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Salimi J, Chinisaz F, Yazdi SAM. A comprehensive study on venous endovascular management and stenting in deep veins occlusion and stenosis: A review study. Surg Open Sci 2024; 19:131-140. [PMID: 38690401 PMCID: PMC11058076 DOI: 10.1016/j.sopen.2024.04.001] [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: 08/25/2023] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024] Open
Abstract
Background Patients with deep venous disease can be classified into two distinct categories: those with disease resulting from known deep vein thrombosis (DVT), which may subsequently lead to post-thrombotic syndrome (PTS), and those with disease caused by compressive factors or non-thrombotic iliac vein lesions (NIVL). The major factor causing the symptoms in patients with PTS and NIVL is venous hypertension which happens due to venous stenosis or venous obstruction. Nowadays Venous stenting offers a noninvasive approach for treatment of NIVL and PTS demonstrating high patency rate. Methods We comprehensively reviewed relevant published papers from 2008 to 2023 that surveyed various influencing factors including the site of occlusion and etiology of occlusions, proper diagnostic imaging, ideal characteristics of venous stents, different dedicated venous stents, pre-operative, concomitant, and post-operative interventions and factors that challenge stenting in both PTS and NIVL patients. The papers were identified by searching the keywords "venous stenting", "PTS", "NIVL", "occlusion", and "stenosis" in PubMed central library MEDLINE and Google Scholar. Results Patency rates, post-stent complications, and relevant data according to the patient's quality of life were included and analyzed from 476 identified studies. There is no validated protocol and guideline for using stents in patients with PTS and NIVL. Conclusion As there is no validated protocol and guideline for using stents in patients with PTS and NIVL, our study may provide comprehensive information to assist researchers interested in writing the protocol and give them insight.
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Affiliation(s)
- Javad Salimi
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Chinisaz
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Nagarsheth K, Fitzpatrick S, Castillo L, Abdulrahman L, Dunlap E. Surgical anteriorization of the left common iliac vein results in improved venous outflow and quality of life for May-Thurner syndrome. J Vasc Surg Cases Innov Tech 2024; 10:101495. [PMID: 38699665 PMCID: PMC11063597 DOI: 10.1016/j.jvscit.2024.101495] [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: 01/29/2024] [Accepted: 03/21/2024] [Indexed: 05/05/2024] Open
Abstract
May-Thurner syndrome or left iliac vein compression occurs when the left common iliac vein is compressed by the right common iliac artery, leading to venous outflow obstruction. This obstruction can cause venous hypertension, resulting in lower extremity swelling, discoloration, pelvic congestion, and venous ulcerations. The standard surgical treatment of May-Thurner syndrome is endovascular venous stent placement. In a small, single-center sample, surgical anteriorization of the left common iliac vein was used to treat symptomatic left common iliac vein compression in younger patients, alleviating their symptoms, and can be considered an alternative treatment.
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Affiliation(s)
- Khanjan Nagarsheth
- Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Suzanna Fitzpatrick
- Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Lidia Castillo
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Eleanor Dunlap
- Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
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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.
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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
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4
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Cagir Y, Yuksel I. RIGHT ILIAC VEIN COMPRESSION CAUSED BY TERMINAL ILEUM PENETRATION OF THE PSOAS IN A PATIENT WITH CROHN'S DISEASE. Gastroenterol Nurs 2024; 47:213-216. [PMID: 38847431 DOI: 10.1097/sga.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/26/2024] [Indexed: 07/27/2024] Open
Affiliation(s)
- Yavuz Cagir
- Yavuz Cagir, MD, is at Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Turkey
- Ilhami Yuksel, MD, is at Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Turkey; and Department of Gastroenterology, School of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Ilhami Yuksel
- Yavuz Cagir, MD, is at Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Turkey
- Ilhami Yuksel, MD, is at Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Turkey; and Department of Gastroenterology, School of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
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Cho LD, Bai H, Collins LC, Chen J, Cooke PV, Kang Y, Vasan V, Kim J, Gonzalez C, Dionne E, Kim SY, Ting W. Race differences in iliofemoral vein stenting for chronic venous insufficiency. Vascular 2024; 32:385-390. [PMID: 36395482 DOI: 10.1177/17085381221140612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Major disparities in outcomes by race are present throughout vascular surgery, yet little has been published on iliac vein stent outcomes by race. This retrospective study assessed iliac vein stent outcomes by patient race. METHODS Patients who underwent iliac vein stenting at a single institution for chronic venous insufficiency (CVI) from 2011 to 2021 were reviewed. Demographic, preoperative, perioperative, and postoperative data were collected. Self-reported race groups included Asian, Black, Hispanic, and White. Univariate differences were analyzed using χ2 tests for categorical variables and 1-way ANOVA for continuous variables. Outcomes included change in Venous Clinical Severity Score (VCSS) at interval timepoints relative to a preoperative baseline and reinterventions. Logistic regression models were used to determine the unadjusted and adjusted odds ratio (OR) of any minor and major reintervention. Multivariate regression models controlled for demographic and comorbidity characteristics. RESULTS A total of 827 patients were included. Asian patients were younger and had a greater proportion of male patients, lower Body mass index (BMI), less smoking history, and fewer comorbidities. White patients were more likely to have a history of deep vein thrombosis (DVT). White patients presented with the most severe CVI symptoms as defined by both Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification and preoperative VCSS composite scores. There were no differences in acute DVT, number of stents deployed, and bilateral versus unilateral stent placement. Black patients had the longest average days of follow-up, followed sequentially by Hispanic, White, and Asian. Black patients had the most reinterventions, while Asian patients had the fewest. Asian patients were less likely to have a major reintervention. No differences in VCSS composite or change in VCSS were observed. CONCLUSIONS In patients with CVI, Asian patients presented younger and healthier, while White patients presented with the most severe symptoms. No differences were observed in VCSS outcomes, though Black patients had the most reinterventions.
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Affiliation(s)
- Logan D Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Halbert Bai
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jenny Chen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter V Cooke
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yeju Kang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vikram Vasan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jinseo Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Elyssa Dionne
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sung Yup Kim
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Secemsky EA, Aronow HD, Kwolek CJ, Meissner M, Muck PE, Parikh SA, Winokur RS, George JC, Salazar G, Murphy EH, Costantino MM, Zhou W, Li J, Lookstein R, Desai KR. Intravascular Ultrasound Use in Peripheral Arterial and Deep Venous Interventions: Multidisciplinary Expert Opinion From SCAI/AVF/AVLS/SIR/SVM/SVS. J Vasc Interv Radiol 2024; 35:335-348. [PMID: 38206255 DOI: 10.1016/j.jvir.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 01/12/2024] Open
Abstract
Percutaneous revascularization is the primary strategy for treating lower extremity venous and arterial disease. Angiography is limited by its ability to accurately size vessels, precisely determine the degree of stenosis and length of lesions, characterize lesion morphology, or correctly diagnose postintervention complications. These limitations are overcome with use of intravascular ultrasound (IVUS). IVUS has demonstrated the ability to improve outcomes following percutaneous coronary intervention, and there is increasing evidence to support its benefits in the setting of peripheral vascular intervention. At this stage in its evolution, there remains a need to standardize the use and approach to peripheral vascular IVUS imaging. This manuscript represents considerations and consensus perspectives that emerged from a roundtable discussion including 15 physicians with expertise in interventional cardiology, interventional radiology, and vascular surgery, representing 6 cardiovascular specialty societies, held on February 3, 2023. The roundtable's aims were to assess the current state of lower extremity revascularization, identify knowledge gaps and need for evidence, and determine how IVUS can improve care and outcomes for patients with peripheral arterial and deep venous pathology.
