of Hospital Surgery with a Course of Paediatric Surgery, Peoples' Friendship University of Russia, Moscow, Russia
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Arendt VA, Mabud TS, Kuo WT, Jeon GS, An X, Cohn DM, Fu JX, Hofmann LV. Comparison of Anticoagulation Regimens Following Stent Placement for Nonthrombotic Lower Extremity Venous Disease. J Vasc Interv Radiol 2021; 32:1584-1590. [PMID: 34478851 DOI: 10.1016/j.jvir.2021.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/21/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine whether subtherapeutic anticoagulation regimens are noninferior to therapeutic anticoagulation regimens following stent placement for nonthrombotic lower extremity venous disease. MATERIALS AND METHODS Fifty-one consecutive patients (88% women; mean age, 44 years) who underwent stent placement for nonthrombotic lower extremity venous disease between 2002 and 2016 were retrospectively identified. The patients were divided into 2 cohorts: those who received prophylactic enoxaparin or no anticoagulation (subtherapeutic) after the procedure and those who received therapeutic doses of anticoagulation with enoxaparin, warfarin, and/or rivaroxaban (therapeutic) after the procedure. Baseline demographic characteristics, procedure characteristics, and outcomes were compared between the 2 groups using the Student t test, Fisher exact test, and χ2 test. The subtherapeutic and therapeutic anticoagulation groups did not differ significantly in the baseline demographic characteristics (eg, sex, race, and age) or procedure characteristics (eg, number of stents placed, stent brand, stent diameter, etc). RESULTS The mean clinical follow-up time was 4.4 years (range, 0-16.3 years). There were no thrombotic adverse events or luminal obstructions due to in-stent restenosis in either group. There were 5 minor bleeding adverse effects in the therapeutic group and no bleeding adverse effects in the subtherapeutic group (P = .051). There were no statistically significant differences in subjective symptom improvement (P = .75). CONCLUSIONS In this retrospective cohort, the subtherapeutic and therapeutic anticoagulation regimens produced equivalent outcomes in terms of adverse event rates, reintervention rates, and symptomatic improvement, suggesting that therapeutic doses of anticoagulation do not improve outcomes compared with subtherapeutic anticoagulation regimens following nonthrombotic venous stent placement.
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Affiliation(s)
- Victoria A Arendt
- Department of Radiology, Stanford Hospital and Clinics, Stanford, California.
| | - Tarub S Mabud
- Department of Radiology, NYU Langone School of Medicine, New York, New York
| | - William T Kuo
- Department of Radiology, Stanford Hospital and Clinics, Stanford, California
| | - Gyeong S Jeon
- Department of Radiology, CHA University Bundang Medical Center, Seongnam, South Korea
| | - Xiao An
- Department of Radiology, Shanghai General Hospital, Shanghai, China
| | - David M Cohn
- Department of Radiology, Stanford Hospital and Clinics, Stanford, California
| | - Jin Xin Fu
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Lawrence V Hofmann
- Department of Radiology, Stanford Hospital and Clinics, Stanford, California
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Engelhorn ALDV, Lima LDB, Werka MJS, Engelhorn AVV, Bombardelli DAR, da Silva LDO, Barbosa GS, Engelhorn CA. Left common iliac vein compression identified by vascular ultrasonography in asymptomatic women: does standing position influence diagnosis? J Vasc Bras 2021; 20:e20200188. [PMID: 34267789 PMCID: PMC8256875 DOI: 10.1590/1677-5449.200188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/01/2021] [Indexed: 11/24/2022] Open
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.
