1
|
Dong HW, Hernandez L, Ghahremani JS, Chapek MA, Safran BA, Lau DL, Brewer MB. Venous Stasis Ulceration due to Massive Splenomegaly Causing Iliac Vein Compression From Secondary Myelofibrosis. Vasc Endovascular Surg 2024:15385744241256318. [PMID: 38770560 DOI: 10.1177/15385744241256318] [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: 05/22/2024]
Abstract
Venous stasis ulcers are nonhealing lesions due to venous hypertension secondary to valvular dysfunction or deep venous outflow obstruction. We describe a case of a 71-year-old male with a history of polycythemia vera, secondary myelofibrosis, and massive splenomegaly up to 38 cm who presented with chronic, perimalleolar venous stasis ulcers and pain on the left lower extremity. CT showed significant compression of the left common iliac vein due to mass effect from the spleen. He was managed medically while being evaluated for partial splenic artery embolization but expired due to other chronic conditions before any intervention could be performed. Partial splenic artery embolization may be considered as a treatment option for patients with symptomatic iliac vein compression due to massive splenomegaly secondary to myelofibrosis, as long as extramedullary hematopoiesis is not compromised.
Collapse
Affiliation(s)
- Henry W Dong
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Lucille Hernandez
- Vascular and Endovascular Surgery, Department of Surgery, Kaiser Permanente Downey Medical Center, Downey, CA, USA
| | - Jacob S Ghahremani
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Michael A Chapek
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Brent A Safran
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Vascular and Endovascular Surgery, Department of Surgery, Kaiser Permanente Downey Medical Center, Downey, CA, USA
| | - David L Lau
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Vascular and Endovascular Surgery, Department of Surgery, Kaiser Permanente Downey Medical Center, Downey, CA, USA
| | - Michael B Brewer
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Vascular and Endovascular Surgery, Department of Surgery, Kaiser Permanente Downey Medical Center, Downey, CA, USA
| |
Collapse
|
2
|
MacDowell CJ, Idzikowski E, Saifuddin A, Kang F. Endovascular resolution of complete common iliac vein stenosis in a case of May-Thurner syndrome with underlying malignancy. Int J Surg Case Rep 2023; 112:108987. [PMID: 37939570 PMCID: PMC10667893 DOI: 10.1016/j.ijscr.2023.108987] [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: 09/17/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE May-Thurner Syndrome (MTS) is an uncommon etiology of left common iliac vein thrombosis due to arterial compression. In this report, we describe a case of MTS with severe occlusion of the left common iliac vein in the context of a previously undiagnosed pancreatic cancer. We detail the endovascular resolution of the iliac vein compression and show long-term patency. CASE PRESENTATION A 33-year-old woman on oral contraceptive pills presented with extensive thrombosis of the left common iliac vein extending cephalad into the lower IVC and inferiorly to the femoral vein. The thrombus was refractory to therapeutic heparin. Mechanical thrombectomy removed the occluding thrombus. Intravenous ultrasound identified severe compression of the left common iliac vein by the right common iliac artery. Angioplasty and stenting provided complete resolution of the lesion. Imaging and hematologic workup revealed a pancreatic malignancy and concomitant hypercoagulable state that likely precipitated the patient's presentation. CLINICAL DISCUSSION Endovascular intervention provided complete resolution of severe iliac vein compression. Patency was maintained at 6-month follow-up. Research suggests that the anatomical lesion predisposing individuals to MTS is relatively common despite infrequent occurrence of the syndrome. This case highlights the importance of a high clinical suspicion for associated hypercoagulable states when MTS is discovered. CONCLUSION There is limited research exploring the relationship between severity of iliac vein compression and endovascular treatment outcome. This case documents endovascular resolution of a severe lesion with maintained patency.