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Affiliation(s)
- Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology and Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Herbert D Aronow
- Department of Medicine, Michigan State University, East Lansing, Michigan; Heart & Vascular Services, Henry Ford Health, Detroit, Michigan
| | - Christopher J Kwolek
- Harvard Medical School, Boston, Massachusetts; Newton-Wellesley Hospital, Wellesley, Massachusetts
| | - Mark Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Patrick E Muck
- Department of Vascular Surgery, Good Samaritan Hospital, Cincinnati, Ohio
| | - Sahil A Parikh
- Center for Interventional Cardiovascular Care, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Ronald S Winokur
- Weill Cornell Vein Treatment Center and Division of Interventional Radiology, Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Jon C George
- Division of Interventional Cardiology and Endovascular Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Gloria Salazar
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin H Murphy
- Venous and Lymphatic Center, Division of Vascular Surgery, Sanger Heart and Vascular, Atrium Health, Charlotte, North Carolina
| | | | - Wei Zhou
- Division of Vascular Surgery, University of Arizona and Banner University Medical Center, Tucson, Arizona
| | - Jun Li
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | | | - Kush R Desai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Jiang L, Zhuang H, Song T, Li XQ. Clinical Outcomes at 3 Years After Stenting for Thrombotic and Non-thrombotic Iliac Vein Compression Syndrome Patients. Clin Appl Thromb Hemost 2024; 30:10760296231220053. [PMID: 38213124 PMCID: PMC10787525 DOI: 10.1177/10760296231220053] [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: 01/13/2024] Open
Abstract
Iliac vein stenting for the treatment of iliac vein compression syndrome (IVCS) has been gradually developed. This article investigated the long-term patency and improvement of clinical symptoms after endovascular stenting for iliac vein obstruction patients. From 2020 to 2022, 83 patients at a single institution with IVCS underwent venous stent implantation and were divided into two groups: non-thrombotic IVCS (n = 55) and thrombotic IVCS (n = 28). The main stent-related outcomes include technical success, long-term patency, and thrombotic events. The technical success rate of all stent implantation was 100%. The mean length of hospital stay and cost were higher in the thrombotic IVCS group than in the non-thrombotic ICVS group, as well as the length of diseased vessel segment and the number of stents implanted were higher than in the control non-thrombotic group. The 1-, 2-, and 3-year patency rates were 85.4%, 80% and 66.7% in the thrombosis group, which were lower than 93.6%, 88.7%, and 87.5% in the control group (P = .0135, hazard ratio = 2.644). In addition, patients in both groups had a foreign body sensation after stent implantation, which resolved spontaneously within 1 year after surgery. Overall, there were statistically significant differences in long-term patency rate outcome between patients with thrombotic and non-thrombotic IVCS, the 1-, 2-, and 3-year patency rates in non-thrombotic IVCS patients were higher than those in thrombotic IVCS patients.
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Affiliation(s)
- Lei Jiang
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Hao Zhuang
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Tao Song
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Xiao-Qiang Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Vascular Surgery, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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Liu Y, Zheng H, Wang X, Wang Z, Zhu Q, Wen C, Tong Y. Ultrasound characteristics of abdominal vascular compression syndromes. Front Cardiovasc Med 2023; 10:1282597. [PMID: 38173818 PMCID: PMC10764025 DOI: 10.3389/fcvm.2023.1282597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
Abdominal vascular compression syndrome (AVCS) is caused by the compression of abdominal blood vessels by adjacent structures or the compression of abdominal organs by neighboring blood vessels. Such compressions can result in a variety of clinical symptoms. They are not commonly seen in ultrasound practices, and their presence may have been underrecognized and underdiagnosed. This article reviews the clinical features, ultrasound characteristics, and diagnostic criteria of four types of AVCS, namely, celiac artery compression syndrome, renal vein compression syndrome, iliac vein compression syndrome, and superior mesenteric artery syndrome to increase awareness of these conditions among ultrasound practitioners. The ultrasound criteria for AVCS are primarily based on studies with small sample sizes, and therefore, it is important to exercise caution if these criteria are used.
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Affiliation(s)
- Yan Liu
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Haining Zheng
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Xiaoqing Wang
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Zi Wang
- Department of Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiang Zhu
- Department of Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chaoyang Wen
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Yisha Tong
- Department of Vascular Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
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Bindlish S. Obesity, thrombosis, venous disease, lymphatic disease, and lipedema: An obesity medicine association (OMA) clinical practice statement (CPS) 2023. OBESITY PILLARS (ONLINE) 2023; 8:100092. [PMID: 38125656 PMCID: PMC10728709 DOI: 10.1016/j.obpill.2023.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 12/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians with an overview on obesity, thrombosis, venous disease, lymphatic disease, and lipedema. Methods The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results Topics in this CPS include obesity, thrombosis, venous disease, lymphatic disease, and lipedema. Obesity increases the risk of thrombosis and cardiovascular disease via fat mass and adiposopathic mechanisms. Treatment of thrombosis or thrombotic risk includes healthful nutrition, physical activity, and the requisite knowledge of how body weight affects anti-thrombotic medications. In addition to obesity-related thrombotic considerations of acute coronary syndrome and ischemic non-hemorrhagic stroke, this Clinical Practice Statement briefly reviews the diagnosis and management of clinically relevant presentations of deep vein thromboses, pulmonary embolism, chronic venous stasis, varicose veins, superficial thrombophlebitis, lipodermatosclerosis, corona phlebectatica, chronic thromboembolic pulmonary hypertension, iliofemoral venous obstruction, pelvic venous disorder, post-thrombotic syndrome, as well as lymphedema and lipedema - which should be included in the differential diagnosis of other edematous or enlargement disorders of the lower extremities. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on obesity, thrombosis, and venous/lymphatic disease is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity.
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Affiliation(s)
- Shagun Bindlish
- Adjunct Faculty Touro University, 7554 Dublin Blvd, Dublin, CA, USA
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10
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Galea M, Brincat MR, Calleja-Agius J. A review of the pathophysiology and evidence-based management of varicoceles and pelvic congestion syndrome. HUM FERTIL 2023; 26:1597-1608. [PMID: 37190955 DOI: 10.1080/14647273.2023.2212846] [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: 07/31/2022] [Accepted: 04/25/2023] [Indexed: 05/17/2023]
Abstract
Pelvic congestion syndrome (PCS) in females and varicoceles in males may be regarded as closely related conditions since the main pathophysiological cause for both processes is pelvic venous insufficiency. Varicoceles are more prevalent amongst sub-fertile males, with an approximate incidence of 15% in the general male population. PCS is commonly diagnosed amongst premenopausal multiparous women, representing one of the leading causes of chronic pelvic pain. Both conditions appear to be predominantly left-sided and are associated with oxidative stress and pro-inflammatory cascades with subsequent effects on fertility. Clinical examination and pelvic ultrasonography play an essential role in the assessment of varicoceles, PCS and chronic pelvic pain. Venography is generally considered as a gold-standard procedure for both conditions. There is still much debate on how these conditions should be managed. This review article provides a comparative analysis of the underlying pathophysiological mechanisms of both PCS and varicoceles, their impact on fertility, as well as their clinical management.
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Affiliation(s)
- Matteo Galea
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Mark R Brincat
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Department of Obstetrics and Gynaecology, Mater Dei Hospital, Msida, Malta
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Li N, Al-Hakim R, Lewis S, Ferracane J, Rugonyi S, Campos L, Farsad K, Kaufman J. Coaxial Placement of Balloon-Expandable and Self-Expanding Stents: Impact on Crush Resistance and Luminal Recovery in a Benchtop Model. J Vasc Interv Radiol 2023; 34:1958-1962.e1. [PMID: 37451538 DOI: 10.1016/j.jvir.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/20/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
During endovascular interventions, coaxial deployment of stents may be required to preserve luminal gain. This study characterized in vitro the effect on crush resistance and postcompression recovery when 316L stainless steel balloon-expandable (BE) and laser-cut nitinol self-expanding (SE) venous stents were deployed coaxially. Various stent configurations were parallel-plate compressed from a fully expanded state to 50% diameter reduction (Criterion, Model 42; MTS, Eden Prairie, Minnesota) in a 37 °C ± 1 water bath. Coaxial deployments of SE stent inside BE stent and BE stent inside SE stent demonstrated higher crush resistances compared with each stent individually or their mathematical summation (analysis of variance P < .0001; pairwise comparison P < .01). The configuration of SE stent inside BE stent showed higher postcompression luminal recovery at 48.7% compared with that of BE stent inside SE stent at 27.5% (P = .0001). Coaxial deployment of SE stent inside BE stent may improve crush resistance and luminal recovery after compression in the appropriate clinical context.