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Cotinine inhibits TLR4/NF-κB signaling pathway and improves deep vein thrombosis in rats. Biosci Rep 2021; 40:224977. [PMID: 32441737 PMCID: PMC7273908 DOI: 10.1042/bsr20201293] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 02/05/2023] Open
Abstract
Background: The present study was designed to explore the regulatory mechanisms and influences of cotinine on deep vein thrombosis (DVT) in rats via the toll-like receptor 4/nuclear factor κ binding (TLR-4/NF-κB) pathway. Methods: In this experimental study, 30 SD rats were randomly assigned to control group, sham operation group, model group, cotinine (10 μg/kg) group, and model + cotinine (10 μg/kg) group. The thromboxane B2 (TXB2), 6-keto-PGF1α, plasminogen activator inhibitor (PAI), tissue plasminogen activator (t-PA), TLR4, NF-κB, and p65 mRNA and protein expression and tissue changes were analyzed by ELISA, Hematoxylin–Eosin (HE) staining, RT-PCR, and Western blot. Results: There was no significant difference between the control and sham operation groups (P>0.05). The model and cotinine groups showed significantly higher mRNA and protein levels of TXB2, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), PAI, TLR-4, and NF-κB, and significantly lower levels of 6-keto-PGF1α and t-PA than the control and sham operation groups (P<0.05), and the model + cotinine group showed significantly higher mRNA and protein levels of TXB2, IL-6 and TNF-α, PAI, TLR-4, and NF-κB and significantly lower levels of 6-keto-PGF1α and t-PA than the model group (P<0.05). Conclusion: Cotinine can aggravate thrombus and inflammation in rats with DVT, and the mechanism may be associated with the activation of the TLR-4/NF-κB inflammatory signaling pathway.
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Akhmetzianov RV, Bredikhin RA, Ignat'ev IM. [Immediate and remote results of endovascular embolization of ovarian veins]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:49-60. [PMID: 33332306 DOI: 10.33529/angio2020410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Presented in the article is a prospective study of endovascular embolization of ovarian veins in female patients suffering from primary pelvic varicose veins, with the assessment of the immediate and remote results, as well as a 1-year follow up. AIM The aim of our investigation was a comprehensive clinical and instrumental assessment of efficacy of endovascular embolization in women with pelvic varicose veins. PATIENTS AND METHODS Our single-centre study included a total of 29 female patients presenting with pelvic varicose veins and undergoing embolization of ovarian veins using microcoils, in 5 cases the procedure was supplemented with injecting a foam sclerosant. RESULTS The technical success of endovascular occlusion of ovarian veins amounted to 100%. Two women immediately after the operation were subjected to a redo intervention: in one case - resection of the ovarian vein and in the second case - repositioning of the microcoils. In the remote period, one patient due to recurrent relapses underwent repeat embolization followed by retroperitoneal resection of the ovarian vein. The findings of the clinical methods of examination demonstrated a decrease in the intensity of manifestations of pelvic varicose veins according to the pelvic venous clinical severity score and visual analogue scale, as well as improvement of the women's quality of life. CONCLUSION Endovascular occlusion of ovarian veins is a highly effective, minimally invasive, and safe method of treatment of female patients with incompetent ovarian veins. Endovascular treatment may be regarded as a method of choice in management of the primary form of pelvic varicose veins.
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Affiliation(s)
- R V Akhmetzianov
- Department of Vascular Surgery, Interregional Clinical and Diagnostic Centre, Kazan, Russia; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
| | - R A Bredikhin
- Department of Vascular Surgery, Interregional Clinical and Diagnostic Centre, Kazan, Russia; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
| | - I M Ignat'ev
- Department of Vascular Surgery, Interregional Clinical and Diagnostic Centre, Kazan, Russia; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
