1
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Guo C, Gao S, Hu L, Shang D, Li Y. Predictive factors for iliac vein compression syndrome in patients with varicose veins. Vascular 2024:17085381241275269. [PMID: 39179517 DOI: 10.1177/17085381241275269] [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: 08/26/2024]
Abstract
OBJECTIVE This study aimed to identify predictors of iliac vein compression syndrome (IVCS) in patients with varicose veins and to evaluate the necessity of routine lower extremity venography for preoperative assessment of these patients. METHODS A retrospective analysis was conducted on data from 1165 patients with lower-limb varicose veins who underwent preoperative venography at Wuhan Union Hospital, Tongji Medical College, China, between January 2019 and September 2023. Logistic regression analyses identified factors associated with concurrent IVCS, and a nomogram was constructed based on these findings. RESULTS Out of 1165 patients, 75 (6.4%) had IVCS according to venography and 769 had iliac vein ultrasound and found 2 (0.17%) positives. Multivariate analysis revealed the independent predictive value of left-sided involvement (odds ratio (OR) = 3.22, 95% confidence interval (CI): 1.24-8.33, p = 0.016), history of deep vein thrombosis (DVT) in the affected limb (OR = 3.11, 95% CI: 1.21-8.00, p = 0.018), pain (OR = 2.24, 95% CI: 1.17-4.26, p = 0.014), and positive results on iliac vein ultrasound (OR = 25.56, 95% CI: 2.10-311.26, p = 0.011) for the presence of IVCS in patients with lower-limb varicose veins. A nomogram incorporating these predictors demonstrated moderate predictive ability (AUV = 0.689, 95% CI: 0.607-0.771), with good calibration upon validation. CONCLUSIONS Patients with left lower extremity varicose veins, pain symptoms, history of DVT in the affected limb, and positive iliac vein ultrasound findings are at a higher risk of concurrent IVCS. Patients with varicose veins who have the aforementioned risk factors may need to undergo preoperative angiography.
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Affiliation(s)
- Chao Guo
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ShuTing Gao
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Longqing Hu
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Shang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiqing Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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2
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Zhang L, Jiang C, Chen Z, Song W, Zhao Y, Li F. Three-Year Outcomes, Risk Factors for Restenosis After Stenting for DVT Combined with Iliac Vein Compression Syndrome. Clin Appl Thromb Hemost 2024; 30:10760296241283821. [PMID: 39252512 PMCID: PMC11388314 DOI: 10.1177/10760296241283821] [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] [Indexed: 09/11/2024] Open
Abstract
This study aimed to evaluate the safety and efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) and stenting for treating acute iliofemoral deep venous thrombosis (DVT) combined with iliac vein compression syndrome (IVCS), and to identify the predictors of stent restenosis. Patients with acute proximal DVT combined with IVCS underwent PCDT and stenting from January 2017 to December 2022 were enrolled. Primary and secondary patency were assessed by duplex ultrasound (DUS). The morbidity of postthrombotic syndrome (PTS) was assessed by the Villalta score. Risk factors for stent restenosis were assessed using univariate and multivariate Cox regression models. Total of 254 patients were included. The mean follow-up time was 36.06 ± 17.66 months. The primary patency rates at 1 year, 3 years, and 5 years were 92.5%±1.7%, 85.4%±2.4%, and 82.4%±2.9%, respectively. The incidence of stent restenosis was 14.2%. Discontinuation of anticoagulants within one year [hazard ratio (HR) = 5.03; P = .048] was the factor associated with acute in-stent thrombosis. Previous DVT history (HR =2.29; P = .037) and stent placement across the inguinal ligament (HR =6.70; P < .001) were identified as independent risk factors significantly associated with stent restenosis. The overall PTS rate was 19.3%. PCDT with stenting is safe and effective for patients with iliofemoral DVT secondary to IVCS, leading to low rates of PTS. Previous DVT history and stents placed across the inguinal ligament may be predictors of stent restenosis. Furthermore, stent restenosis typically occurs within one year and is mainly caused by acute thrombosis due to discontinuation of anticoagulants.