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Affiliation(s)
- Ningcheng Li
- The Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon.
| | - Ramsey Al-Hakim
- Division of Interventional Radiology, Department of Radiology, Scripps Green Hospital, San Diego, California
| | - Steven Lewis
- Department of Oral Rehabilitation and Biosciences, Oregon Health & Science University, Portland, Oregon
| | - Jack Ferracane
- Department of Oral Rehabilitation and Biosciences, Oregon Health & Science University, Portland, Oregon
| | - Sandra Rugonyi
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon
| | - Leonardo Campos
- The Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon
| | - Khashayar Farsad
- The Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon
| | - John Kaufman
- The Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon
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12
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Wu J, Yang H. A commentary on "Clinical outcomes of different endovenous procedures among patients with varicose veins and iliac vein compression: a retrospective cohort study". Int J Surg 2023; 109:3193-3194. [PMID: 37318874 PMCID: PMC10583960 DOI: 10.1097/js9.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Affiliation(s)
| | - Hongwei Yang
- Department of Vascular Surgery, Shenzhen Second Hospital (First Affiliated Hospital of Shenzhen University), Shenzhen, Guangdong, China
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13
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Zeng M, Teng B, Zhao Y, Li F, Wang X, Jiang C, Zhang W, Xiang Z, Zeng Q. Effectiveness of iliac vein stenting combined with endovenous laser treatment of recurrent varicose veins associated with iliac vein compression. Quant Imaging Med Surg 2023; 13:5986-5995. [PMID: 37711789 PMCID: PMC10498234 DOI: 10.21037/qims-22-1280] [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: 11/19/2022] [Accepted: 07/07/2023] [Indexed: 09/16/2023]
Abstract
Background Iliac vein compression syndrome (IVCS) is an underlying cause of varicose vein (VV) recurrence after venous surgery. However, the management of recurrent varicose veins (RVVs) combined with IVCS has rarely been reported. This study aimed to investigate the outcomes of a one-stop procedure to correct outflow obstruction and superficial reflux for patients with RVVs and IVCS. Methods A retrospective analysis was conducted of 102 consecutive patients diagnosed with RVVs. Computed tomography venography (CTV) was performed to confirm IVCS. The cases were divided into 2 groups: the IRVVs group, including patients with RVVs and IVCS (n=48), and the RVVs group, including patients with RVVs only (n=54). The characteristics, vein reflux, and clinical, etiological, anatomical, and pathophysiological (CEAP) distribution were investigated. Then, the IRVVs group patients who underwent endovenous laser ablation (EVLA) (n=39) were divided into a further 2 groups: the EVLA + S group (n=19), who received EVLA and stenting of iliac vein, and the EVLA group (n=20), who received EVLA treatment alone. The great/small saphenous vein (GSV/SSV) trunk occlusion, VV recurrence, visual analogue scale (VAS), and venous clinical severity score (VCSS) were investigated. Results The prevalence rate of femoral vein reflux was 81.2% in IRVVs group and 50% in RVVs group (P<0.05). In the IRVVs group, 72.9% of patients manifested as CEAP clinical class >3, which was higher than that in RVVs group (48.1%) (P<0.05). The 12-month GSV/SSV occlusion rate in the EVLA + S and EVLA groups were 94.7% and 90.0%, respectively. Totals of 9 patients in EVLA + S group and 6 patients in EVLA group had active venous ulcers, and the ulcer healing time in EVLA + S group was significantly shorter (27.22±7.12 vs. 46.67±9.83 days, P<0.05). The reductions in the VAS and VCSS values between baseline, 1 month, and 12 months in the EVLA + S group were more obvious than those in EVLA group (P<0.05). Conclusions The one-stop combination treatment of iliac venous stenting and EVLA in patients with RVVs and IVCS is safe and effective and provides prominent symptom relief, improved quality of life, and a more satisfactory ulcer healing than EVLA alone.
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Affiliation(s)
- Mingzhu Zeng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Biyun Teng
- 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
| | - Xuehu Wang
- 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
| | - Wei Zhang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi Xiang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiu Zeng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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14
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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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15
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Melian CM, Giannopoulos S, Volteas P, Virvilis D. Intravascular Ultrasound in Treating Iliac Vein Compression With Endovascular Stenting: A Necessary Tool for Optimal Outcomes. Vasc Endovascular Surg 2023; 57:299-305. [PMID: 36472054 DOI: 10.1177/15385744221145143] [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: 12/12/2022]
Abstract
Symptomatic compression of the left common iliac vein between the right common iliac artery and spinal vertebrae is referred to as May-Thurner Syndrome (MTS). Atypical cases of MTS including compression of the left external iliac vein, right iliac vein or the inferior vena cava can also coexist and cause double vein compression. Current literature suggests that endovascular treatment including thrombolysis, thrombectomy, venoplasty and stent placement to correct the mechanical obstruction together with anticoagulation therapy is safe and a reasonable management for patients with MTS. Intravascular ultrasound (IVUS) can aid in the diagnosis and the operative planning of MTS, especially regarding sizing and precise deployment of venous stents. Here we present 2 unique atypical cases of MTS with double left iliac vein compression treated endovascularly with stent placement along the common and external iliac vein with the assistance of IVUS.
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Affiliation(s)
- Christina M Melian
- 480303Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Stefanos Giannopoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, 22161Stony Brook University Hospital, Stony Brook, NY, USA
| | - Panagiotis Volteas
- Division of Vascular and Endovascular Surgery, Department of Surgery, 22161Stony Brook University Hospital, Stony Brook, NY, USA
| | - Dimitrios Virvilis
- Division of Vascular and Endovascular Surgery, Department of Surgery, 22161Stony Brook University Hospital, Stony Brook, NY, USA
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16
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Osaki M, Yoshimatsu R, Matsumoto T, Yamanishi T, Osaragi K, Hamada R, Togami K, Yamagami T. Symptomatic Chronic Severe Stenosis of the Iliac Vein Successfully Treated Endovascularly Using an Interventional Radiology Computed Tomography System. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:18-22. [PMID: 36936257 PMCID: PMC10017268 DOI: 10.22575/interventionalradiology.2021-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/30/2022] [Indexed: 03/04/2023]
Abstract
We report a woman with chronic severe stenosis of the left common and external iliac veins and severe post-thrombotic syndrome symptoms. We successfully recanalized the stenotic segment via interventional radiology, which immediately relieved the symptoms. The interventional radiology computed tomography system was helpful for the safe and precise performance of endovascular treatments.
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Affiliation(s)
- Marina Osaki
- Department of Diagnostic and Interventional Radiology, Kochi University, Kochi Medical School, Japan
| | - Rika Yoshimatsu
- Department of Diagnostic and Interventional Radiology, Kochi University, Kochi Medical School, Japan
| | - Tomohiro Matsumoto
- Department of Diagnostic and Interventional Radiology, Kochi University, Kochi Medical School, Japan
| | - Tomoaki Yamanishi
- Department of Diagnostic and Interventional Radiology, Kochi University, Kochi Medical School, Japan
| | - Kensuke Osaragi
- Department of Diagnostic and Interventional Radiology, Kochi University, Kochi Medical School, Japan
| | - Ryo Hamada
- Department of Diagnostic and Interventional Radiology, Kochi University, Kochi Medical School, Japan
| | - Koki Togami
- Department of Diagnostic and Interventional Radiology, Kochi University, Kochi Medical School, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi University, Kochi Medical School, Japan
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17
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Ali S, Pinto P, Huber S, Perez-Lozada JC, Attaran R, Ochoa Chaar CI. Complex pathologies in a patient referred for varicose veins. J Vasc Surg Cases Innov Tech 2023; 9:101107. [PMID: 36852313 PMCID: PMC9958068 DOI: 10.1016/j.jvscit.2023.101107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/05/2023] [Indexed: 01/22/2023] Open
Abstract
Varicose veins are commonly due to saphenous vein reflux, but they can manifest more complex venous pathologies. A 45-year-old woman presented with painful leg varicosities and pelvic pain. Duplex examination showed bilateral superficial venous reflux, and, on further interrogation, cross-sectional imaging demonstrated enlarged ovarian veins and nonthrombotic iliac vein compression. Ovarian vein embolization followed by iliac vein stenting and bilateral lower extremity venous ablations and sclerotherapy was performed. After 5 years, she reports no pelvic symptoms and minimal leg symptoms. This case highlights the complex interplay of these venous pathologies and their successful treatment.
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Affiliation(s)
- Sahar Ali
- Vascular Surgery Department, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Paula Pinto
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
- Correspondence: Paula Pinto, MD, Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510
| | - Steffen Huber
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT
| | - Juan Carlos Perez-Lozada
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT
| | - Robert Attaran
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
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18
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Liu Y, Deng X, Zhu F, Zhu W, Wang Z. High fibrinogen and mixed proximal and distal thrombosis are associated with the risk of residual venous thrombosis in patients with posttraumatic deep vein thrombosis. Front Cardiovasc Med 2023; 10:1003197. [PMID: 36818330 PMCID: PMC9928750 DOI: 10.3389/fcvm.2023.1003197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
Background The risk factors for residual venous thrombosis (RVT) in patients with post-trauma deep vein thrombosis (DVT) are unknown. Methods We evaluated 127 patients with DVT after trauma, all of whom were treated with conventional anticoagulation and assessed for the presence of RVT with venous compression ultrasound (CUS), using an internal diameter of the venous lumen ≥ 4 mm after compression as the criterion. Results RVT was present in 59 (46%) patients, and complete thrombus dissolution was present in 68 (54%) patients. Among them, mixed proximal and distal thrombosis (OR, 4.292; 95% CI, 1.253-14.707), diabetes (OR, 6.345; 95% CI, 1.125-35.786), fibrinogen > 4.145 g/L (OR, 2.858; 95% CI, 1.034-7.897), the time between detection of thrombus and initiation of antithrombotic therapy > 2.5 days (OR, 3.470; 95% CI, 1.085-11.094) was an independent risk factor for RVT in patients with posttraumatic DVT. Conclusion A mixed proximal and distal thrombosis, diabetes mellitus, late initiation of antithrombotic therapy, and high fibrinogen levels increase the risk of RVT in patients with posttraumatic DVT. Therefore, treatment regimens for patients with posttraumatic DVT can be adjusted according to the site of thrombosis, the presence of diabetes mellitus, and the level of fibrinogen, and antithrombotic therapy can be started as early as possible after the detection of thrombosis to prevent the development of RVT and its serious complications.
