A Huge Capital Drop with Compression of Femoral Vessels Associated with Hip Osteoarthritis

Extrinsic venous compression secondary to spine osteophytes

OBJECTIVE

This study aims to report two cases of symptomatic extrinsic compression of the inferior vena cava and left iliac vein caused by vertebral osteophytes.

METHODS

We present two case reports of extrinsic venous compression by vertebral osteophytes. Both cases were endovascularly treated, with a successful outcome. A review of the literature of this unusual condition is also presented.

RESULTS

The first patient is an 80-year-old woman who presented to the vascular surgery clinic with bilateral lower extremity edema and pain. A computed-tomography angiography (CTA) revealed extrinsic compression of the inferior vena cava from enlarged osteophytes. Venography and intravascular ultrasound were performed, confirming the diagnosis. A self-expanding venous stent was successfully deployed in the inferior vena cava relieving the extrinsic compression. The edema resolved the following day and was discharged without complications. The second patient is a 61-year-old male that presented to the emergency department with a left iliofemoral deep venous thrombosis. CTA showed left iliac vein compression by a lumbar osteophyte. Percutaneous thrombectomy was successfully achieved and an expanding stent was deployed covering the entire lesion. One month after the procedure the patient died from COVID-19-associated respiratory failure.

CONCLUSION

Osteophytes must be considered when dealing with extrinsic venous compression, especially in elderly people.

Lumbosacral exostosis as a rare cause of iliac vein compression and significant limb swelling

A 67-year-old woman presented to our vein clinic for chronic left lower extremity edema, pain, and varicosities. After failed conservative management, a computed tomography scan revealed central venous stenosis secondary to compression of the left common iliac vein by a large osteophyte along the anterolateral aspect of the L5-S1 disk space. An anterior osteophytectomy was performed, followed by iliac venous stenting at a 1-month interval. The patient had resolution of symptoms and remains symptom free at 15 months of follow-up. This report describes a spinal exostosis causing symptomatic venous compression successfully relieved by surgical decompression.