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Affiliation(s)
- Lin Zhang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuli Jiang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Song
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fenghe Li
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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3
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Chen HW, Chen CH, Fan YJ, Lin CY, Hsu WH, Su IC, Lin CL, Chiang YC, Huang HM. CFD Study of the Effect of the Angle Pattern on Iliac Vein Compression Syndrome. Bioengineering (Basel) 2023; 10:688. [PMID: 37370619 DOI: 10.3390/bioengineering10060688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Iliac vein compression syndrome (IVCS, or May-Thurner syndrome) occurs due to the compression of the left common iliac vein between the lumbar spine and right common iliac artery. Because most patients with compression are asymptomatic, the syndrome is difficult to diagnose based on the degree of anatomical compression. In this study, we investigated how the tilt angle of the left common iliac vein affects the flow patterns in the compressed blood vessel using three-dimensional computational fluid dynamic (CFD) simulations to determine the flow fields generated after compression sites. A patient-specific iliac venous CFD model was created to verify the boundary conditions and hemodynamic parameter set in this study. Thirty-one patient-specific CFD models with various iliac venous angles were developed using computed tomography (CT) angiograms. The angles between the right or left common iliac vein and inferior vena cava at the confluence level of the common iliac vein were defined as α1 and α2. Flow fields and vortex locations after compression were calculated and compared according to the tilt angle of the veins. Our results showed that α2 affected the incidence of flow field disturbance. At α2 angles greater than 60 degrees, the incidence rate of blood flow disturbance was 90%. In addition, when α2 and α1 + α2 angles were used as indicators, significant differences in tilt angle were found between veins with laminar, transitional, and turbulent flow (p < 0.05). Using this mathematical simulation, we concluded that the tilt angle of the left common iliac vein can be used as an auxiliary indicator to determine IVCS and its severity, and as a reference for clinical decision making.
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Affiliation(s)
- Hsuan-Wei Chen
- Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei 11031, Taiwan
| | - Chao-Hsiang Chen
- Department of Imaging Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan
| | - Yu-Jui Fan
- School of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan
| | - Chun-Yu Lin
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
| | - Wen-Hsien Hsu
- Department of Lymphovascular Surgery, Taipei Municipal Wanfang Hospital, Taipei 11600, Taiwan
| | - I-Chang Su
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Department of Neurosurgery, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City 235041, Taiwan
| | - Chun-Li Lin
- Medical Device Innovation and Translation Center, Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Yuan-Ching Chiang
- Department of Mechanical Engineering, Chinese Culture University, Taipei 111396, Taiwan
| | - Haw-Ming Huang
- School of Dentistry, Taipei Medical University, Taipei 11031, Taiwan
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4
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Li C, Zhan Y, Wang Z, Gao Y, Ye K, Lu X, Qiu P, Yao C. Effect of stent treatment on hemodynamics in iliac vein compression syndrome with collateral vein. Med Eng Phys 2023; 115:103983. [PMID: 37120173 DOI: 10.1016/j.medengphy.2023.103983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/17/2023] [Accepted: 04/19/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Iliac vein compression syndrome (IVCS) leads to blood flow obstruction in the lower extremities and is usually treated with stents, but stenting may worsen the hemodynamics and increase the risk of thrombosis in the iliac vein. The present work evaluates the advantages and disadvantages of the stent on IVCS with a collateral vein. METHODS The computational fluid dynamics method is adopted to analyze the preoperative and postoperative flow fields in a typical IVCS. The geometric models of the iliac vein are constructed from medical imaging data. The porous model is used to simulate the flow obstruction in IVCS. RESULTS The preoperative and postoperative hemodynamic characteristics in the iliac vein are obtained, e.g., the pressure gradient at two ends of the compressive region and the wall shear stress. It is found that the stenting restores the blood flow in the left iliac vein. CONCLUSION Impacts of the stent are classified into short-term and long-term effects. The short-term effects are beneficial in relieving IVCS, i.e., shortening the blood stasis and reducing the pressure gradient. The long-term effects increase the risk of thrombosis in the stent, i.e., enlarging wall shear stress due to a large corner and a diameter constriction in the distal vessel, and suggests the need to develop a venous stent for IVCS.
