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Yamanaka T, Ishihara T, Hara T, Ichinohe Y, Fukatsu T. Right-sided iliac vein compression syndrome: when the vein is compressed between the internal and external iliac arteries-a case report. Eur Heart J Case Rep 2024; 8:ytae011. [PMID: 38239308 PMCID: PMC10794860 DOI: 10.1093/ehjcr/ytae011] [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] [Received: 09/18/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024]
Abstract
Background In its normal anatomical relationship, the inferior vena cava is located on the right side of the abdominal aorta. Iliac vein compression syndrome (IVCS) is a pathological condition in which a blood clot is formed due to blood flow obstruction when the left common iliac vein is compressed between the right common iliac artery and the vertebral body. Therefore, right-sided IVCS (RIVCS) is rare. The effectiveness of treatment for RIVCS has not been sufficiently investigated. Case summary A 51-year-old man developed deep vein thrombosis in the right lower extremity and non-massive pulmonary embolism during steroid treatment for IgA nephropathy. Magnetic resonance angiography (MRA) suggested iliac compression syndrome. Symptoms improved with the use of direct oral anticoagulants and compression stockings. At the 8-month follow-up, the clinical course was uneventful. Discussion The causes of RIVCS in this case are believed to be the effects of steroids, prolonged sitting, and compression of the right external iliac vein. However, considering that deep vein thrombosis did not form in the left lower limb where there was no venous compression, it can be considered that the compression of the right external iliac vein had a significant impact. This case has been followed up for 8 months with anticoagulants and is progressing well. This is the first case to report the course of RIVCS treated conservatively with anticoagulant therapy for 8 months. This case suggested that conservative treatment is effective for RIVCS.
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Affiliation(s)
- Tetsuo Yamanaka
- Department of Cardiology, Tokyo Teishin Hospital, 2-14-23 Fujimi, Chiyoda-ku, Tokyo 102-8798, Japan
| | - Tatsuhiko Ishihara
- Department of Cardiology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, 6-25-1 Kamiyouga, Setagaya-ku, Tokyo 158-8531, Japan
| | - Toru Hara
- Department of Cardiology, Tokyo Teishin Hospital, 2-14-23 Fujimi, Chiyoda-ku, Tokyo 102-8798, Japan
| | - Yoshimaro Ichinohe
- Department of Cardiology, Tokyo Teishin Hospital, 2-14-23 Fujimi, Chiyoda-ku, Tokyo 102-8798, Japan
| | - Toru Fukatsu
- Department of Cardiology, Tokyo Teishin Hospital, 2-14-23 Fujimi, Chiyoda-ku, Tokyo 102-8798, Japan
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Zhang F, Gu J, Li HL. Diagnosis and treatment of venous thromboembolism and clinical application of inferior vena cava filter in China. J Vasc Surg Venous Lymphat Disord 2023; 11:1149-1156. [PMID: 37196920 DOI: 10.1016/j.jvsv.2023.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE This study investigated the trend of venous thromboembolism (VTE) in China during the past 10 years and assessed the clinical application of inferior vena cava filters (IVCFs). METHODS A survey designed to investigate the diagnosis and management of VTE, specifically the application of IVCFs, was distributed nationally from January 2009 to December 2019. The respondents were mainly designated medical professionals and were asked to complete 4 major and 61 minor items in the survey. RESULTS A total of 53 medical centers, including 27 radiologic and 26 vascular surgery centers, from 21 provinces in China participated in the study. These centers had diagnosed and treated 171,310 patients with VTE; 83,969 were inpatients (49%). During a 10-year period, an increasing trend of VTE diagnosis and inpatient management, 3.8-fold and 4.8-fold, respectively, was observed. The characteristics of the inpatients were as follows: 15% bilateral lower extremity deep vein thrombosis (DVT), 27% right lower extremity DVT, and 58% left lower extremity DVT. Anticoagulation therapy included unfractionated heparin with vitamin K antagonists (8%), low-molecular-weight heparin (LMWH) with vitamin K antagonists (21%), LMWH with transition to rivaroxaban (34.2%), LMWH with transition to dabigatran (2.4%), rivaroxaban alone (33.4%), and dabigatran alone (1.0%). The percentage of patients continuing anticoagulation therapy at 3, 6, 12, 24, and >24 months was 36%, 35%, 18%, 6.0%, and 5%, respectively. The in-hospital mortality for the patients with VTE was 3.2%, with DVT and pulmonary embolism responsible for 5.2% and DVT alone for 2.7%. Thrombolytic therapy was initiated for 39,046 of 83,969 patients (46.5%), including catheter-directed thrombolysis for 33,189 of the 39,046 patients (85%) and evaluation of the iliac vein using ultrasound and/or venography for 63,816 patients (76%). Urokinase was the main thrombolytic drug used (98%), followed by recombinant tissue-type plasminogen activator. Complete and partial thrombolysis was achieved in 70% and 30% of the patients, respectively. Bleeding complications were observed in 3.5% of patients, and 20% of the patients with bleeding complications required intervention. Between 2009 and 2019, 40,478 IVCFs (76% retrievable) were implanted in hospitalized VTE patients. During the enrollment period, the total number of IVCFs implanted increased by 3.8-fold, with a 4.8-fold increase in retrievable IVCFs and 7.5-fold decline in permanent IVCFs. The removal rate for the retrievable IVCFs was 72%. After IVCF implantation, 94.8% of patients received anticoagulation therapy for an average of 9.1 ± 8.6 months. The overall complication rate associated with IVCF placement was 15.5% (n = 6274 of 40,478 IVCFs), including tilting (54%), vena cava thrombosis (26.1%), caval penetration (12.6%), and migration (7.3%). No IVCF placement-related mortality occurred. CONCLUSIONS A significant increase occurred in VTE diagnosis in China during the past decade. Anticoagulation therapy was the mainstay treatment, and catheter-directed thrombolysis was widely used. Most IVCFs placed were retrievable, and the use of permanent IVCFs has largely been discarded.
