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Zhu Q, Yang L, Zhu H, Kong W, Feng R, Luo J, Chen M, Wu D, Yu Q, Zhang R, Luo M. Prevalence of left iliac vein compression in an asymptomatic population and patients with left iliofemoral deep vein thrombosis: A multicenter cross-sectional study in southern China. Phlebology 2022; 37:602-609. [PMID: 35786081 DOI: 10.1177/02683555221113111] [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: 11/16/2022]
Abstract
OBJECTIVE Population-based epidemiological data on left common iliac vein (LCIV) compression is scarce. This study aimed to investigate the prevalence of LCIV compression in an asymptomatic population and patients with left iliofemoral deep vein thrombosis (IF-DVT). MATERIALS AND METHODS Nonprobability sampling method was used in this multicenter cross-sectional study. The minimum diameter of LCIV and right common iliac vein minimum were measured. The percentage of LCIV compression (LCIV-CP) was calculated. Compression severity (CS) was classified as mild (CP ≤ 50%), moderate (50% < CP ≤ 70%), and severe (CP > 70%). RESULTS In all, 896 subjects constituted the asymptomatic population and 93 patients constituted the IF-DVT population. In the asymptomatic population, LCIV-CP ranged from 1.1% to 89.9% (mean 44.0%), and people with mild, moderate, and severe CS accounted for 62.3%, 28.2%, and 9.5%, respectively. In the IF-DVT population, the mean LCIV-CP was 71.1% (range 42.2%-95.2%), and patients with severe CS accounted for 75.3%. Gender and age differences in LCIV-CP and CS distribution were observed in the asymptomatic population. Females, the young- and middle-aged group had higher LCIV-CPs. In the population with moderate-severe CS, the middle-aged group accounted for a larger proportion. Middle-aged females comprised the highest percentage of patients with moderate or severe CS. Sex and age affected the LCIV-CP and CS distribution. No gender and age differences were observed in the IF-DVT population. CONCLUSIONS LCIV compression is common in population. Middle-aged females are the predominant population with moderate-severe compression. Overlapping of LCIV-CP in the asymptomatic and IF-DVT population is significant and other risk factors should be integrated into the consideration when assessing the risk of IF-DVT secondary to LCIV compression.
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Affiliation(s)
- Qiaohua Zhu
- Department of Oncology and Interventional Radiology, 477688Southern Medical University Shunde Hospital, Foshan, China
| | - Lun Yang
- Zhuhai Chronic Disease Prevention and Control Center, Zhuhai, Guangdong, China
| | - Huiyan Zhu
- Department of Radiology, 577901Nongken Central Hospital of Guangdong , Zhanjiang, China
| | - Wei Kong
- Department of Medical Imaging, Shaoguan First People's Hospital, Shaoguan, China
| | - Ruizhi Feng
- Department of Radiology, Dongguan Third People's Hospital, Dongguan, China
| | - Jun Luo
- Department of Radiology, 70570Southern Medical University Baoan People's Hospital, Shenzhen, China
| | - Minming Chen
- Department of Radiology, Yangchun People's Hospital, Yangjiang, China
| | - Dehua Wu
- Department of Diagnostic Radiology, 70570Southern Medical University Shunde Hospital, Foshan, China
| | - Qirong Yu
- Department of Radiology, 47879Shunde Hospital of Traditional Chinese Medicine, Shunde, China
| | - Ruyan Zhang
- Department of Interventional Medicine, 66477Shantou University Medical College First Affiliated Hospital, Shantou, China
| | - Meihua Luo
- Department of Oncology and Interventional Radiology, 477688Southern Medical University Shunde Hospital, Foshan, China
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Chen ZH, Huang Y, Wang LP, Peng MY, Li C, Huang W. Preliminary study of hemodynamics of iliac venous compression syndrome using magnetic resonance imaging. J Vasc Surg Venous Lymphat Disord 2021; 10:131-138.e3. [PMID: 34634518 DOI: 10.1016/j.jvsv.2021.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/30/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE In clinical practice, the degree of iliac vein stenosis has often been inconsistent with the symptoms of chronic venous disease (CVD). To the best of our knowledge, no clinical studies have evaluated the hemodynamic changes associated with iliac vein stenosis. Magnetic resonance imaging (MRI) can noninvasively provide hemodynamic information. In the present study, we assessed the degree of stenosis associated with iliac venous compression syndrome and the relationships between iliac venous compression syndrome-induced, MRI-determined hemodynamic changes and lower limb symptoms. METHODS Stenosis severity, the presence of collateral vessels, and flow rate (FR) differences between the common and external iliac veins secondary to iliac vein stenosis were measured using MRI in 69 patients with CVD. Villalta scores were used as a measure of symptom severity for all patients, and the percentage of change in the Villalta score was used as a measure of symptom improvement for the patients who had received iliac vein stents. Symptom severity for all patients, a subgroup of patients with iliac vein compression (affected limbs), and a group of patients with unilateral iliac vein compression treated with stents was correlated