Collapse
Affiliation(s)
| | - Emma Idzikowski
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Ali Saifuddin
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Francis Kang
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| |
Collapse
|
3
|
Gozzo C, Farina R, Coppolino P, Cancemi G, Foti PV, Palmucci S, Venturini M, Basile A. Double May-Thurner syndrome causing chronic deep vein thrombosis and natural venous femoro-femoral bypass: a description of rare case. Radiol Case Rep 2021; 16:1608-1612. [PMID: 33995751 PMCID: PMC8105594 DOI: 10.1016/j.radcr.2021.04.020] [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: 03/28/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/24/2022] Open
Abstract
May-Thurner syndrome (MTS) belongs to a group of uncommon vascular syndromes. It consists in left common iliac vein (LCIV) compression between the right common iliac artery (RCIA) anteriorly and the lumbar spine posteriorly. A compression of LCIV by the left common iliac artery (LCIA) or by both iliac arteries were described. We present a rare case of "double MTS" which consist in double stenosis of LCIV by both RCIA and LCIA. Double MTS can cause acute or chronic DVT; this latter could be clinical manifest or well compensated. A 58-year-old woman with chronic mild pelvic pain underwent Doppler Ultrasound (US) of the pelvis and lower extremity vessels which showed thrombosis of both LCIV and ipsilateral common femoral vein caused by the extrinsic compression by both common iliac arteries against the spine. CT angiography confirmed the US data and ruled out other causes of compression. CT scan also showed the development of a natural venous femoro-femoral bypass which allowed to counteract the venous stasis and compensate venous drainage. Therefore, we decide for a long-term prophylaxis with anticoagulant drugs and doppler US follow-up at 6 months. In conclusion, doppler US is a non-invasive, low-cost, repeatable and sensitive method which allows to diagnose MTS and associated DVT. It may be considered the first level exam which allows to easily detect pelvic vascular compression syndrome.
Collapse
Affiliation(s)
- Cecilia Gozzo
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Radio diagnostic and Radiotherapy Unit, Catania, Italy
| | - Renato Farina
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Radio diagnostic and Radiotherapy Unit, Catania, Italy
| | - Pietro Coppolino
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Radio diagnostic and Radiotherapy Unit, Catania, Italy
| | - Giovanna Cancemi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Radio diagnostic and Radiotherapy Unit, Catania, Italy
| | - Pietro Valerio Foti
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Radio diagnostic and Radiotherapy Unit, Catania, Italy
| | - Stefano Palmucci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Radio diagnostic and Radiotherapy Unit, Catania, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, Insubria University, Varese, Italy
| | - Antonio Basile
- Diagnostic and Interventional Radiology Department, Circolo Hospital, Insubria University, Varese, Italy
| |
Collapse
|
4
|
Park JY, Park KM, Cho SG, Hong KC, Jeon YS. Atypical iliac vein compression in patients with symptomatic May-Thurner syndrome. ACTA ACUST UNITED AC 2021; 27:372-377. [PMID: 34003124 DOI: 10.5152/dir.2021.20183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE We aimed to investigate the incidence, etiology, treatment, and clinical course of atypical iliac vein compressions (AIVCs) among patients with May-Thurner syndrome (MTS). METHODS A total of 173 patients who presented with MTS were retrospectively analyzed at a single center. Computed tomographic venography (CTV) was used to diagnose MTS. An AIVC was defined as the compression of the left common iliac vein (LCIV) by structures other than the right common iliac artery (RCIA) or the compression of other venous structures in the pelvic cavity instead of the LCIV. The patients with AIVC were categorized into the LCIV compression group (category A) and non-LCIV compression group (category B). RESULTS Ten patients with AIVC were identified (5.8%; male/female, 5/5), five in category A and five in category B. The median age of patients was 76 years (range, 51-94 years), and the median follow-up duration was 388 days (range, 12-4694 days). In category A, the LCIVs were compressed by the left common iliac artery (LCIA) (n=2), uterine leiomyoma (n=1), LCIA aneurysm (n=1), and RCIA aneurysm (n=1). In category B, the right common iliac veins were compressed by the RCIA (n=4) and L5 osteophyte (n=1). Endovascular treatment, including balloon angioplasty and stent placement, was performed in six patients, three from each group. Three patients underwent conservative treatment due to their advanced age and comorbidities. Endovascular aneurysm repair was performed in one patient with RCIA aneurysm. Follow-up images were available for six patients, and all of them had patent venous flow. CONCLUSION The AIVC had an incidence of 5.8% (10/173) among symptomatic MTS patients and wide spectrum of etiologies. Pathogenesis-tailored endovascular treatments are safe and effective.
Collapse
Affiliation(s)
- Ju Yong Park
- Department of Radiology, Inha University Hospital, Inha University College of Medicine, Jung-gu, Incheon, Korea
| | - Keun-Myoung Park
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University Hospital, Inha University College of Medicine, Jung-gu, Incheon, Korea
| | - Kee Chun Hong
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University Hospital, Inha University College of Medicine, Jung-gu, Incheon, Korea
| |
Collapse
|
5
|
Fereydooni A, Stern JR. Contemporary treatment of May-Thurner Syndrome. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:447-455. [PMID: 33870678 DOI: 10.23736/s0021-9509.21.11889-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Compression of the left common iliac vein by the overlying right common iliac artery is a benign anatomic abnormality in most individuals. However, in patients with significant vein compression, outflow obstruction and chronic intraluminal venous damage may lead to May-Thurner Syndrome. This syndrome commonly manifests as unilateral left leg swelling or acute iliofemoral deep venous thrombosis. In addition to clinical findings, diagnosis is made with ultrasound, computed tomography venography, or magnetic resonance venography. The extent of compression of the iliac vein is best determined by venography with intravascular ultrasound. Symptoms and hemodynamic significance of the compression guides the ideal treatment approach. Iliocaval stenting has become the standard treatment for this condition and has promising patency rates and clinical outcomes. This review paper provides an overview of pathophysiology, and utility and limitations of the existing diagnostic modalities and treatment options in the management of May-Thurner Syndrome.