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Affiliation(s)
- Yating Liu
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China,Central South University, Changsha, Hunan, China
| | - Xiaozhi Deng
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China,Central South University, Changsha, Hunan, China
| | - Fang Zhu
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wenhui Zhu
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China,*Correspondence: Wenhui Zhu,
| | - Zheng Wang
- Department of Vascular Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China,Zheng Wang,
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19
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Ding Y, Li X, Zhou M, Wang Y, Zhou Z, Xie T, Guo D, Shi Z, Fu W. Minimal vessel area predicts in-stent restenosis in nonthrombotic iliac vein compression syndrome after stenting. Chin Med J (Engl) 2023; 136:111-113. [PMID: 36752786 PMCID: PMC10106142 DOI: 10.1097/cm9.0000000000002522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Indexed: 02/09/2023] Open
Affiliation(s)
- Yong Ding
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai 200032, China
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20
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Zeman J, Kompella R, Lee J, Kim AS. Case report: Non-thrombotic iliac vein lesion: an unusual cause of unilateral leg swelling in a patient with endometrial carcinoma. Front Cardiovasc Med 2023; 10:1115870. [PMID: 37200980 PMCID: PMC10185828 DOI: 10.3389/fcvm.2023.1115870] [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: 12/04/2022] [Accepted: 04/12/2023] [Indexed: 05/20/2023] Open
Abstract
81-year-old female presented with subacute right lower extremity edema due to iliac vein compression by a markedly enlarged external iliac lymph node later identified as newly relapsed metastatic endometrial carcinoma. The patient underwent a full evaluation of the iliac vein lesion and cancer and had an intravenous stent placed with complete resolution of symptoms post-procedure.
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Affiliation(s)
- Jan Zeman
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, United States
| | - Ritika Kompella
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, United States
| | - JuYong Lee
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, United States
- Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT, United States
| | - Agnes S. Kim
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, United States
- Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT, United States
- Correspondence: Agnes S. Kim
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21
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Divakaran S, Meissner MH, Kohi MP, Chen S, Song Y, Hawkins BM, Rosenfield K, Parikh SA, Secemsky EA. Utilization of and Outcomes Associated with Intravascular Ultrasound during Deep Venous Stent Placement among Medicare Beneficiaries. J Vasc Interv Radiol 2022; 33:1476-1484.e2. [PMID: 35998803 PMCID: PMC9758974 DOI: 10.1016/j.jvir.2022.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/07/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE To evaluate temporal trends, practice variation, and associated outcomes with the use of intravascular ultrasound (US) during deep venous stent placement among Medicare beneficiaries. MATERIALS AND METHODS All lower extremity deep venous stent placement procedures performed between January 1, 2017, and December 31, 2019 among Medicare beneficiaries were included. Temporal trends in intravascular US use were stratified by procedural setting and physician specialty. The primary outcome was a composite of 12-month all-cause mortality, all-cause hospitalization, or repeat target vessel intervention. The secondary outcome was a composite of 12-month stent thrombosis, embolization, or restenosis. RESULTS Among the 20,984 deep venous interventions performed during the study period, 15,184 (72.4%) utilized intravascular US. Moderate growth in intravascular US use was observed during the study period in all clinical settings. There was a variation in the use of intravascular US among all operators (median, 77.3% of cases; interquartile range, 20.0%-99.2%). In weighted analyses, intravascular US use during deep venous stent placement was associated with a lower risk of both the primary (adjusted hazard ratio, 0.72; 95% confidence interval [CI], 0.69-0.76; P < .001) and secondary (adjusted hazard ratio, 0.32; 95% CI, 0.27-0.39; P < .001) composite end points. CONCLUSIONS Intravascular US is frequently used during deep venous stent placement among Medicare beneficiaries, with further increase in use from 2017 to 2019. The utilization of intravascular US as part of a procedural strategy was associated with a lower cumulative incidence of adverse outcomes after the procedure, including venous stent thrombosis and embolization.
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Affiliation(s)
- Sanjay Divakaran
- Division of Cardiovascular Medicine and Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. https://twitter.com/SanjayDivakaran
| | - Mark H Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Maureen P Kohi
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Siyan Chen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Yang Song
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Beau M Hawkins
- Section of Cardiovascular Diseases, University of Oklahoma, Oklahoma City, Oklahoma
| | - Kenneth Rosenfield
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sahil A Parikh
- Division of Cardiovascular Medicine, Columbia University Medical Center, New York, New York
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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22
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Schrufer-Poland TL, Florio K, Grodzinsky A, Borsa JJ, Schmidt L. Management of May Thurner Syndrome in Pregnant Patients. J Cardiovasc Dev Dis 2022; 9:jcdd9120410. [PMID: 36547407 PMCID: PMC9784684 DOI: 10.3390/jcdd9120410] [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: 09/29/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022] Open
Abstract
May Thurner Syndrome contributes to thromboembolic disease and can cause significant morbidity in pregnant patients secondary to exaggerated anatomic relationships and physiologic changes in the hematologic system favoring thrombogenesis. Because this condition is both underrecognized and underreported, management in pregnant and postpartum patients is based on expert opinion without any formal evidence-based guidance. Herein, we review five pregnancies in four patients with May Thurner Syndrome and general management strategies. Through collaborative and multidisciplinary care, patients with May Thurner Syndrome can be safely and successfully managed during pregnancy and the postpartum period with appropriate anticoagulation.
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Affiliation(s)
- Tabitha L. Schrufer-Poland
- Maternal and Fetal Medicine, Saint Luke’s Health System, Kansas City, MO 64111, USA
- Cardiovascular Outcomes Research Department, Saint Luke’s Health System, Kansas City, MO 64111, USA
- Correspondence:
| | - Karen Florio
- Maternal and Fetal Medicine, Saint Luke’s Health System, Kansas City, MO 64111, USA
- Cardiovascular Outcomes Research Department, Saint Luke’s Health System, Kansas City, MO 64111, USA
| | - Anna Grodzinsky
- Cardiovascular Outcomes Research Department, Saint Luke’s Health System, Kansas City, MO 64111, USA
| | - John J. Borsa
- Department of Radiology, Saint Luke’s Health System, Kansas City, MO 64111, USA
- Department of Radiology, University of Missouri Kansas City, Kansas City, MO 64108, USA
| | - Laura Schmidt
- Cardiovascular Outcomes Research Department, Saint Luke’s Health System, Kansas City, MO 64111, USA
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23
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Wang H, Jia W, Xi Y, Li Y, Fan Y, Deng X, Chen Z. Morphometric and Hemodynamic Analysis of the Compressed Iliac Vein. J Endovasc Ther 2022:15266028221134895. [PMID: 36408873 DOI: 10.1177/15266028221134895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE To investigate the relationship between the morphological structure and hemodynamic properties of the compressed iliac vein and explore the reason for the formation of thrombosis in the compressed iliac vein. MATERIALS AND METHODS A total of 11 patients with iliac vein compression syndrome (IVCS) were included in this study, and their iliac veins were reconstructed in 3 dimensions (3D). The morphological structures of the iliac veins (confluence angle, degree of stenosis) were analyzed based on the 3D model. Variations in the hemodynamic properties of the iliac vein were investigated at 4 typical moments in one cardiac cycle, and the relationship between the different morphological configurations and the pressure difference was investigated. RESULTS In the region of the compressed iliac vein, the blood flow velocity is accelerated and the pressure changes abruptly accompanied by the increase in pressure difference. Higher time averaged wall shear stress (TAWSS) and lower relative residence time (RRT) appeared in stenosis regions of compressed iliac vein, while TAWSS was low and RRT was large near the stenosis position. There was a strong positive correlation between the degree of stenosis and the pressure difference (r=0.894), and a positive correlation between the confluence angle of the iliac vein and the pressure difference (r=0.638). CONCLUSION The morphological structure of the compressed iliac vein has an obvious influence on the hemodynamic surroundings; the pressure difference becomes larger when the degree of stenosis and the confluence angle increase. The iliac vein luminal areas with low TAWSS and high RRT near the compressed location can impede blood flow and lead to accumulation of blood components, which may increase the risk of thrombosis formation and should be fully considered in the treatment of IVCS.