with stenosis, differences in the external and common iliac vein FRs (<0-mL/s group, indicating stenosis-induced decreased common iliac vein flow, and ≥0-mL/s group), and stenosis-induced collateral vessel formation. RESULTS Iliac vein stenosis severity and FR differences in all affected limbs were correlated with the Villalta scores of the affected limbs (stenosis: r = 0.38, P < .001, n = 95; FR difference: r = -0.44, P < .001). In the unilateral compression subgroup, stenosis severity, FR differences, and the presence of collateral vessels were not associated with significant changes in contralateral symptoms. In the endovascular treatment subgroup, both lower limbs exhibited significant improvement after stent implantation (affected limb symptom remission, 64.6% ± 18.2%, n = 15; contralateral limb symptom remission, 49.1% ± 29.1%, n = 11). The rate of symptom remission was greater for patients with decreased iliac vein flow in the affected limbs (<0-mL/s group: 74.6% ± 16.4%, n = 7; ≥0-mL/s group: 52.2% ± 16.6%, n = 6; P = .032). CONCLUSIONS Iliac vein stenosis, the presence of collateral vessels, and decreased FRs due to stenosis correlated significantly with lower limb symptom severity. Endovascular treatment yielded good outcomes in patients with stenosis >50%. A decreased iliac venous FR could indicate a better response to stent implantation and could be used in the diagnosis and guiding decisions to treat iliac venous compression.
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Affiliation(s)
- Zi-Hui Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China
| | - Yang Huang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China
| | - Liang-Peng Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China
| | - Ming-Yong Peng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China
| | - Chao Li
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China
| | - Wen Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China.
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Armenta Flores R, Armenta-Villalobos D, Ramirez-Centeno E, Harrison-Ragle D, Carrillo LGD. May Thurner syndrome: Sixty years later. Phlebology 2021; 37:5-13. [PMID: 34494483 DOI: 10.1177/02683555211045202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
May-Thurner syndrome (MTS) was described sixty years ago. Once ignored for several years, it is currently a recognized pathology in the vascular surgery community; but not long ago due to several factors, it was underdiagnosed and sub-optimally treated. In the last 20 years, with renewed interest in venous pathology, technical imaging advances and the recent interventional procedures, it has become a better known disease. On the other hand, nowadays the easiness in diagnosis and treatment of the syndrome has lead to overtreatment of such patients. In this article, we do a historical review and describe the significant advances and current management of May-Thurner syndrome.
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Affiliation(s)
- Romulo Armenta Flores
- Hospital Medica Campestre, Department of Cardiovascular Surgery, Leon, Guanajuato, Mexico
| | - Diego Armenta-Villalobos
- Guanajuato University Medical School, Department of Medicine and Nutrition, Leon, Guanajuato, Mexico
| | | | - Derek Harrison-Ragle
- Hospital General del Norte de Puebla SSA, Department of Internal Medicine, Puebla, Puebla, Mexico
| | - Luis G Dominguez Carrillo
- Guanajuato University Medical School, Department of Medicine and Nutrition, Leon, Guanajuato, Mexico
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Montes MC, Carbonell JP, Gómez-Mesa JE. Endovascular and medical therapy of May-Thurner syndrome: Case series and scoping literature review. JOURNAL DE MÉDECINE VASCULAIRE 2021; 46:80-89. [PMID: 33752850 DOI: 10.1016/j.jdmv.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/11/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION May-Thurner syndrome has been recognized as a cause of chronic venous insufficiency and a trigger for venous thromboembolism. There is no consensus about the definition, diagnosis, and therapeutic approach. We are aiming to describe its characteristics and a scoping literature review. METHODS A retrospective review of patients with May-Thurner syndrome from March 2010 to May 2018 and scoping literature review were made. RESULTS Seven patients were identified. All patients were female with a median age of 36 (20-60) years. The median time from the first symptom to diagnosis was 3.41 (0.01-9) years. The primary clinical presentation was post-thrombotic syndrome (4 patients). Six patients had at least one risk factor for deep venous thrombosis. All patients underwent angioplasty with stent; patients with acute deep venous thrombosis, furthermore mechanic thrombectomy with or without catheter-directed thrombolysis were done. There were three complications (one patient, lymphedema, and two venous stent thrombosis). Scoping review results were descriptively summarized. CONCLUSION May-Thurner syndrome has a varied spectrum of clinical presentation, and clinical awareness is paramount for diagnosis. Its principal complication is the post-thrombotic syndrome, which is associated with high morbidity. There is no consensus on the antithrombotic treatment approach.