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Huang C, Zhang W, Liang H. A retrospective comparison of thrombectomy followed by stenting and thrombectomy alone for the management of deep vein thrombosis with May-Thurner syndrome. J Vasc Surg Venous Lymphat Disord 2020; 9:635-642. [PMID: 33045391 DOI: 10.1016/j.jvsv.2020.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To summarize the clinical results of thrombectomy with stenting (TBS) in patients with deep venous thrombosis (DVT) secondary to May-Thurner syndrome (MTS) compared with the outcomes in patients treated with thrombectomy alone (TB). METHODS A retrospective observation of patients with proximal DVT secondary to MTS was conducted in our institution. Patients accepted treatment including either catheter-directed TBS or TB. The complications and stent patency rates were recorded after treatments. The clinical results were assessed in both groups. The independent predictors for in-stent restenosis were further calculated in this study. RESULTS We included 372 patients with DVT secondary to MTS. Two hundred twenty-one patients received treatment with thrombectomy with TBS and 151 with TB. A longer mean procedure time (65.1 ± 13.9 minutes vs 49.5 ± 15.7 minutes; P < .001) and higher venous perforation rate (23 patients vs 5 patients; P = .011) were observed in the TBS group than in the TB group. The median follow-up time was 34 months. The patency rates in the TBS group at 36 months were as follows: primary patency rate of 74.0% and secondary patency rate of 92.1%. Independent predictors for restenosis included visible remaining collateral vessels (hazard ratio [HR], 1.12-3.29; P = .02), residual thrombus (HR, 1.40-4.38; P = .002), and tapered iliac vein (HR, 1.26-4.06; P = .006). Clinical results, including Venous Clinical Severity Scores (TBS, 8.0 ± 3.0; TB, 11.4 ± 3.2), Chronic Venous Insufficiency Questionnaire score (TBS, 76.4 ± 4.0; TB, 83.1 ± 4.6), Villalta scores (TBS, 3.8 ± 1.7; TB, 6.6 ± 3.2), and edema scores (TBS, 0.7 ± 0.7; TB, 1.6 ± 0.6), improved significantly in the TBS group. CONCLUSIONS TBS is effective and feasible for patients with proximal DVT secondary to MTS. Furthermore, compared with TB, additional stenting might be effective in improving the venous clinical results at follow-up observations.
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Affiliation(s)
- Chen Huang
- Department of Vascular Surgery, Affiliated Hospital of Nantong University, Nantong, China.
| | - Wenwen Zhang
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University Medical School, Nanchang, China
| | - Huoqi Liang
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
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Abstract
May–Thurner and Paget–Schroetter syndromes are rare conditions encountered by vascular surgeons. An updated knowledge about these conditions is crucial for the effective management of patients with these syndromes who are mostly young. May–Thurner syndrome (MTS) is caused by the compression of the left common iliac vein by the right common iliac artery, and it is a risk factor for left leg deep venous thrombosis (DVT). Imaging (conventional venogram, computed tomography venography (CTV), magnetic resonance imaging (MRV)) can reveal the stenotic venous segment where the artery crosses. Stenting in symptomatic patients yields good results with minimal recurrence. Paget–Schroetter syndrome (PSS) is an idiopathic axillary-subclavian vein thrombosis mostly affecting the young population, particularly those who have repeated overhead arm activities. Narrower costoclavicular space along with other anatomical and coagulation factors can possibly lead to this condition. Patients can present with acute DVT, post-thrombotic syndrome or subclinical syndromes. Venogram, CTV or MRV with provocative maneuvres can confirm the dynamic obstruction. Thrombolysis followed by early bony decompression is advocated in patients presenting with acute arm DVT, as this approach is associated with limited residual disability and recurrence. This review discusses the current concepts and treatment options of both conditions.
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Affiliation(s)
- Zia Ur Rehman
- Section of Vascular Surgery, The Aga Khan University Hospital, Karachi, Pakistan
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10
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Góes AMDO, Araújo RDS, Furlaneto IP, Vieira WDB. Compression of left renal vein and left common iliac vein on CT scans: how often are they detected? J Vasc Bras 2020; 19:e20190121. [PMID: 34178065 PMCID: PMC8202167 DOI: 10.1590/1677-5449.190121] [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] [Indexed: 11/26/2022] Open
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.