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Affiliation(s)
- Chaoqun Li
- College of Civil Engineering, Hefei University of Technology, 230009, Hefei, China
| | - Yanqing Zhan
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230011, China; Department of General Surgery, Anhui Public Health Clinical Center, Hefei, 230011, China
| | - Zhongming Wang
- College of Civil Engineering, Hefei University of Technology, 230009, Hefei, China
| | - Yongxin Gao
- College of Civil Engineering, Hefei University of Technology, 230009, Hefei, China
| | - Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China
| | - Peng Qiu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China.
| | - Cheng Yao
- College of Civil Engineering, Hefei University of Technology, 230009, Hefei, China.
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5
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May-Thurner Syndrome and Lymphedema Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4377. [PMID: 35702363 PMCID: PMC9187167 DOI: 10.1097/gox.0000000000004377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022]
Abstract
May-Thurner syndrome (MTS) is an anatomical variant that results in compression of the left common iliac vein by the right common iliac artery. Although often asymptomatic, lower extremity swelling/edema, deep venous thrombosis, post-thrombotic syndrome, and eventual lymphedema (due to long-standing venous obstruction) can develop. The clinical management of patients presenting for lymphedema surgery with concomitant or undiagnosed MTS is not well described. Methods This review investigates two patients who were evaluated for unilateral lower extremity lymphedema, both of whom were subsequently diagnosed with MTS. Standard imaging (including lymphoscintigraphy, indocyanine green lymphangiography, and magnetic resonance venography) were performed to identify proximal venous obstruction. Treatment was accomplished using vascular surgical management, including stenting of the iliac vein before lymphedema reconstruction with vascularized lymph node transfer and multiple lymphovenous bypass. Results Both patients we examined in this review had improvement of lymphedema with vascular surgical management. Literature review reveals that MTS has an incidence as high as 20% in the population, although commonly unidentified due to lack of symptomatology. Conclusions There are no studies documenting the incidence of MTS in patients referred for lymphedema surgical management. Routine studies should be obtained to screen for proximal venous obstruction in patients presenting for surgical management of lower extremity lymphedema. Additional research is needed regarding the approach to managing patients with both MTS and lymphedema. Careful observational and prospective studies may elucidate the appropriate time interval between venous stenting and lymphedema microsurgical reconstruction.
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6
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Engelhorn ALDV, Lima LDB, Werka MJS, Engelhorn AVV, Bombardelli DAR, da Silva LDO, Barbosa GS, Engelhorn CA. Left common iliac vein compression identified by vascular ultrasonography in asymptomatic women: does standing position influence diagnosis? J Vasc Bras 2021; 20:e20200188. [PMID: 34267789 PMCID: PMC8256875 DOI: 10.1590/1677-5449.200188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background Vascular ultrasonography is the imaging exam of choice for initial screening for left common iliac vein compression, which is an asymptomatic finding that can be detected in up to 25% of some patient samples. Objective To determine, using vascular ultrasonography, whether findings of left common iliac vein compression in asymptomatic women are different when assessed in the prone and standing positions. Methods This is a cross-sectional observational study of 50 adult female volunteers with no symptoms of pelvic venous compression. The parameters assessed with vascular ultrasonography in the prone and standing positions were diameters and maximum velocities of the left common iliac vein at the point at which it crosses behind the right common iliac artery and before this point, in addition to left common iliac vein velocity indices at the crossing. Results Eight cases of significant compression of the left common iliac vein were identified when assessed in prone position (16%) and just two cases (4%) were identified in the standing position. Left common iliac vein diameters were statistically larger (p = 0.002) at the point where it crosses behind the right common iliac artery in the standing position and velocities and velocity indices were statistically higher (p < 0.001) in the prone position. No significant compression of the left common iliac vein was identified in the standing position when velocity indices were normal in the prone position. Conclusions There was no difference in detection of significant compression of the left common iliac vein when assessed in the standing position in comparison with assessment in the prone position. However, the study showed that anatomic compression of the left common iliac vein may be reduced in the standing position.