Collapse
Affiliation(s)
- Arash Fereydooni
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Jordan R Stern
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA, USA -
| |
Collapse
|
6
|
Li J, Chen H, Chen W, Zhou K, Xu Z, Xu M, Sun Z. Novel typing of iliac vein compression in asymptomatic individuals evaluated by contrast enhanced CT. Surg Radiol Anat 2021; 43:1149-1157. [PMID: 33481132 PMCID: PMC8273055 DOI: 10.1007/s00276-021-02678-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/02/2021] [Indexed: 01/16/2023]
Abstract
Purpose Compression of the iliac vein between the iliac artery and lumbosacral vertebra can cause iliac vein compression syndrome (IVCS). The purpose of this study is to assess compression characteristics and establish a new sub-typing in asymptomatic IVCS individuals using contrast-enhanced CT. Methods A retrospective analysis of abdomen contrast-enhanced CT images from 195 asymptomatic subjects with iliac vein compressed was investigated. Patients had no history of venous pathology, and images were collected from June 2018 to January 2019. Qualitative and quantitative characteristics of compression were examined including the location, pattern, minor diameter, area, and the percentage compression on an orthogonal section by the post-processing of multiple planar reconstruction and volume rendering. Results There were 107 females and 88 males with age range 18–92 years. The most common site of iliac vein compression was localized to the left common iliac vein (LCIV) (178/195, 91.3%). Notably, four compression types (type I–IV) were established according to the compression location, with type II being the most common. The four compression types had differences in the upper limit and fluctuation range of compression. It was found that the average level of iliac vein compression was below 25%. The compression degree of the left common iliac vein in type II was relatively concentrated, and the upper limit of compression was close to 70%. Conclusion Asymptomatic iliac vein compression was categorized according to compression location. The proposal of four types might help clinicians to predict which IVCS patients would benefit from interventional therapy.
Collapse
Affiliation(s)
- Jiaying Li
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, 310006, China
| | - Haibo Chen
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, 310006, China
| | - Wujie Chen
- Department of Radiology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, China
| | - Kefeng Zhou
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, 310006, China
| | - Zhichao Xu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, 310006, China
| | - Maosheng Xu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, 310006, China
| | - Zhichao Sun
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China. .,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, 310006, China.
| |
Collapse
|
7
|
Xu F, Tian Z, Huang X, Xiang Y, Yao L, Zou C, Fu C, Wang Y. A case report of May-Thurner syndrome induced by anterior lumbar disc herniation: Novel treatment with radiofrequency thermocoagulation. Medicine (Baltimore) 2019; 98:e17706. [PMID: 31689801 PMCID: PMC6946357 DOI: 10.1097/md.0000000000017706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Lumbar degeneration-related May-Thurner syndrome (dMTS) is characterized by venous compression induced by degenerated lower lumbar structures. Treatment strategies for May-Thurner syndrome (MTS) include clearing the thrombus and correcting venous compression. Despite having different etiological factors from other MTS types, treatments for dMTS are similar, including endovascular angioplasty and continuous anticoagulation therapies. Thus, a particular treatment was designed herein to focus on compressive lumbar structures instead of intravenous management. PATIENT CONCERNS A 59-year-old female patient with dMTS, which was induced by inferior vena cava (IVC) stenosis compressed by L4-5 anterior disc herniation. DIAGNOSIS The patient was diagnosed with IVC stenosis and L4-5 lumbar disc herniation based on abdominal computed tomography, ultrasound, and lumbar magnetic resonance imaging findings. INTERVENTIONS Radiofrequency thermocoagulation (RF) was applied to the patient to decrease the compression caused by anterior disc herniation. OUTCOMES After surgery, the patient's swelling started to improve within 5 hours and completely diminished after 48 hours. Postsurgical abdominal ultrasound showed that her IVC patency increased by 20%. On follow-up, her leg symptoms did not recur at 12 months after surgery. LESSONS We provided a novel idea in the treatment of dMTS, in which we shifted the treatment focus from endovascular patency restoration to extravascular decompression. Our case proved that RF was effective in treating dMTS, which is a complementary treatment modality to angioplasty.