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Akhmetzianov RV, Bredikhin RA, Fomina EE, Ignat'ev IM. [Endovascular treatment of women with pelvic varicose veins due to post-thrombotic iliac vein lesion]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:92-99. [PMID: 31855205 DOI: 10.33529/angio2019402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Post-thrombotic iliac vein lesion is one of the causes of secondary pelvic varicose veins (PVV) in women. Endovascular treatment of this cohort of patients requires further studies. AIM The study was undertaken to investigate the aspects of endovascular treatment of female patients diagnosed as having PVV secondary to post-thrombotic alterations of the iliac veins. PATIENTS AND METHODS Presented herein are the results of diagnosis and treatment of nine women suffering from PVV in obstructive lesion of the iliac veins. All patients underwent phlebography with stenting of the iliac veins, followed by clinical and instrumental assessment of efficacy of treatment. RESULTS The technical success rate of stenting amounted to 100%. In the early postoperative period thrombotic complications developed in two women and in the remote period in one. The operation was followed by a decrease in the intensity of PVV manifestations, as well as chronic venous insufficiency of the lower limbs, which was confirmed by clinical and instrumental methods of objectification and visualization. The composite index of quality of life was noted to decrease from 47±5.3 to 27.8±3.3 points (p<0.05). The median of the composite value of the Pelvic Venous Clinical Severity Score decreased by 8.6±1.8 points (p<0.05). The average value of the composite index of the Venous Clinical Severity Score (VCSS) diminished by 6.8±1.4 points (p<0.05) and that of the Villalta score by 8.3±1.6 points (p<0.05). CONCLUSION Pelvic varicose veins appear to develop in two of three women after endured thrombosis. The experience with stenting of the iliac veins demonstrated good efficacy and safety. Efficiency of the intervention was determined by improved quality of life of the patients and positive dynamics of the clinical course of the disease.
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Affiliation(s)
- R V Akhmetzianov
- Interregional Clinical and Diagnostic Centre, Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University of the RF Ministry of Public Health, Kazan, Russia
| | - R A Bredikhin
- Interregional Clinical and Diagnostic Centre, Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University of the RF Ministry of Public Health, Kazan, Russia
| | - E E Fomina
- Interregional Clinical and Diagnostic Centre, Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University of the RF Ministry of Public Health, Kazan, Russia
| | - I M Ignat'ev
- Interregional Clinical and Diagnostic Centre, Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University of the RF Ministry of Public Health, Kazan, Russia
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Mabud TS, Sailer AM, Swee JKY, Tamboli M, Arendt VA, Jeon GS, An X, Cohn DM, Kuo WT, Hofmann LV. Inferior Vena Cava Atresia: Characterisation of Risk Factors, Treatment, and Outcomes. Cardiovasc Intervent Radiol 2019; 43:37-45. [PMID: 31650242 DOI: 10.1007/s00270-019-02353-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/08/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE To characterise (1) the risk factors associated with inferior vena cava (IVC) atresia, (2) the radiographic and clinical presentations of deep vein thrombosis (DVT) in patients with IVC atresia, and (3) the treatment and outcome of DVT in patients with IVC atresia. METHODS The electronic medical record was systematically reviewed for thrombotic risk factors in patients who presented with lower-extremity DVT (n = 409) at a single centre between 1996 and 2017. Patients with IVC atresia were identified based on imaging and chart review. Differences in demographics and thrombotic risk factors between patients with and without IVC atresia were statistically assessed. Extent and chronicity of DVT on imaging, clinical presentation, treatment, and outcomes were evaluated for all patients with IVC atresia. RESULTS 4.2% of DVT patients (17/409) were found to have IVC atresia; mean age at diagnosis was 25.5 ± 9.4 years. The rate of heritable thrombophilia was significantly higher in patients with IVC atresia compared to patients without IVC atresia (52.9% vs. 17.9%, p < 0.0001). There were bilateral DVT in 70.6% of IVC atresia patients; DVT was chronic in 41.2% and acute on chronic in 58.8%. Pre-intervention Villalta scores were 13.9 ± 9.8 in the left limb and 8.5 ± 7.0 in the right limb. DVT in IVC atresia patients was typically treated with catheter-directed thrombolysis followed by stent placement, achieving complete or partial symptom resolution in 78.6% of cases. CONCLUSION Thrombotic risk factors such as heritable thrombophilia are associated with IVC atresia. IVC atresia patients can experience high burdens of lower-extremity thrombotic disease at a young age which benefit from endovascular treatment. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Tarub S Mabud