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7
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Hejazi M, Sassani F, Gagnon J, Hsiang Y, Phani AS. Deformation mechanics of self-expanding venous stents: Modelling and experiments. J Biomech 2021; 120:110333. [PMID: 33730560 DOI: 10.1016/j.jbiomech.2021.110333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
Deformation properties of venous stents based on braided design, chevron design, Z design, and diamond design are compared using in vitro experiments coupled with analytical and finite element modelling. Their suitability for deployment in different clinical contexts is assessed based on their deformation characteristics. Self-expanding stainless steel stents possess superior collapse resistance compared to Nitinol stents. Consequently, they may be more reliable to treat diseases like May-Thurner syndrome in which resistance against a concentrated (pinching) force applied on the stent is needed to prevent collapse. Braided design applies a larger radial pressure particularly for vessels of diameter smaller than 75% of its nominal diameter, making it suitable for a long lesion with high recoil. Z design has the least foreshortening, which aids in accurate deployment. Nitinol stents are more compliant than their stainless steel counterparts, which indicates their suitability in veins. The semi-analytical method presented can aid in rapid assessment of topology governed deformation characteristics of stents and their design optimization.
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Affiliation(s)
- Masoud Hejazi
- Department of Mechanical Engineering, 6250 Applied Science Lane, University of British Columbia, Vancouver, B.C V6T 1Z4, Canada
| | - Farrokh Sassani
- Department of Mechanical Engineering, 6250 Applied Science Lane, University of British Columbia, Vancouver, B.C V6T 1Z4, Canada
| | - Jöel Gagnon
- Division of Vascular Surgery, 4219-2775 Laurel Street, Vancouver General Hospital, Vancouver, B.C V5Z 1M9, Canada
| | - York Hsiang
- Division of Vascular Surgery, 4219-2775 Laurel Street, Vancouver General Hospital, Vancouver, B.C V5Z 1M9, Canada
| | - A Srikantha Phani
- Department of Mechanical Engineering, 6250 Applied Science Lane, University of British Columbia, Vancouver, B.C V6T 1Z4, Canada.
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8
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Jerjes-Sánchez C, Rodriguez D, Farjat AE, Kayani G, MacCallum P, Lopes RD, Turpie AGG, Weitz JI, Haas S, Ageno W, Goto S, Goldhaber SZ, Angchaisuksiri P, Nielsen JD, Schellong S, Bounameaux H, Mantovani LG, Prandoni P, Kakkar AK. Pregnancy-Associated Venous Thromboembolism: Insights from GARFIELD-VTE. TH OPEN 2021; 5:e24-e34. [PMID: 33532693 PMCID: PMC7840428 DOI: 10.1055/s-0040-1722611] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction
The risk of venous thromboembolism (VTE) increases during pregnancy and the puerperium such that VTE is a leading cause of maternal mortality.
Methods
We describe the clinical characteristics, diagnostic strategies, treatment patterns, and outcomes of women with pregnancy-associated VTE (PA-VTE) enrolled in the Global Anticoagulant Registry in the FIELD (GARFIELD)-VTE. Women of childbearing age (<45 years) were stratified into those with PA-VTE (
n
= 183), which included pregnant patients and those within the puerperium, and those with nonpregnancy associated VTE (NPA-VTE;
n
= 1,187). Patients with PA-VTE were not stratified based upon the stage of pregnancy or puerperium.
