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Meeus R, Christian JS, Meeus N, Khan MA. Iatrogenic Venous Compression Syndrome Following Bilateral Hip Arthroplasty: A Unique Case of Bilateral Femoral Vein Compression in a Patient With May-Thurner Syndrome. Cureus 2024; 16:e56362. [PMID: 38633923 PMCID: PMC11022268 DOI: 10.7759/cureus.56362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
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.
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Affiliation(s)
- Roel Meeus
- Cardiology, Catholic University of Leuven, Leuven, BEL
| | | | - Nele Meeus
- Cardiology, Catholic University of Leuven, Leuven, BEL
| | - M Akram Khan
- Cardiology, Cardiac Center of Texas, McKinney, USA
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Serena T, Bailey W, Bendix S. Endovascular management of extensive iliocaval thrombosis secondary to synchronous uterine myoma compression and May-Thurner syndrome. J Vasc Surg Cases Innov Tech 2022; 8:179-182. [PMID: 35402754 PMCID: PMC8990033 DOI: 10.1016/j.jvscit.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/28/2022] [Indexed: 10/28/2022] Open
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Farina R, Foti PV, Pennisi I, Vasile T, Clemenza M, Rosa GL, Crimi L, Catalano M, Vacirca F, Basile A. Vascular compression syndromes: a pictorial review. Ultrasonography 2022; 41:444-461. [PMID: 35644605 PMCID: PMC9262661 DOI: 10.14366/usg.21233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/23/2022] [Indexed: 12/01/2022] Open
Abstract
Vascular compression syndromes include a group of rare vascular changes due to extrinsic compression of veins or arteries by surrounding structures. These pathologies are often underestimated due to their rarity, clinicians’ poor level of knowledge, and the non-specificity of their symptoms. The best known are Eagle syndrome, thoracic outlet syndrome, nutcracker syndrome, May-Thurner syndrome, Dunbar syndrome, and popliteal entrapment syndrome. This work summarizes the main ultrasonographic characteristics, symptoms, and treatments of choice for these syndromes. Knowledge of these conditions’ characteristic signs is essential for the differential diagnosis. Failure to diagnose these rare diseases can expose patients to serious complications and risks to their health.
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Affiliation(s)
- Renato Farina
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Pietro Valerio Foti
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Isabella Pennisi
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Tiziana Vasile
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Mariangela Clemenza
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Giuliana La Rosa
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Luca Crimi
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Marco Catalano
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Francesco Vacirca
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Antonio Basile
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
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Farina R, Foti PV, Iannace FA, Conti A, Pennisi I, Coppolino P, Vasile T, Gozzo C, Failla G, Basile A. May-Thurner Syndrome with Double Compression of the Iliac Vein: Lessons Based on a Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928957. [PMID: 33895771 PMCID: PMC8083791 DOI: 10.12659/ajcr.928957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Female, 73-year-old Final Diagnosis: May-Thurner syndrome with double stenosis of the left common iliac vein Symptoms: Acute onset of worsening dyspnea, with lymphedema of the left lower limb Medication: — Clinical Procedure: — Specialty: Diagnostics, Laboratory • Radiology
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Affiliation(s)
- Renato Farina
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Pietro Valerio Foti
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Francesco Aldo Iannace
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Andrea Conti
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Isabella Pennisi
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Pietro Coppolino
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Tiziana Vasile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Cecilia Gozzo
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Giovanni Failla
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
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Gatmaitan R, Werner-Gibbings K, Donati T, Saha P, Black S. Treatment of May–Thurner Syndrome in a Patient with an Iliac Artery Stent. VASCULAR AND ENDOVASCULAR REVIEW 2020. [DOI: 10.15420/ver.2020.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
May–Thurner syndrome (MTS) is caused by compression of the left iliac vein by the right iliac artery, leading to clinical manifestations of outflow obstruction in the lower limb and deep vein thrombosis. There have been increasing reports of iatrogenic MTS caused by medical implants. The authors report the case of a 60-year-old man who developed MTS after stenting of the right common iliac artery. Due to the debilitating nature of the patient’s symptoms of venous congestion in the left leg, he proceeded with endovascular venoplasty and venous stent insertion with concurrent intra-arterial balloon angioplasty of the existing right common iliac artery stent. Technical success and primary patency of arterial and venous stents were achieved. The patient remained asymptomatic at 6 weeks and 3 months follow-up and arterial and venous stents were found to be patent on duplex ultrasound. Surgical management of MTS may include thrombolysis, thrombectomy, venoplasty and stenting of the left common iliac vein. Care must be taken to preserve existing medical implants during treatment of MTS. The authors demonstrate that concurrent angioplasty of the right common iliac artery during treatment of the vein is an effective method of preventing arterial stent disruption during surgical management of MTS.
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Affiliation(s)
- Raleene Gatmaitan
- Department of Vascular Surgery, Nepean Hospital, Kingswood, NSW, Australia
| | - Keagan Werner-Gibbings
- Department of Vascular Surgery, Nepean Hospital, Kingswood, NSW, Australia; Department of Vascular Surgery, Guy’s Hospital, London, UK;. Department of Vascular Surgery, St Thomas’ Hospital, London, UK
| | - Tommaso Donati
- Department of Vascular Surgery, Guy’s Hospital, London, UK;. Department of Vascular Surgery, St Thomas’ Hospital, London, UK
| | - Prakash Saha
- Department of Vascular Surgery, Guy’s Hospital, London, UK;. Department of Vascular Surgery, St Thomas’ Hospital, London, UK
| | - Stephen Black
- Department of Vascular Surgery, Guy’s Hospital, London, UK;. Department of Vascular Surgery, St Thomas’ Hospital, London, UK
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