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Affiliation(s)
- Fuxian Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jianping Gu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Hai-Lei Li
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
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Shi Y, Chen L, Gu J. Re. Common Iliac Vein Compression, How To Measure? Eur J Vasc Endovasc Surg 2023; 66:444-445. [PMID: 37451605 DOI: 10.1016/j.ejvs.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Yadong Shi
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liang Chen
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianping Gu
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Shi Y, Yuan Y, Kong J, Su H, Chen L, Huang H, Lu Z, Gu J. Impact of Common Iliac Vein Compression on the Incidence of Pulmonary Embolism in Patients with Acute Deep Vein Thrombosis. Eur J Vasc Endovasc Surg 2023; 65:887-894. [PMID: 36931552 DOI: 10.1016/j.ejvs.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/21/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE This study aimed to investigate the association between common iliac vein (CIV) compression and pulmonary embolism (PE) in lower extremity deep vein thrombosis (DVT). METHODS This was a single centre retrospective study. Between January 2016 and December 2021, DVT patients with enhanced computed tomography of the iliac vein and pulmonary artery were included. Patient demographics, comorbidities, risk factors, and degree of CIV compression were collected and analysed. Logistic regression was performed to evaluate the odds ratio (OR) with a 95% confidence interval (CI) of PE in relation to compression severity groups. The association between PE and compression degree was evaluated with restricted cubic splines (RCS) based on an adjusted logistic regression model. RESULTS Two hundred and twenty-six DVT patients (left side, n = 153; right side, n = 73) were included. Univariable analyses suggested that symptomatic or asymptomatic PE (54.4%, 123/226) was more common in men (p = .048) and right side DVT (p = .046) patients. Compared with no CIV compression, multivariable analyses suggested that mild compression did not statistically significantly reduce the PE risk, whereas moderate (adjusted OR 0.36; 95% CI 0.15 - 0.88; p = .025) and severe (adjusted OR 0.18; 95% CI 0.06 - 0.54; p = .002) compression statistically significantly reduced the risk. RCS showed that a smaller minimum diameter or greater compression percentage was correlated with continuously decreasing PE risk at a minimum diameter of < 6.77 mm or compression > 42.9%. CONCLUSION PE is more common in men and right side DVT patients. An increasing severity of CIV compression is consistently associated with a decreasing risk of PE when the minimum diameter is < 6.77 mm or the compression is > 42.9%, indicating that it is a protective factor against PE.
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Affiliation(s)
- Yadong Shi
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yuan Yuan
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jie Kong
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Haobo Su
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liang Chen
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hao Huang
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhaoxuan Lu
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianping Gu
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Wu PH, Chang CP, Chang CY, Kuo YT, Lin LC, Wu KH. A Woman with Unilateral Leg Swelling. Ann Emerg Med 2022; 79:e15-e16. [DOI: 10.1016/j.annemergmed.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Indexed: 11/01/2022]
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Hocagil AC, Hocagil H, Coskun Sungur E, Yardimci Yar N, Akkaya Hocagil T. Comparison of examination techniques of anterior and posterior compartments of the leg for the diagnosis of deep vein thrombosis: A new examination technique. Vascular 2022; 31:526-532. [DOI: 10.1177/17085381221075494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Several examination techniques have been described for the diagnosis of leg deep vein thrombosis. These previously described examination techniques aim to detect muscle pain that occurs secondary to increased pressure in the posterior compartment of the leg. However, to the best of our knowledge no studies investigated the frequency of muscle pain on the anterior compartment in patients with leg deep vein thrombosis the objective of this study is to investigate the prevalence of muscle pain in the anterior compartment. Methods The patients who were diagnosed with acute deep vein thrombosis were included in this prospective cross-sectional study. Each patient was examined using the techniques that determine the pain on the posterior compartment as well as using the technique we described to detect muscle pain on the anterior compartment. Results Two hunderd forty three patients were enrolled in the study. Among those, both distal and proximal deep vein thrombosis was present in 128 (52.7%) patients. 75% of them had muscle pain in the anterior compartment. Conclusion The results suggested that examination of muscle pain in anterior compartment of leg in patients with both proximal and distal deep vein thrombosis can be used as an additional physical examination techniques for early diagnosis.
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Affiliation(s)
- Abdullah C Hocagil
- Department of Emergency Medicine, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Hilal Hocagil
- Department of Emergency Medicine, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Elif Coskun Sungur
- Department of Cardiovascular Surgery, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Neriman Yardimci Yar
- Department of Emergency Medicine, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Tugba Akkaya Hocagil
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario
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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.
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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
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