Results
Women with PA-VTE were younger (30.5 vs. 34.8 years), less likely to have pulmonary embolism (PE) (19.7 vs. 32.3%) and more likely to have left-sided deep vein thrombosis (DVT) (73.9 vs. 54.8%) compared with those with NPA-VTE. The most common risk factors in PA-VTE patients were hospitalization (10.4%), previous surgery (10.4%), and family history of VTE (9.3%). DVT was typically diagnosed by compression ultrasonography (98.7%) and PE by chest computed tomography (75.0%). PA-VTE patients more often received parenteral (43.2 vs. 15.1%) or vitamin K antagonists (VKA) (9.3 vs. 7.6%) therapy alone. NPA-VTE patients more often received a DOAC alone (30.2 vs. 13.7%). The risk (hazard ratio [95% confidence interval]) of all-cause mortality (0.59 [0.18–1.98]), recurrent VTE (0.82 [0.34–1.94]), and major bleeding (1.13 [0.33–3.90]) were comparable between PA-VTE and NPA-VTE patients. Uterine bleeding was the most common complication in both groups.
Conclusion
VKAs or DOACs are widely used for treatment of PA-VTE despite limited evidence for their use in this population. Rates of clinical outcomes were comparable between groups.
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Affiliation(s)
- Carlos Jerjes-Sánchez
- Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud, Instituto de Cardiologia y Medicina Vascular, TecSalud, Monterrey, Mexico
| | - David Rodriguez
- Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud, Instituto de Cardiologia y Medicina Vascular, TecSalud, Monterrey, Mexico
| | | | - Gloria Kayani
- Thrombosis Research Institute, London, United Kingdom
| | - Peter MacCallum
- Thrombosis Research Institute, London, United Kingdom.,Queen Mary University of London, London, United Kingdom
| | - Renato D Lopes
- Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina, United States
| | | | - Jeffrey I Weitz
- McMaster University, Hamilton, Ontario, Canada.,Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Sylvia Haas
- Formerly Technical University of Munich, Munich, Germany
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Shinya Goto
- Department of Medicine (Cardiology), Tokai University School of Medicine, Tokai, Japan
| | | | | | | | | | | | - Lorenzo G Mantovani
- IRCCS Multimedica Milan, Milan, Italy.,University of Milano, Bicocca, Milan, Italy
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9
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C-arm-based flat-panel detector cone-beam computed tomography venography in the diagnosis of iliac vein compression syndrome. Chin Med J (Engl) 2020; 134:431-438. [PMID: 32858590 PMCID: PMC7909329 DOI: 10.1097/cm9.0000000000001046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: C-arm-based flat-panel detector cone-beam computed tomography (CBCT) venography has never been used in the management of iliac vein compression syndrome (IVCS). This study aimed to determine the technical feasibility and safety of CBCT venography in the diagnosis of IVCS compared with conventional venography (CV). Methods: Twenty patients with clinical manifestations of lower extremity venous insufficiency were prospectively enrolled between May 2018 and December 2018. Each patient underwent both CV and CBCT venography. The feasibility and safety of CBCT venography were assessed by technical success rate and complication rate. The relationships between the clinical indexes and the results of CBCT venography and CV were analyzed with correlation analysis. The consistency of the diagnosis of IVCS using each modality was analyzed by the kappa test. Results: The technical success rate was 100% for CBCT venography and for CV, without any complications. Compared with CV, CBCT venography was able to show more details of adjacent tissues which might be helpful for making etiological diagnosis. The stenosis rate under CBCT venography had excellent consistency with that under CV (kappa = 0.78, Chi-square test). The stenosis rate under CBCT venography was positively correlated with the presence of collateral veins (odds ratio 1.12, 95% confidence interval: [1.00, 1.26], P = 0.049), while the stenosis rate under CV was not. Unexpectedly, only one patient had a venous pressure gradient of more than 2 mmHg (1 mmHg = 0.133 kPa). Conclusions: For the diagnosis of IVCS, C-arm-based CBCT venography was technically feasible, with good safety. The presence of collateral veins on CBCT was clinically significant. A C-arm fluoroscopy-based technique that combines CV and CBCT might be a promising protocol for the management of IVCS during a single session.