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Affiliation(s)
- Hongyu Wang
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Wei Jia
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yifeng Xi
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yuan Li
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yubo Fan
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiaoyan Deng
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Zengsheng Chen
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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24
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Vasan V, Bai H, Chen J, Storch J, Kim J, Dionne E, Cho LD, Gonzalez C, Cooke PV, Kang Y, Rao A, Ting W. Iliac vein stenting outcomes for patients with superficial venous insufficiency concurrent with deep venous disease. J Vasc Surg Venous Lymphat Disord 2022; 10:1215-1220.e1. [PMID: 35952955 DOI: 10.1016/j.jvsv.2022.06.015] [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: 03/07/2022] [Revised: 06/12/2022] [Accepted: 06/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Many patients will present with chronic proximal venous outflow obstruction (PVOO) and superficial venous insufficiency (SVI) at the time of iliac vein stenting. In the present study, we aimed to determine whether differences in outcomes were present for patients receiving an iliac vein stent according to whether concurrent SVI was present. METHODS A registry of 553 patients who had undergone iliac vein stent placement for chronic PVOO from 2011 to 2021 was retrospectively analyzed. Two groups of patients were followed for ≤6 years after initial vein stent placement: group 1 (n = 178; 32.2%) had not had SVI before or after stent placement and group 2 (n = 375; 67.8%) had had SVI at initial iliac vein stent procedure. The patients' symptoms were evaluated using the venous clinical severity score (VCSS). Postoperative procedures after initial stent placement were recorded. Postoperative procedures included any operation performed after the index iliac vein stent procedure. Endovenous thermal ablation was classified as a minor postoperative procedure, and any intervention with venography was classified as a major postoperative reintervention. Multivariate regression models were used to determine the odds of a major reintervention or minor procedure postoperatively. RESULTS Across the two groups, the mean age (group 1, 65.3 years; group 2, 59.9 years; P < .001), body mass index (27.6 vs 26.1 kg/m2; P = .004), diabetes (32.6% vs 17.6%; P < .001), arterial hypertension (68.5% vs 42.1%; P < .001), and coronary artery disease (16.9% vs 9.6%; P = .048) differed significantly. The time to follow-up was similar between the two groups (P = .915). Longitudinally, both groups had had similar improvements in the composite VCSSs. After multivariable adjustment, group 2 was more likely than group 1 (odds ratio, 5.26; 95% confidence interval, 3.33-8.59; P < .001) to have required a postoperative minor procedure, but not a major reintervention. Group 2 had also averaged a shorter interval from the index procedure to a postoperative procedure than group 1 (525.7 days vs 258.1 days; P < .001). CONCLUSIONS Compared with patients without SVI, those with SVI and chronic PVOO were younger, had had fewer comorbidities, and fared similarly in the change in the composite VCSSs but were more likely to have required a minor procedure and less likely to have required a major reintervention after the index iliac vein stent procedure.
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Affiliation(s)
- Vikram Vasan
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Halbert Bai
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jenny Chen
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Jason Storch
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jinseo Kim
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elyssa Dionne
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Logan D Cho
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Peter V Cooke
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yeju Kang
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ajit Rao
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Windsor Ting
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Efficacy Analysis of Endovascular Therapy for Nonthrombotic Iliac Vein Compression Syndrome Combined with Chronic Venous Insufficiency. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2718314. [PMID: 35928969 PMCID: PMC9345696 DOI: 10.1155/2022/2718314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022]
Abstract
Purpose This research is aimed at elucidating the clinical efficacy of balloon dilatation (BD) plus stent implantation for nonthrombotic iliac vein compression syndrome (NIVCS) combined with chronic venous insufficiency (CVI) in different compression positions. Methods Sixty-five NIVCS patients comorbid with CVI admitted between December 2015 and April 2020 were selected and assigned to two groups according to different iliac vein compression positions. Both groups of patients received iliac vein BD + stent implantation, with the difference lying in that the tip of the stent was inserted 0.5-1 cm into the inferior vena cava (IVC) in the experimental group versus 2-3 cm in the control group. The technical success rate, the postoperative venous clinical severity score (VCSS), and the incidence of complications were compared. Results The technical success rate of both groups was 100%. Patients were followed up for 12-36 months (average: 25.5 ± 6.2). Decreases in VCSS were observed in both cohorts at 3, 6, 12, 24, and 36 months postoperatively compared with the preoperative scores, but with no statistical difference. There was no death, nor related complications such as restenosis and lower limb deep vein thrombosis during the follow-up period, with no statistical difference in the incidence of complications between groups. Conclusions BD + stent implantation is a safe and effective treatment for NIVCS with few complications and remarkable short-term and medium-term effects.
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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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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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Saleem T, Lucas M, Raju S. Comparison of intravascular ultrasound and magnetic resonance venography in the diagnosis of chronic iliac venous disease. J Vasc Surg Venous Lymphat Disord 2022; 10:1066-1071.e2. [PMID: 35561972 DOI: 10.1016/j.jvsv.2022.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The diagnosis of chronic iliofemoral venous obstruction (CIVO) can be made with several different modalities. Intravascular ultrasound (IVUS) is the gold standard in the diagnosis of CIVO. However, being invasive, it should not be the initial examination to screen patients with CIVO. The aim of this report is to compare the performance of magnetic resonance venography (MRV) to IVUS in the diagnosis of CIVO. METHODS From January, 2016 to December, 2020, records of all patients who underwent pre-operative MRV and then IVUS in the evaluation of CIVO were retrospectively analyzed. RESULTS 505 patients were evaluated by any modality for CIVO. 15% (78) of these patients were evaluated by MRV. Patients who had failed a trial of conservative therapy for at least 3 - 6 months and who had disabling and life-style limiting symptoms of CIVO were selected to undergo further evaluation with MRV at the treating physician's discretion. For inclusion in analysis, technically satisfactory IVUS and MRV data was mandatory. Data was available for 60 common iliac vein (CIV) segments and 61 external iliac vein (EIV) segments for comparative analysis after appropriate exclusions. The mean age of the patients was 56 ± 15 years. Male to female ratio was 1:2. The distribution of patients across different CEAP classes was as follows: CEAP 3: 28%, CEAP 4: 62%, CEAP 5: 2% and CEAP 6: 8%. Bland-Altman plots of mean difference in area between IVUS and MRI were 74.1% for CIV and 56.9% for EIV. The sensitivity of MRV was 93% and 100% while the specificity was 0 and 50% for CIV and EIV respectively. The positive predictive value was 93% and 86% while the negative predictive value was 0 and 50% for CIV and EIV respectively. Improvement was noted in clinical parameters (Venous Clinical Severity score; VCSS, visual analogue pain scale and grade of swelling) after IVUS and stenting following MRV investigation. For VCSS, the score improved from 6 ± 2.7 (pre-procedure) to 4 ± 2.7 (post-procedure), p=0.0001. CONCLUSION There is dimensional disparity between MRV and IVUS in the diagnosis of symptomatic CIVO. MRV has a high sensitivity but low specificity when compared to IVUS and overestimates the severity of the stenosis in both the EIV and CIV. MRV is not a reliable diagnostic tool for iliac vein stenosis and should not be used for the definitive disposition of CIVO patients.
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Affiliation(s)
- Taimur Saleem
- The RANE Center for Venous and Lymphatic Diseases, Jackson, MS 39216.
| | - Michael Lucas
- The RANE Center for Venous and Lymphatic Diseases, Jackson, MS 39216
| | - Seshadri Raju
- The RANE Center for Venous and Lymphatic Diseases, Jackson, MS 39216
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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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Wang H, Sun A, Li Y, Xi Y, Fan Y, Deng X, Chen Z. A systematic review of DVT and stent restenosis after stent implantation for iliac vein compression syndrome. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Thangjui S, Trongtorsak A, Zoltick JM, Doyle A. May-Thurner Syndrome in an Elderly Man. Cureus 2022; 14:e21611. [PMID: 35228968 PMCID: PMC8872673 DOI: 10.7759/cureus.21611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 01/18/2023] Open
Abstract
May-Thurner syndrome (MTS) is a rare cause of deep vein thrombosis (DVT). This diagnosis is seldomly included in the differential diagnosis. The disease is defined as extraluminal iliac vein compression by the arterial system against bony structures in the iliocaval area. This occurs more commonly on the left side due to the unfortunate position of the proximal left iliac vein that runs between the right common iliac artery and spine. MTS is commonly presented in younger female patients with left unilateral proximal DVT. However, MTS is rarely reported in elderly patients. We present a case of a 69-year-old man with a diagnosis of MTS and further management with a venous stent.