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
| | - Anna M Sailer
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Joshua K Y Swee
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Mallika Tamboli
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Victoria A Arendt
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Gyeong-Sik Jeon
- CHA University Bundang Medical Center, Seongnam, South Korea
| | - Xiao An
- Shanghai General Hospital, Shanghai, China
| | - David M Cohn
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - William T Kuo
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Lawrence V Hofmann
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
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Bondarev S, Keller EJ, Han T, Young VA, Gupta S, Vogelzang RL, Eskandari M, Resnick SA. Predictors of Disease Recurrence after Venoplasty and Stent Placement for May–Thurner Syndrome. J Vasc Interv Radiol 2019; 30:1549-1554. [DOI: 10.1016/j.jvir.2019.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/08/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022] Open
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Reposar AL, Mabud TS, Eifler AC, Hoogi A, Arendt V, Cohn DM, Rubin DL, Hofmann LV. Automated Quantitative Imaging Measurements of Disease Severity in Patients with Nonthrombotic Iliac Vein Compression. J Vasc Interv Radiol 2019; 31:270-275. [PMID: 31542272 DOI: 10.1016/j.jvir.2019.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/22/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE An automated segmentation technique (AST) for computed tomography (CT) venography was developed to quantify measures of disease severity before and after stent placement in patients with left-sided nonthrombotic iliac vein compression. MATERIALS AND METHODS Twenty-one patients with left-sided nonthrombotic iliac vein compression who underwent venous stent placement were retrospectively identified. Pre- and poststent CT venography studies were quantitatively analyzed using an AST to determine leg volume, skin thickness, and water content of fat. These measures were compared between diseased and nondiseased limbs and between pre- and poststent images, using patients as their own controls. Additionally, patients with and without postthrombotic lesions were compared. RESULTS The AST detected significantly increased leg volume (12,437 cm3 vs 10,748 cm3, P < .0001), skin thickness (0.531 cm vs 0.508 cm, P < .0001), and water content of fat (8.2% vs 5.0%, P < .0001) in diseased left limbs compared with the contralateral nondiseased limbs, on prestent imaging. After stent placement in the left leg, there was a significant decrease in the water content of fat in the right (4.9% vs 2.7%, P < .0001) and left (8.2% vs 3.2%, P < .0001) legs. There were no significant changes in leg volume or skin thickness in either leg after stent placement. There were no significant differences between patients with or without postthrombotic lesions in their poststent improvement across the 3 measures of disease severity. CONCLUSIONS ASTs can be used to quantify measures of disease severity and postintervention changes on CT venography for patients with lower extremity venous disease. Further investigation may clarify the clinical benefit of such technologies.
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Affiliation(s)
- Aaron L Reposar
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305.
| | - Tarub S Mabud
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
| | - Aaron C Eifler
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
| | - Assaf Hoogi
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
| | - Victoria Arendt
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
| | - David M Cohn
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
| | - Daniel L Rubin
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
| | - Lawrence V Hofmann
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
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15
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Khan TA, Rudolph KP, Huber TS, Fatima J. May-Thurner syndrome presenting as pelvic congestion syndrome and vulvar varicosities in a nonpregnant adolescent. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:252-254. [PMID: 31304434 PMCID: PMC6600079 DOI: 10.1016/j.jvscit.2019.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/19/2019] [Indexed: 12/22/2022]
Abstract
May-Thurner syndrome (MTS) refers to compression of the left common iliac vein (CIV) by the common iliac artery. Although this is typically manifested as acute left lower extremity deep venous thrombosis, MTS is a rare cause of pelvic congestion syndrome. A 17-year-old girl presented with a 5-year history of worsening painful vulvar and labial varicosities. Venography demonstrated pelvic collateralization and left CIV stenosis consistent with MTS. The left CIV was stented with complete radiographic resolution. At 1-year follow-up, the patient is asymptomatic with a widely patent stent. This case highlights the role of endovascular therapy for patients presenting with MTS causing pelvic congestion syndrome.