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10
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Abstract
Iliac vein compression syndrome (May-Thurner syndrome - MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.
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Affiliation(s)
- Katalin Mako
- University of Medicine and Pharmacy, Targu Mures, Romania
| | - Attila Puskas
- Angio-Center-Vascular Medicine Romania, Targu Mures, Romania
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11
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Le TB, Lee TK, Park KM, Jeon YS, Hong KC, Cho SG. Contralateral Deep Vein Thrombosis after Iliac Vein Stent Placement in Patients with May-Thurner Syndrome. J Vasc Interv Radiol 2018; 29:774-780. [DOI: 10.1016/j.jvir.2018.01.771] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 12/20/2022] Open
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12
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Freitas VMPD, Pereira SM, Enokihara MMSES, Cestari SDCP. Pyoderma gangrenosum associated with left iliac vein compression syndrome: presentation of difficult diagnosis. An Bras Dermatol 2018; 92:129-131. [PMID: 29267470 PMCID: PMC5726701 DOI: 10.1590/abd1806-4841.20176109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 11/27/2016] [Indexed: 02/07/2023] Open
Abstract
Pyoderma gangrenosum is a rare neutrophilic dermatosis of unknown etiology, of
which the most frequent clinical manifestations are ulcers. The diagnosis
difficulty is, among other things, to rule out other causes of ulcers, since it
is considered a diagnosis of exclusion. Skin ulcerations may also occur in the
iliac vein compression syndrome, which, like pyoderma gangrenosum, mainly
affects young women. Because they have such similar characteristics, the
presence of vascular disease may hinder the diagnosis of concurrent pyoderma
gangrenosum. Because of the clinical relevance of ulcerated lesions and scars,
the early diagnosis and treatment of this condition is considered extremely
important. We report a case in which the two diseases were associated, hampering
the diagnosis of pyoderma gangrenosum.
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Affiliation(s)
- Verena Mony Paes de Freitas
- Department of Dermatology at Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp) - São Paulo (SP), Brazil
| | - Silvia Marcondes Pereira
- Outpatient Clinic of Geriatric Dermatology of the Department of Dermatology at Escola Paulista de Medicina, Universidade Federal de São Paulo (EPMUnifesp) - São Paulo (SP), Brazil
| | - Mílvia Maria Simões E Silva Enokihara
- Department of Dermatology at Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp) - São Paulo (SP), Brazil.,Department of Pathology at Escola Paulista de Medicinada Universidade Federal de São Paulo (EPM-Unifesp) - São Paulo (SP), Brazil
| | - Silmara da Costa Pereira Cestari
- Department of Dermatology at Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp) - São Paulo (SP), Brazil
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13
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Iyer S, Angle JF, Uflacker A, Sharma AM. Venous Compression Syndromes: a Review. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:45. [PMID: 28470367 DOI: 10.1007/s11936-017-0541-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OPINION STATEMENT Venous compression syndromes present a diagnostic and therapeutic challenge as the clinical presentation can be vague, diagnostic criteria are often not present, and high quality standardization of when and how to treat is not available in part due to the limited number of cases reported and also due to the limited literature available. Significant venous compression should be considered when clinical symptoms correlate to location of compression and there is evidence of hemodynamic changes including venous hypertension, collateral/variceal formation, and/or thrombus formation. In general, treatment of venous compression should address the etiology of the compression as opposed to just treating symptoms associated with it such as significant varices or anticoagulation for thrombus to avoid recurrence of symptoms.
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Affiliation(s)
- Sunil Iyer
- Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - John F Angle
- Department of Radiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Andre Uflacker
- Department of Radiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Aditya M Sharma
- Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
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