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Affiliation(s)
- M C Montes
- Internal Medicine Department, Cardiology Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia
| | - J P Carbonell
- Surgery Department, Vascular Surgery Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia
| | - J E Gómez-Mesa
- Surgery Department, Vascular Surgery Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia.
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Transplant renal artery and vein occlusion evaluated with ferumoxytol-enhanced magnetic resonance angiography. Clin Imaging 2021; 77:142-146. [PMID: 33684787 DOI: 10.1016/j.clinimag.2021.02.022] [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: 12/15/2020] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Compromise of the transplanted vasculature accompanying a kidney allograft can lead to graft failure if not diagnosed and treated expeditiously. Location of the vascular defect in the transplant renal artery or vein is difficult to anticipate, given the variety of etiologies. However, early diagnosis can anticipate further progression of kidney allograft dysfunction. Ferumoxytol-enhanced magnetic resonance angiography (FeMRA) can precisely localize lesions in both the transplant renal artery and vein and provide a comprehensive survey of the vascular conduits of concern. It avoids complications of kidney injury associated with intravenous iodinated contrast that may amplify a diagnosis of delayed graft function or further impair an allograft already compromised by donor-derived vascular disease. METHODS We report a case of concomitant and irreversible proximal transplant renal artery and vein stenosis diagnosed by FeMRA and treated with surgical intervention. RESULTS AND CONCLUSIONS FeMRA offers a rapid, non-invasive approach to simultaneously diagnose compromised blood flow through the transplant artery and or vein in preparation for definitive correction of the defect.
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Wang X, Yu C, Chen G, Hong Y, Zhou B, Ge J, Liu T. Iliac vein stenting guided by intravascular ultrasound without iodinated contrast medium. VASA 2021; 50:68-73. [PMID: 32552609 DOI: 10.1024/0301-1526/a000873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Iliac vein compression syndrome, also known as May-Thurner Syndrome, is a type of vein reflux disorders which is often ignored due to lack of efficient diagnostic methods. The traditional gold standard of diagnosis is venography, but this has been challenged and largely replaced by intravascular ultrasound (IVUS). Here we report a case that a patient suffered with iodine anaphylaxis was successfully performed iliac vein stenting guided by using IVUS alone. This case provides the evidence that IVUS can offer necessary information for physicians in the diagnosis and treatment of iliac vein compression. We also find that balloon dilatation notch cannot precisely reflect the whole lesion, indicating it may be unreliable for diagnosis. Differ from the commonly accepted opinion, we find that comparing to IVUS, the notch of balloon dilatation cannot completely reflect the extent of lesion narrowness. Thus, we think the notch should not be used as a reference for seriousness of the lesion, and the diagnosis of stenosis cannot be ruled out even if there is no presence of notch.
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Affiliation(s)
- Xiang Wang
- Department of Vascular Surgery, Tongji University Affiliated East Hospital, Shanghai, China
| | - Chong Yu
- Department of Vascular Surgery, Tongji University Affiliated East Hospital, Shanghai, China
| | - Guojun Chen
- Department of Vascular Surgery, Tongji University Affiliated East Hospital, Shanghai, China
| | - Yi Hong
- Department of Vascular Surgery, Tongji University Affiliated East Hospital, Shanghai, China
| | - Bin Zhou
- Department of Vascular Surgery, Tongji University Affiliated East Hospital, Shanghai, China
| | - Jin Ge
- Department of Vascular Surgery, Tongji University Affiliated East Hospital, Shanghai, China
| | - Tuoen Liu
- Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia, United States
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Gavrilov SG, Vasilyev AV, Krasavin GV, Moskalenko YP, Mishakina NY. Endovascular interventions in the treatment of pelvic congestion syndrome caused by May-Thurner syndrome. J Vasc Surg Venous Lymphat Disord 2020; 8:1049-1057. [DOI: 10.1016/j.jvsv.2020.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/08/2020] [Indexed: 11/17/2022]
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Toonder IM. The Myth of May Thurner. PHLEBOLOGIE 2020. [DOI: 10.1055/a-1213-0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractLess invasive contemporary endovenous techniques with improved stents have made treatment of the May Thurner Syndrome(MTS) more accessible and safer. However, clear criteria for the accurate diagnosis remain obscure. All imaging modalities are performed with patients in a supine position were compression of the left Common Iliac Vein is seen in both asymptomatic and symptomatic patients. There is no clear threshold value. There are no validated hemodynamic criteria. This leads to the necessity of additional information such as measurements performed in an upright position as well as greater scrutiny in detecting fibrous wall thickening and spurs as well as identifying the presence of venous collaterals. Moreover, those contemplating treating MTS should not only identify specific symptoms, but also should consider that patient complaints may be related to a more complex presentation of pelvic congestion.