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Liu Q, Liu F, Lü P, Wu HX, Ye P, You Y, Yao Z. Current Status and Prospect of Stent Placement for May-Thurner Syndrome. Curr Med Sci 2021; 41:1178-1186. [PMID: 34918176 DOI: 10.1007/s11596-021-2481-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
Stent implantation has been proven to be safe and has become the first-line intervention for May-Thurner syndrome (MTS), with satisfactory mid-term patency rates and clinical outcomes. Recent research has demonstrated that catheter-directed thrombolysis is the preferred strategy when MTS is combined with deep vein thrombosis after self-expanding stent placement. However, the stent used for the venous system was developed based on the experience obtained in the treatment of arterial disease. Consequently, relatively common corresponding complications may come along later, which include stent displacement, deformation, and obstruction. Different measures such as adopting a stent with a larger diameter, improving stent flexibility, and increasing stent strength have been employed in order to prevent these complications. The ideal venous stent is presently being evaluated and will be introduced in detail in this review.
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Affiliation(s)
- Qin Liu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Fang Liu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ping Lü
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Hong-Xiao Wu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Pin Ye
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yun You
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhong Yao
- Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, Ontario, M5S 2E8, Canada
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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: 1] [Impact Index Per Article: 0.3] [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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Jin W, Yu G, Huang J, Lu K, Huang C. Timing of Endovascular Interventions for Iliac Vein Compression Syndrome With Thrombus. Clin Appl Thromb Hemost 2021; 27:10760296211026974. [PMID: 34151610 PMCID: PMC8221663 DOI: 10.1177/10760296211026974] [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] [Indexed: 11/30/2022] Open
Abstract
The aim of this study is to explore the timing and method of endovascular intervention for iliac vein compression syndrome (IVCS) with thrombus. Data from 111 patients with IVCS, complicated acute deep vein thrombosis (DVT), or post-thrombotic syndrome (PTS) who underwent endovascular interventions were analyzed retrospectively. Patients were divided into Group A (DVT group), including 56 patients with IVCS and iliofemoral DVT, with or without femoropopliteal DVT, with sudden lower limb swelling, and Group B (PTS group) included 55 patients with IVCS and PTS, including 18 with lower extremity wet ulcers and 32 with lower limb infections. Interventional therapies were used to treat the thrombus and eliminate stenosis and occlusion of the iliac vein. In both groups, clinical symptoms in the lower limbs after surgery were reduced significantly, and PTS incidence was low during long-term follow-up. The cumulative patency rate was 75.2% in the DVT group and 88.6% in the PTS group. Comprehensive interventional therapies are safe and effective in patients with IVCS and thrombi. Long-term efficacy in the PTS group tended to be better than that in the DVT group.
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Affiliation(s)
- Wenxu Jin
- Department of Vascular Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guanfeng Yu
- Department of Vascular Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jingyong Huang
- Department of Vascular Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kangkang Lu
- Department of Breast and Thyroid Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chongqing Huang
- Department of Vascular Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Tanaka ME, Kutsenko O, Salazar G. Choosing the Most Appropriate Treatment Option for Pelvic Venous Disease: Stenting versus Embolization. Semin Intervent Radiol 2021; 38:182-188. [PMID: 34108804 DOI: 10.1055/s-0041-1727104] [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: 10/21/2022]
Abstract
Pelvic venous disease (PeVD) in women encompasses a wide variety of entities all resulting in pelvic pain and varices. Successful treatment with percutaneous interventions is dependent on identifying underlying factors contributing to the disease and addressing them with either embolization of incompetent veins or stenting for venous stenoses. There are a multitude of embolization methods with marked practice heterogeneity. Moreover, with the ongoing development of dedicated venous stents in the treatment of chronic venous disease, there are more opportunities to consider this modality for the treatment of PeVD, as many patients present with combined vein reflux and central venous stenosis. The necessity to address both and the order of interventions in these patients is still to be elucidated. Here, we describe when to choose stenting or embolization for PeVD, their limitations, and our practice and identify further areas of research in this field.
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Affiliation(s)
- Mari E Tanaka
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Oleksandra Kutsenko
- Department of Radiology, SUNY Upstate University Hospital, Syracuse, New York
| | - Gloria Salazar
- Division of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Cohen CT, Kirk S, Desai SB, Kukreja KU, Srivaths L. Diagnosis, Clinical Characteristics, and Treatment Modalities of Adolescent May-Thurner Syndrome-associated Deep Venous Thrombosis. J Pediatr Hematol Oncol 2021; 43:e346-e350. [PMID: 33093351 DOI: 10.1097/mph.0000000000001968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/13/2020] [Indexed: 12/17/2022]
Abstract
May-Thurner syndrome (MTS) predisposes individuals to develop lower extremity deep venous thrombosis (DVT) because of compression of the left common iliac vein. Diagnosis of the anatomic obstruction is critical for effective therapy, as treatment by interventional radiology is often required in addition to anticoagulation to prevent thrombus progression and recurrence. The authors performed a retrospective review of adolescent patients who presented with MTS-associated DVT at a pediatric tertiary care center from 2009 to 2018 to assess for delays in MTS diagnosis after the presentation. Fourteen patients (median age 16.5 y, range, 13.8 to 17.9 y) were included, no DVTs were provoked by a central venous catheter. The median time from DVT to MTS diagnosis was 0.65 months (range, 0 to 21.5 mo). The initial imaging modalities used for DVT diagnosis were not able to diagnosis MTS. All patients were treated with anticoagulation and 13 underwent interventional therapy. Four patients had thrombus progression or recurrence, whereas 6 had complete thrombus resolution on follow-up imaging. Three patients who had a delayed MTS diagnosis had clinical worsening despite therapeutic anticoagulation requiring rehospitalization. Adolescent patients with "unprovoked" left lower extremity DVT should undergo appropriate imaging to diagnose MTS to allow for adequate medical and interventional therapy.
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Affiliation(s)
- Clay T Cohen
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers
| | - Susan Kirk
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers
| | - Sudhen B Desai
- Department of Radiology, Section of Interventional Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Kamlesh U Kukreja
- Department of Radiology, Section of Interventional Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Lakshmi Srivaths
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers
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Miyashita H, Tobita K, Morishita E, Saito S. Ilio-femoral venous thrombosis with hereditary antithrombin deficiency: a case report of rare thrombotic disease and successful treatment with catheter directed thrombolysis. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytaa531. [PMID: 33738401 PMCID: PMC7954265 DOI: 10.1093/ehjcr/ytaa531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/24/2020] [Accepted: 11/21/2020] [Indexed: 11/14/2022]
Abstract
Background Hereditary antithrombin (AT) deficiency is an uncommon autosomal dominant thrombogenic disorder, which can cause venous thromboembolism (VTE). Although conservative treatment options for hereditary AT deficiency-associated VTE such as anticoagulation (warfarin, direct oral anticoagulant, or heparin), intravenous thrombolysis, and recombinant AT are well known, interventional treatment options have not been reported so far. Case summary A 19-year-old man with a family history of thrombogenic diseases, referred to our hospital with left leg pain, was diagnosed with AT deficiency-associated VTE. In the absence of symptomatic relief with intravenous thrombolysis and anticoagulation, he received venous intervention and catheter directed thrombolysis (CDT) for 4 days for left iliac venous thrombosis. Following a second venous intervention, venous thrombus disappeared almost entirely on cross-sectional imaging, and his symptoms improved. He was discharged on apixaban and has been recurrence-free for one and a half years. Discussion This case presents CDT and maintenance therapy with apixaban as possible treatment options for VTE in patients with hereditary AT deficiency, especially following failure of conservative therapy. Individual risks and benefits should be considered when CDT is performed for acute VTE in patients with AT deficiency.