Collapse
Affiliation(s)
- Feng Xu
- Department of Spine Surgery, The First Hospital of Jilin University
| | - Zhisen Tian
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University
| | | | - Yipeng Xiang
- Department of Spine Surgery, The First Hospital of Jilin University
| | - Liyu Yao
- Department of Pediatrics Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Congcong Zou
- Department of Spine Surgery, The First Hospital of Jilin University
| | - Changfeng Fu
- Department of Spine Surgery, The First Hospital of Jilin University
| | - Yuanyi Wang
- Department of Spine Surgery, The First Hospital of Jilin University
| |
Collapse
|
8
|
Tai E, Jaberi A, Oreopoulos GD, Forbes TL, Tan KT, Mafeld S. Diagnosis and management of right external iliac vein "sandwich": A rare cause of iliofemoral deep venous thrombosis. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:314-318. [PMID: 31334408 PMCID: PMC6614602 DOI: 10.1016/j.jvscit.2019.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/12/2019] [Indexed: 10/26/2022]
Abstract
Several anatomic abnormalities predispose patients to iliofemoral deep venous thrombosis, the most common of which is compression of the left iliac vein between the right common iliac artery and lumbar vertebrae, or May-Thurner syndrome. Other areas of venous compression can occur but are rare. This case report describes the presentation, diagnosis, and management of a patient with compression of the right iliac vein "sandwiched" between the right internal and external iliac arteries. After treatment, the patient demonstrated significant improvement in symptoms.
Collapse
Affiliation(s)
- Elizabeth Tai
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Arash Jaberi
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - George D Oreopoulos
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kong Teng Tan
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sebastian Mafeld
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Fereydooni A, Deyholos C, Nezami N, Feler JR, Mojibian H, Nassiri N. Anomalous course of the left common iliac vein anterior to the right common iliac artery with resultant May-Thurner syndrome. J Vasc Surg Venous Lymphat Disord 2019; 7:450-451. [PMID: 31000065 DOI: 10.1016/j.jvsv.2019.01.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Christine Deyholos
- Section of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Nariman Nezami
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn
| | | | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn
| | - Naiem Nassiri
- Section of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
| |
Collapse
|
10
|
Bergen MA, Wall KC, Kim CY, Garrigues GE. Occult Left Common Iliac Vein Compression Increases Postoperative Venous Thromboembolism Risk Following Total Hip Arthroplasty. J Arthroplasty 2019; 34:375-378. [PMID: 30448323 DOI: 10.1016/j.arth.2018.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Left common iliac vein (LCIV) compression by the right or left common iliac artery (RCIA, LCIA) is known to cause venous thromboembolism (VTE), but the extent to which occult LCIV compression synergizes with lower extremity orthopedic surgery is unknown. We hypothesize that occult LCIV compression is associated with increased VTE risk following total hip or knee arthroplasty (THA, TKA). METHODS This case-control study involves all patients at our institution who underwent primary or revision THA or TKA from 2009 to 2017 who had computed tomography or magnetic resonance imaging of the abdomen or pelvis available preoperatively. VTE cases (pulmonary embolism or left-sided deep vein thrombosis) within 30 days of surgery were matched to a control by age, gender, body mass index, Charlson Comorbidity Index, surgical site, and hypercoagulable risk factors. LCIV compression by the right common iliac artery and/or the left common iliac artery was measured in a blinded fashion and was considered present at 50% diameter reduction. RESULTS One hundred twelve patients (22 cases, 90 controls) were included for analysis. Nineteen (86.4%) cases and 46 (51.1%) controls demonstrated LCIV compression. The overall sample odds ratio of postoperative VTE in the presence of LCIV compression was 5.97 (95% confidence interval 1.59-33.67, P = .003). In patients who underwent THA (n = 75), LCIV compression was highly predictive of VTE (odds ratio ∞, 95% confidence interval 2.83-∞, P < .001). Compression in the TKA patients did not significantly predict VTE. CONCLUSION Compression of the LCIV significantly increases odds of developing postoperative VTE following THA. This effect may suggest a new method of stratifying VTE risk in the orthopedic population to reduce VTE-associated morbidity and mortality.
Collapse
Affiliation(s)
- Michael A Bergen
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Kevin C Wall
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Charles Y Kim
- Department of Radiology, Duke University School of Medicine, Durham, NC
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| |
Collapse
|