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Affiliation(s)
- Irwin M. Toonder
- European Vascular Centre Aachen- Maastricht, University Hospital Aachen, Maastricht, University Hospital, the Netherlands
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French S, Daugherty S, Thul S. Pelvic Venous Disease: Identifying This Commonly Overlooked Cause of Chronic Pelvic Pain in Women. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kaltenmeier CT, Erben Y, Indes J, Lee A, Dardik A, Sarac T, Ochoa Chaar CI. Systematic review of May-Thurner syndrome with emphasis on gender differences. J Vasc Surg Venous Lymphat Disord 2018; 6:399-407.e4. [DOI: 10.1016/j.jvsv.2017.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 11/02/2017] [Indexed: 02/08/2023]
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van Vuuren TM, van Laanen JHH, de Geus M, Nelemans PJ, de Graaf R, Wittens CHA. A randomised controlled trial comparing venous stenting with conservative treatment in patients with deep venous obstruction: research protocol. BMJ Open 2017; 7:e017233. [PMID: 28893753 PMCID: PMC5595185 DOI: 10.1136/bmjopen-2017-017233] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Deep venous obstruction (DVO) has a great impact on quality of life (QoL) comparable to angina pectoris or chronic pulmonary disease. Post-thrombotic scar formation and May-Thurner syndrome (MTS) are the most common causes of DVO. Conventional treatment of DVO focuses on reducing pain or leg swelling by use of (pain) medication and therapeutic elastic stockings. In the past, a venous bypass was offered in severe post-thrombotic cases, but this procedure showed bad clinical and patency outcomes. With the introduction of percutaneous angioplasty and dedicated venous stents new opportunities were created. Deep venous stenting has been shown to be effective in retrospective case series. However, there is no prior research in which QoL after interventional treatment is compared with QoL after conventional treatment. Currently, there is a debate about the true additional value of interventional treatment. We investigate whether those patients who are treated with stenting experience a change in short form 36 (SF-36) and the Veines-QoL/Sym questionnaires compared with conventionally treated patients. METHODS AND ANALYSIS This is a randomised trial comparing conservative deep venous management to interventional treatment. A total of 130 patients with post-thrombotic syndrome (PTS) or MTS, eligible for interventional percutaneous treatment, who did not have previous deep venous intervention will be included. Patients will be randomised to conservative treatment or venous stenting and stratified for the PTS or MTS subgroup. Conservative treatment consists of either one or a combination of pain medications, manual lymphatic drainage, compression stockings and regular post-thrombotic anticoagulant therapy.The primary outcome is the QoL change after 12 months compared with baseline QoL. Secondary outcomes are QoL changes at 6 weeks, clinical assessment of DVO, recurrence rate of deep venous thrombosis at 6 weeks and 12 months, and the total amount of working days lost. Intervention-specific outcomes include complications and patency. ETHICS AND DISSEMINATION The protocol is approved by the Medical Ethics Committee of Academisch ziekenhuis Maastricht/Universiteit Maastricht, The Netherlands (protocol number NLNL55641.068.15 / METC 161008).We aim to publish the results of this study in a peer reviewed journal and present our findings at national or international conferences. TRIAL REGISTRATION NUMBER The study protocol was registered at www.clinicaltrials.gov (registration number: NCT03026049) on 17 January 2017.
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Affiliation(s)
- Timme Maj van Vuuren
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Vascular surgery, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Jorinde H H van Laanen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maaike de Geus
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Vascular surgery, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Patty J Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Rick de Graaf
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cees H A Wittens
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Vascular surgery, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands
- Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
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