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Affiliation(s)
- Hirokazu Miyashita
- Department of Cardiology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura 247-8533, Japan
| | - Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura 247-8533, Japan
| | - Eriko Morishita
- Department of Clinical Laboratory Science, Kanazawa University School of Medical Science, Kanazawa, Japan
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura 247-8533, Japan
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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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Grilli CJ, Leung DA, Chedrawy C, Garcia MJ, Kimbiris G, Agriantonis DJ, Putnam SG, Graif A. The Protégé Nitinol Self-Expanding Stent for the Treatment of Iliofemoral Veno-Occlusive Disease. Cardiovasc Intervent Radiol 2021; 44:558-564. [PMID: 33506282 DOI: 10.1007/s00270-020-02747-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the safety and effectiveness of the Protégé nitinol self-expanding stent for the treatment of iliofemoral veno-occlusive disease. MATERIALS AND METHODS A retrospective review was performed of 376 (284 left, 92 right) Protégé stents in 212 limbs of 183 patients (mean age: 53 ± 17 years, 52% female) treated for iliofemoral veno-occlusive disease between 2011 and 2018. Binary patency was assessed with duplex ultrasound and calculated by Kaplan Meier analysis. Clinical outcomes were evaluated by clinical-etiology-anatomy-pathophysiology (CEAP) classification and Villalta scores. Adverse events were recorded and categorized per Society of Interventional Radiology reporting standards. RESULTS Of the 212 limbs, 125 presented with acute thrombosis and 28 with chronic thrombosis requiring thrombectomy (n = 44), catheter directed thrombolysis (n = 32), or both (n = 77). Fifty-nine limbs were non-thrombotic. Mean follow-up time was 11.44 ± 11.37 months. Kaplan Meier analysis revealed a primary limb-level patency of 92.3%, 88.6%, 86.9% and 86.9% at 6, 12, 24 and 36 months, respectively. CEAP and Villalta scores improved from a median of C3 (range: 0-6) to C1 (0-5) (p < 0.001) and from a mean of 13.4 ± 7.5 to 5.3 ± 4.9 (p < 0.001), respectively. Nine minor and 2 major adverse events were recorded. CONCLUSIONS Endovascular treatment of iliofemoral veno-occlusive disease with the Protégé self-expanding stent appears to have good mid-term patency. LEVEL OF EVIDENCE Level 4, Case Series.
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Affiliation(s)
- Christopher J Grilli
- Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Ste 1e20, Newark, DE, 19713, USA
| | - Daniel A Leung
- Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Ste 1e20, Newark, DE, 19713, USA
| | - Christelle Chedrawy
- Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Ste 1e20, Newark, DE, 19713, USA
| | - Mark J Garcia
- Endovascular Consultants, 701 N Clayton St, Suite 601 MSB, Wilmington, DE, 19805, USA
| | - George Kimbiris
- Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Ste 1e20, Newark, DE, 19713, USA
| | - Demetrios J Agriantonis
- Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Ste 1e20, Newark, DE, 19713, USA
| | - Samuel G Putnam
- Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Ste 1e20, Newark, DE, 19713, USA
| | - Assaf Graif
- Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Rd, Ste 1e20, Newark, DE, 19713, USA.
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Zaccaria A, Migliavacca F, Contassot D, Heim F, Chakfe N, Pennati G, Petrini L. Finite Element Simulations of the ID Venous System to Treat Venous Compression Disorders: From Model Validation to Realistic Implant Prediction. Ann Biomed Eng 2021; 49:1493-1506. [PMID: 33398616 PMCID: PMC8137589 DOI: 10.1007/s10439-020-02694-8] [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: 07/30/2020] [Accepted: 11/13/2020] [Indexed: 12/17/2022]
Abstract
The ID Venous System is an innovative device proposed by ID NEST MEDICAL to treat venous compression disorders that involve bifurcations, such as the May-Thurner syndrome. The system consists of two components, ID Cav and ID Branch, combined through a specific connection that prevents the migration acting locally on the pathological region, thereby preserving the surrounding healthy tissues. Preliminary trials are required to ensure the safety and efficacy of the device, including numerical simulations. In-silico models are intended to corroborate experimental data, providing additional local information not acquirable by other means. The present work outlines the finite element model implementation and illustrates a sequential validation process, involving seven tests of increasing complexity to assess the impact of each numerical uncertainty separately. Following the standard ASME V&V40, the computational results were compared with experimental data in terms of force-displacement curves and deformed configurations, testing the model reliability for the intended context of use (differences < 10%). The deployment in a realistic geometry confirmed the feasibility of the implant procedure, without risk of rupture or plasticity of the components, highlighting the potential of the present technology.
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Affiliation(s)
- Alissa Zaccaria
- LaBS, Department of Chemistry Materials and Chemical Engineering, Politecnico di Milano, Milan, Italy
| | - Francesco Migliavacca
- LaBS, Department of Chemistry Materials and Chemical Engineering, Politecnico di Milano, Milan, Italy
| | | | - Frederic Heim
- Laboratoire de Physique et Mécanique Textiles (LPMT), Université de Haute-Alsace, Mulhouse, France.,Groupe Européen De Recherche Sur Les Prothèses Appliquées À La Chirurgie Vasculaire (GEPROVAS), Strasbourg, France
| | - Nabil Chakfe
- Groupe Européen De Recherche Sur Les Prothèses Appliquées À La Chirurgie Vasculaire (GEPROVAS), Strasbourg, France.,Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Giancarlo Pennati
- LaBS, Department of Chemistry Materials and Chemical Engineering, Politecnico di Milano, Milan, Italy
| | - Lorenza Petrini
- Department of Civil and Environmental Engineering, Politecnico di Milano, Milano, Italy.
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Ji L, Yang F, Chen X, Chen J, Cheng X, Yin J, Qin Y, Yang S. Case Report: Rare Iliac Vein Compression (May-Thurner) Syndrome in a Pediatric Patient. Front Pediatr 2021; 9:694782. [PMID: 34336743 PMCID: PMC8319599 DOI: 10.3389/fped.2021.694782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/11/2021] [Indexed: 11/30/2022] Open
Abstract
Iliac vein compression syndrome (IVCS) or May-Thurner syndrome occurs predominantly in young to middle-aged women. Here we reported a case of IVCS in a 5-year-old boy. The child was admitted to our vasculocardiology department with left lower extremity that had been swollen for 1 month. Blood tests revealed coagulation routine and platelets in the normal ranges. Computer tomography angiography (CTA) and magnetic resonance imaging (MRI) showed the left common iliac vein had become narrow before it entered the right common iliac vein. To further clarify, we performed angiography, which clearly showed the stenosis and the blood return of the left common iliac vein. So IVCS was diagnosed. What is more, we found the aorta descended to the right of the spine, and this may be the reason for the apparent compression of the left common iliac vein. Given the young age and mild symptoms of the child, the treatment was conservative mainly including elevation of the affected limb, wearing medical elastic socks, and short-term oral aspirin for anticoagulation. Meanwhile, the boy is being followed up closely. If the swelling of the left lower extremity significantly increases, stent placement may need to be considered in the future.
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Affiliation(s)
- Lianfu Ji
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Fan Yang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xuan Chen
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jinlong Chen
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xueying Cheng
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Yin
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yuming Qin
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Shiwei Yang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
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43
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Tips on the endovascular treatment of May-Thurner syndrome. ANGIOLOGIA 2021. [DOI: 10.20960/angiologia.00239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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44
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Aurshina A, Huber S, Deng Y, Attaran R, Nassiri N, Dardik A, Ochoa Chaar CI. Correlation of venous symptoms with iliac vein stenosis on magnetic resonance imaging. J Vasc Surg Venous Lymphat Disord 2020; 9:1291-1296.e1. [PMID: 33387666 DOI: 10.1016/j.jvsv.2020.12.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/20/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is used in patients with lower extremity venous disease to screen for iliac vein stenosis. The objective of the present study was to determine the prevalence of iliac vein stenosis and associated lower extremity venous symptoms in consecutive patients undergoing MRI of the pelvis. METHODS A retrospective study of all consecutive adult patients who had undergone MRI of the pelvis for various indications from March 2012 to June 2016 was performed. The electronic medical records (EMRs) were reviewed for patient characteristics and, specifically, for the presence and laterality of venous symptoms. All MRI scans were reviewed, and the maximal degree of iliac vein stenosis was recorded. All the patients also responded to a brief telephone survey inquiring about the presence of venous symptoms. Two thresholds of venous stenosis, ≥50% and ≥70%, were used to correlate its presence with the presence of venous symptoms determined from the EMR review and telephone survey results. RESULTS A total of 120 patients were included, with a mean age of 53 ± 14 years; 79% were women and 79% were white. The prevalence of iliac vein stenosis ≥50% was significantly greater on the left than on the right (34.2% vs 16.7%; P < .001). The survey demonstrated that 44 of the 120 patients (36.7%) had had venous symptoms compared with only 30 patients (25%) according to the EMR review (P = .001). No differences were found between patients with positive vs negative survey results for venous symptoms and the occurrence of iliac vein stenosis ≥50% on the right (17.2% vs 15.2%; P = .78) or the left (38% vs 26.8%; P = .22). We also found no differences when the occurrence of iliac vein stenosis ≥70% was used as threshold between the right (2.3% vs 3%; P = .99) and the left (10.1% vs 2.4%; P = .16). Analysis of the venous symptoms from the EMR review yielded similar results. CONCLUSIONS In our study, iliac vein stenosis was more common on the left and was encountered in up to one third of patients who had undergone MRI of the pelvis. No correlation was found in our study between the presence of iliac vein stenosis and the occurrence of ipsilateral venous symptoms. Venous symptoms were underreported in the EMRs. Further studies are necessary to identify the predictors of pathologic iliac vein stenosis.