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Affiliation(s)
- Tabassum A Khan
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Karen P Rudolph
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Javairiah Fatima
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
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16
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Slippery Stents: A Case Report and Review of the Literature Describing Patients with May-Thurner Syndrome That Experienced Stent Migration. Case Rep Vasc Med 2019; 2019:7606727. [PMID: 30956838 PMCID: PMC6425386 DOI: 10.1155/2019/7606727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 11/17/2022] Open
Abstract
Endovascular stent placement is an effective treatment for relieving chronic venous obstruction in patients with May-Thurner Syndrome (MTS) with or without the presence of thrombotic lesions. Stent migration is a rare but potentially life-threatening complication of endovascular stenting. Herein, we describe a case of stent migration from the left common iliac vein into the right heart, requiring open-heart surgery. We also completed a literature review of MTS patients with stent migration in hopes of raising awareness of this rare and life-threatening complication.
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17
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Affiliation(s)
- Robert P Liddell
- Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Natalie S Evans
- Section of Vascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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18
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Antiplatelet Therapy is Associated with Stent Patency After Iliocaval Venous Stenting. Cardiovasc Intervent Radiol 2018; 41:1691-1698. [DOI: 10.1007/s00270-018-2062-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/12/2018] [Indexed: 02/06/2023]
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19
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Garrie A, Jones LE, Chen JF, Feldtman RW, Kollmeyer KR, Richmond JL, Ferrara CA, Uceda PV, Mocio L, Ahn SS. New Vein Compression Entities in Patients with Unexplained Leg Swelling. Ann Vasc Surg 2017. [PMID: 28647635 DOI: 10.1016/j.avsg.2017.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This retrospective study identifies often overlooked anatomical sites for nonthrombotic venous outflow obstruction (NTVO) in patients with unexplained lower extremity edema and pain. METHODS We reviewed the charts of 75 consecutive patients experiencing symptoms of unexplained lower extremity edema with pain that were unexplained by ultrasound, computed tomography angiography (CTA), and magnetic resonance imaging (MRI), who subsequently underwent venography in an outpatient medical office from 2010 to 2014. We categorized venograms based on the presence or absence of NTVO lesions and calculated prevalence of each at specific sites. The patients with NTVO lesions showing >50% stenosis on venography were then treated with angioplasty and/or stenting. After intervention, we documented subjective levels of pain and edema. RESULTS Of the 75 venograms reviewed, physicians classified 52 as normal and 23 as showing evidence of compression, including 9 with May-Thurner syndrome and 14 with anatomical compressions at previously underreported sites. These 14 compression sites occurred at the following: iliofemoral vein at the inguinal ligament region (n = 7, 50%), external iliac vein at the iliac artery bifurcation (n = 1, 7.1%), both inguinal ligament region and iliac artery bifurcation (n = 4, 28.6%), and popliteal vein at the popliteal fossa (n = 2, 14.3%). Nine of the 14 patients (64.3%) reported total or near total resolution of lower extremity pain and edema at follow-up between 1 and 7 months (mean = 5.3 ± 2 months, median = 6 months) after balloon angioplasty and/or stent. Five with failed primary interventions underwent subsequent stenting and/or angioplasty and reported total or near total resolution of pain and clinical resolution of edema. CONCLUSIONS This study provides evidence to broaden the disease profile of venous compression syndromes to other sites such as the hypogastric artery, inguinal ligament, and popliteal fossa. The results support previous research that suggests increased incidence of NTVO exists among patients with unexplained lower extremity edema and pain. In an effort to encourage further exploration, we developed a diagnostic algorithm to support a critical and systematic review of patients with lower extremity edema and pain that may go unexplained using traditional diagnostic measures, including ultrasound, CTA, and MRI alone.