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Affiliation(s)
- Afsha Aurshina
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Steffen Huber
- Department of Radiology, Yale University School of Medicine, New Haven, Conn
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale University School of Medicine, New Haven, Conn
| | - Robert Attaran
- Section of Cardiology, Yale University School of Medicine, New Haven, Conn
| | - Naiem Nassiri
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Alan Dardik
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
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Zhao Z, Zhang H, Liu B, Shi H, Liu X, Ye K, Wang R, Qin J, Li W, Jiang M, Lu X, Yin M. Three-dimensional computed tomography venography reconstruction facilitates identification of atypical radiologic features of May-Thurner syndrome. J Vasc Surg Venous Lymphat Disord 2020; 9:946-953. [PMID: 33248296 DOI: 10.1016/j.jvsv.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE May-Thurner syndrome (MTS) is typically characterized by compression of the left common iliac vein by the overlying right common iliac artery. The present study evaluated the occurrence of atypical imaging features of MTS using three-dimensional computed tomography venography reconstruction (3D-CTV) and analyzed their correlation with clinical features. METHODS We analyzed the data from 268 patients with left lower extremity chronic venous disease (CVD) using 3D-CTV at a single institution from January to June 2019. An area stenosis percentage >50% was defined as significant venous compression. Of the 268 patients, 92 had at least one significant iliac and/or vena cava compression confirmed by 3D-CTV. Of the 92 patients, 89 underwent digital subtraction venography via the left common femoral vein, and the outcomes were compared with their 3D-CTV findings. Different types of venous compression were evaluated using 3D-CTV. The relationship among compression type, sex, age, and CVD symptoms was evaluated. RESULTS A total of 106 venous compression sites were found in 92 patients. Atypical compression included inferior vena cava (IVC) compression and partial IVC compression (8.5% and 55.7%, respectively). Multiple compression sites were present in 13 patients (14.1%). The compression sites correlated significantly with clinical symptoms (P = .017) and were related to sex (P = .001). The number of patients with IVC and partial IVC compression but false-negative venography findings was four (33.3%) and six (50%), respectively. CONCLUSIONS 3D-CTV facilitates the detection of atypical venous compression in patients with MTS with notable chronic symptoms. Patients with multiple compression sites had more severe clinical symptoms and greater false-negative rates with venography. IVC compression was more likely to occur in female patients with MTS.
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Affiliation(s)
- Zhen Zhao
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China
| | - Hongze Zhang
- Emergency Critical Care Division, Shanghai Songjiang District Central Hospital, Songjiang Hospital affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China
| | - Bing Liu
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Huihua Shi
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China
| | - Xiaobing Liu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China
| | - Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China
| | - Ruihua Wang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China
| | - Weimin Li
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China; Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Mier Jiang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China; Vascular Center of Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China; Vascular Center of Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Minyi Yin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China; Vascular Center of Shanghai JiaoTong University, Shanghai, People's Republic of China.
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Li M, Zhang L, Zhang K, Zhu Y, Shi Z, Zhang W, Gao B, Li L, Fang Z, Yin L, Chen B, Liu Z. An efficacy and safety study of rivaroxaban for the prevention of deep vein thrombosis in patients with left iliac vein compression treated with stent implantation (PLICTS): study protocol for a prospective randomized controlled trial. Trials 2020; 21:811. [PMID: 32993773 PMCID: PMC7526216 DOI: 10.1186/s13063-020-04742-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Balloon dilatation with stent implantation has been proved to be an effective option for left iliac vein compression syndrome (LIVCS), but thrombosis may still occur after the operation. Currently, warfarin is used for anticoagulant therapy, but long-term monitoring is required, while rivaroxaban does not need laboratory monitoring, which can simplify treatment. Therefore, this study aimed to compare the efficacy and safety of rivaroxaban and warfarin in anticoagulation. METHODS This study is a multicenter, randomized controlled trial. We will recruit 224 patients with thrombotic LIVCS from 9 hospitals. Moreover, these patients will be randomized to either the experimental group (rivaroxaban) or the control group (warfarin plus nadroparin). The primary outcome is stent occlusion rate. Secondary outcomes are quality of life scale survey results, all-cause mortality, anticoagulation-related mortality, and the proportion of participants with stent displacement/fracture, thrombosis, hemorrhage, and other vascular events. DISCUSSION This study will provide reliable, evidence-based clinical evidence for the efficacy and safety of rivaroxaban antithrombotic therapy after stent implantation. TRIAL REGISTRATION ClinicalTrials.gov NCT04067505 . Registered on August 26, 2019.
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Affiliation(s)
- Miaomiao Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China.,School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Libin Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China
| | - Kaijie Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital of Zhejiang University, School of Medicine, Hangzhou, 310016, China
| | - Yuefeng Zhu
- Department of Vascular Surgery, Sir Run Run Shaw Hospital of Zhejiang University, School of Medicine, Hangzhou, 310016, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Zhongshan Hospital of Fudan University, Shanghai, 210023, China
| | - Wan Zhang
- Department of Vascular Surgery, Huadong Hospital of Fudan University, Shanghai, 210023, China
| | - Bin Gao
- Department of Vascular Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Lubin Li
- Department of Vascular Surgery, Yantai Yuhuangding Hospital, Yantai, 264000, China
| | - Zhengdong Fang
- Department of Vascular Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China
| | - Li Yin
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China
| | - Bing Chen
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China
| | - Zhenjie Liu
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China.
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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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Esposito A, Charisis N, Kantarovsky A, Uhl JF, Labropoulos N. A Comprehensive Review of the Pathophysiology and Clinical Importance of Iliac Vein Obstruction. Eur J Vasc Endovasc Surg 2020; 60:118-125. [DOI: 10.1016/j.ejvs.2020.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/17/2020] [Accepted: 03/18/2020] [Indexed: 12/28/2022]
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Novel Diagnostic Options without Contrast Media or Radiation: Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging in Treating Different Leg Venous Diseases. Diagnostics (Basel) 2020; 10:diagnostics10060355. [PMID: 32485855 PMCID: PMC7344462 DOI: 10.3390/diagnostics10060355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Venous diseases in the lower extremities long lacked an objective diagnostic tool prior to the advent of the triggered angiography non-contrast-enhanced (TRANCE) technique. METHODS An observational study with retrospective data analysis. MATERIALS Between April 2017 and June 2019, 66 patients were evaluated for venous diseases through TRANCE-magnetic resonance imaging (MRI) and were grouped according to whether they had occlusive venous (OV) disease, a static venous ulcer (SU), or symptomatic varicose veins (VV). The clinical appliance of TRANCE-MRI was analysed by groups. RESULTS In total, 63 patients completed the study. TRANCE-MRI could identify venous thrombosis, including that of the abdominal and pelvic vessels, and it enabled the timely treatment of underlying diseases in patients with OV disease. TRANCE-MRI was statistically compared with the duplex scan, the gold standard to exclude deep vein thrombosis (DVT) in the legs, with regard to their abilities to detect venous thrombosis by using Cohen's kappa coefficient at a compatible value of 0.711. It could provide the occlusion degree of the peripheral artery for treating an SU. Finally, TRANCE-MRI can be used to outline all collateral veins and occult thrombi before treating symptomatic or recurrent VV to ensure a perfect surgical plan and to avoid complications. CONCLUSIONS TRANCE-MRI is an innovative tool in the treatment of versatile venous pathology in the lower extremities and is widely used for vascular diseases in our institution.
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Salahuddin T, Armstrong EJ. Intervention for Iliofemoral Deep Vein Thrombosis and May-Thurner Syndrome. Interv Cardiol Clin 2020; 9:243-254. [PMID: 32147124 DOI: 10.1016/j.iccl.2019.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
May-Thurner syndrome, also known as iliac vein compression syndrome, may cause symptoms of venous hypertension and is a predisposing factor for the development of iliofemoral deep vein thrombosis (DVT). Iliofemoral DVT is associated with high rates of development of postthrombotic syndrome, a potentially debilitating condition associated with development of symptoms related to venous outflow obstruction and resulting in reduced quality of life. In this Clinics article, we review procedural intervention with catheter-directed thrombolysis and stenting for iliofemoral DVT and iliac vein compression.
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Affiliation(s)
- Taufiq Salahuddin
- Cardiology Section, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling Street, Aurora, CO 80045, USA
| | - Ehrin J Armstrong
- Cardiology Section, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling Street, Aurora, CO 80045, USA; Interventional Cardiology, Vascular Laboratory, Rocky Mountain Regional VA, Division of Cardiology, University of Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
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