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20
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Intravascular ultrasound versus digital subtraction angiography: direct comparison of intraluminal diameter measurements in pediatric and adolescent imaging. Pediatr Radiol 2017; 47:450-457. [PMID: 28102453 DOI: 10.1007/s00247-016-3771-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/27/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intravascular ultrasound (IVUS) allows intraluminal imaging of blood vessels rather than the one-dimensional luminal outline depicted by digital subtraction angiography (DSA). Despite extensive literature in multiple adult vascular diseases, IVUS has not been directly compared to DSA in pediatric and adolescent vascular pathologies. OBJECTIVE The purpose of this manuscript is to compare absolute luminal diameter measurements obtained via IVUS and DSA during a variety of pediatric endovascular procedures. MATERIALS AND METHODS We conducted a retrospective review of all pediatric and adolescent endovascular procedures from October 2014 to March 2016 in which IVUS and DSA were used. We compared the vessel diameter measurements and analyzed them using SAS software with a paired t-test. RESULTS There were 102 total measurements (DSA = 56; IVUS = 56; 22 procedures; 20 patients). On average, IVUS measured 0.6 ± 2.1 mm larger than DSA (95% confidence interval [CI] -0.01 to 1.12; P = 0.06; r = 0.90). When venous compression syndrome (May-Thurner, Nutcracker, superior vena cava syndrome) measurements were excluded, IVUS measured 0.7 ± 1.6 mm larger than DSA (95% CI 0.14 to 1.18; P = 0.01; r = 0.93). When venous compression syndrome measurements were evaluated separately, IVUS measured 0.3 ± 3.0 mm larger than DSA (95% CI -1.16 to 1.82; P = 0.65; r = 0.45). CONCLUSION Overall, IVUS measurements were slightly larger than DSA measurements in all data subsets. Absolute vessel diameter measurements obtained with IVUS in the pediatric and adolescent population are statistically significantly larger than those obtained using DSA when excluding venous compression syndromes. In venous compression syndromes, IVUS might provide a more accurate representation of vessel compression and diameter than DSA.
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21
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Stern JR, Patel VI, Cafasso DE, Gentile NB, Meltzer AJ. Left-Sided Varicocele as a Rare Presentation of May-Thurner Syndrome. Ann Vasc Surg 2017; 42:305.e13-305.e16. [PMID: 28258018 DOI: 10.1016/j.avsg.2016.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/12/2016] [Accepted: 12/22/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND May-Thurner syndrome (MTS), the clinical sequelae of left iliac vein compression between the right iliac artery and the spine, is an accepted cause of lower extremity edema and venous thromboembolism. It is more prevalent in younger women and typically presents with left lower extremity symptoms. Atypical presentations such as right-sided symptoms, chronic pelvic pain, and even fatal venous rupture have been reported. Here, we describe iliac vein compression presenting as a chronic left-sided testicular varicocele. METHODS A 22-year-old man presented with left testicular varicocele, scrotal edema, and pain after failing multiple attempts at surgical repair. MRI revealed left iliac vein compression and marked cross-pelvic collaterals. Venography and intravascular ultrasound confirmed left common iliac vein compression and typical changes of MTS. There was no gonadal vein (GV) reflux. An iliac vein stent (WALLSTENT, Boston Scientific) was placed. RESULTS A good technical result was achieved, with elimination of internal iliac vein reflux and marked reduction in pelvic collateral flow (see image). The patient reported resolution of his symptoms. CONCLUSIONS Varicocele is a leading cause of testosterone insufficiency and infertility in young males. In the majority of cases, successful treatment can be achieved by addressing reflux in the internal spermatic vein (ISV) and/or GV by a variety of surgical or endovascular approaches. In unusual cases, the culprit pathology may be reflux in the vein of the vas deferens, which unlike the ISV and GV, drains into the internal iliac vein. In such cases, iliac vein compression usually associated with MTS may result in varicocele. To our knowledge, this is the first report of refractory varicocele secondary to iliac vein compression successfully treated with endovenous stenting.
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Affiliation(s)
- Jordan R Stern
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| | - Virendra I Patel
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Danielle E Cafasso
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| | - Nicole B Gentile
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| | - Andrew J Meltzer
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY.
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22
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Kohi MP, Kohlbrenner R, Kolli KP, Lehrman E, Taylor AG, Fidelman N. Catheter directed interventions for acute deep vein thrombosis. Cardiovasc Diagn Ther 2016; 6:599-611. [PMID: 28123980 DOI: 10.21037/cdt.2016.11.20] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Venous thromboembolism (VTE) is an extremely common form of vascular disease and impacts a great number of patients worldwide. Acute deep vein thrombosis (DVT) is a subset of VTE and is traditionally been treated with anticoagulation. There is good quality data which suggests the use of catheter directed interventions for the treatment of acute DVT with the aim of reducing post-thrombotic syndrome (PTS). The present review will discuss the various therapies available for acute DVT, focusing on catheter directed interventions, ranging from traditional anticoagulation to the most novel forms of aspiration thrombectomy.
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Affiliation(s)
- Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Ryan Kohlbrenner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Kanti P Kolli
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Evan Lehrman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Andrew G Taylor
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Nicholas Fidelman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
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23
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Goldman RE, Arendt VA, Kothary N, Kuo WT, Sze DY, Hofmann LV, Lungren MP. Endovascular Management of May-Thurner Syndrome in Adolescents: A Single-Center Experience. J Vasc Interv Radiol 2016; 28:71-77. [PMID: 27818112 DOI: 10.1016/j.jvir.2016.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/03/2016] [Accepted: 09/06/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To report a single-center experience in regard to the technique, safety, and clinical outcomes of endovascular therapy for treatment of May-Thurner syndrome (MTS) in adolescent patients. MATERIALS AND METHODS A retrospective review identified 10 patients (6 female; mean age, 16 y; range, 12-18 y; mean weight, 73 kg; range, 50-116 kg) treated by endovascular therapy for MTS from 1998 to 2015. Clinical presentations consisted of acute thrombotic MTS (n = 6) and nonthrombotic MTS (n = 4). Catheter-directed thrombolysis was performed in all cases of thrombosis. Venoplasty and stent placement were performed in all cases. Self-expanding stents 12-16 mm in diameter and 4-9 cm in length were deployed. RESULTS No major periprocedural complications were observed. Median follow-up was 32 months (range, 6-109 mo). Primary and secondary patency rates were 79% and 100% at 12 months and 79% and 89% at 36 months, respectively. In a single patient with permanent loss of flow in the treated segment, multiple risk factors for thrombosis were identified. Rates of posttreatment symptoms were 0% by Villalta score and 60% (n = 6; mild symptoms) by modified Villalta score at the last clinical follow-up. CONCLUSIONS Endovascular therapy for the treatment of MTS in our adolescent cohort was safe and effective in relieving venous obstruction. Stent placement in patients with underlying thrombophilic disorders is associated with loss of secondary patency, suggesting the need for further consideration in this population.
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Affiliation(s)
- Roger E Goldman
- Department of Radiology, Stanford University Medical Center, Stanford, California.
| | - Victoria A Arendt
- Stanford School of Medicine, Stanford University, 300 Pasteur Dr., Room H-1307, MC 5621, Stanford, CA 94305-5621
| | - Nishita Kothary
- Department of Radiology, Stanford University Medical Center, Stanford, California; Stanford School of Medicine, Stanford University, 300 Pasteur Dr., Room H-1307, MC 5621, Stanford, CA 94305-5621
| | - William T Kuo
- Department of Radiology, Stanford University Medical Center, Stanford, California; Stanford School of Medicine, Stanford University, 300 Pasteur Dr., Room H-1307, MC 5621, Stanford, CA 94305-5621
| | - Daniel Y Sze
- Department of Radiology, Stanford University Medical Center, Stanford, California; Stanford School of Medicine, Stanford University, 300 Pasteur Dr., Room H-1307, MC 5621, Stanford, CA 94305-5621
| | - Lawrence V Hofmann
- Department of Radiology, Stanford University Medical Center, Stanford, California; Stanford School of Medicine, Stanford University, 300 Pasteur Dr., Room H-1307, MC 5621, Stanford, CA 94305-5621
| | - Matthew P Lungren
- Stanford School of Medicine, Stanford University, 300 Pasteur Dr., Room H-1307, MC 5621, Stanford, CA 94305-5621
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