Case Report: Rare Iliac Vein Compression (May–Thurner) Syndrome in a Pediatric Patient

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.

May-Thurner Syndrome, an Often Overlooked Cause of Deep Vein Thrombosis: A Case Report

Deep vein thrombosis (DVT) is a common medical condition, but the predisposing anatomical factors, which may be amenable to definitive treatment, are usually overlooked. Therefore, a high index of clinical suspicion is the key to early diagnosis. We report here one such case of May-Thurner syndrome (MTS) to raise awareness. MTS (also known as iliac vein compression syndrome) should be suspected in cases of extensive DVT of the leg, particularly involving the iliac vein on the left side. The prognosis is improved with thrombolysis followed by angioplasty and stent to address the venous stenosis.

Comparing the efficacy of endovascular treatment for iliac vein compression syndrome with or without acute deep venous thrombosis: A single-center retrospective study

Background To compare the efficacy of endovascular treatment for iliac vein compression syndrome (IVCS) with or without acute deep venous thrombosis of lower extremity. Methods This study retrospectively analyzed the clinical data of 300 IVCS patients, who received endovascular treatment between January 2013 and December 2017. According to whether IVCS was complicated by deep venous thrombosis or not, these patients were divided into non-thrombotic iliac vein lesion group (NIVL group, n = 127) and post-thrombotic iliac vein lesion group (PIVL group, n = 173). After endovascular treatment, all patients were followed up to assess the symptoms improvement and to evaluate the patency of iliac vein. Results The technical success rate was 98% (294/300), and percutaneous transluminal angioplasty with stenting was adopted in 294 cases. The incidence of perioperative complications was 36.33% (109/300), but no severe complications occurred. During a mean follow-up of 22.3 months (range 6–30 months), 9(6.82%, 9/132) patients in PIVL group had recurrence of deep venous thrombosis, but nobody had deep venous thrombosis and varicose veins recurrence in NIVL group. The effective rate of endovascular treatment in NIVL group and PIVL group was 96.88% and 90.15% ( P = 0.050), while the cumulative primary patency of iliac vein in NIVL group was significantly higher than that in PIVL group ( P = 0.008). Conclusions The endovascular treatment is an effective, feasible, safe method for treating IVCS. There is no difference in the efficacy of IVCS patients with or without deep venous thrombosis, but the medium and long-term patency of patients with deep venous thrombosis is lower than that in patients without deep venous thrombosis.

Iatrogenic Venous Compression Syndrome due to Surgical Lumbar Hardware

Background: The Iliac vein compression syndrome (IVCS) is most commonly due to May-Thurner variant, an anatomic variant where in the right common iliac artery overlies the left common iliac vein and compresses it against the lumbar spine. The compression of the common venous outflow tract of the left lower extremity may cause discomfort, swelling, or deep vein thrombosis in the iliofemoral veins. The role of the pelvic surgery particularly the lumbar hardware in the development of symptomatic Venous compression syndrome in patients with May-Thurner syndrome is not well understood. The incidence is presumably very low. Herein, we present six patients who developed IVCS after Lumbar hardware. Method: The cases were diagnosed between Nov. 2016 to Oct. 2019 in the Outpatient Cath Lab of McKinney, TX. The patient’s medical records were retrospectively analyzed looking for risk factors, clinical features, venogram findings, and post venogram. The evaluation of each case was described, and common trends were later presented in a cross-case analysis. Conclusion: The cases presented in this report suggest that the hardware used in lumbar/spinal surgery could lead to an IVCS. Patient’s symptoms are unspecific. Venogram/venoplasty is the gold standard for diagnosis and treatment. It is imperative having a high level of suspicion and familiarizing with the natural history of IVCS due to the invasive nature of venogram and the relevance of an early diagnosis to reduce the occurrences of complications. Keywords: Venous disease, Iliac vein compression, May-Thurner syndrome, Lumbar surgery complications, Unexplained edema of left leg, May-Thurner Syndrome, Lumbar hardware, Venous compression, IVUS, Venogram, Angioplasty

Iliac vein stenting guided by intravascular ultrasound without iodinated contrast medium

Summary: Iliac vein compression syndrome, also known as May-Thurner Syndrome, is a type of vein reflux disorders which is often ignored due to lack of efficient diagnostic methods. The traditional gold standard of diagnosis is venography, but this has been challenged and largely replaced by intravascular ultrasound (IVUS). Here we report a case that a patient suffered with iodine anaphylaxis was successfully performed iliac vein stenting guided by using IVUS alone. This case provides the evidence that IVUS can offer necessary information for physicians in the diagnosis and treatment of iliac vein compression. We also find that balloon dilatation notch cannot precisely reflect the whole lesion, indicating it may be unreliable for diagnosis. Differ from the commonly accepted opinion, we find that comparing to IVUS, the notch of balloon dilatation cannot completely reflect the extent of lesion narrowness. Thus, we think the notch should not be used as a reference for seriousness of the lesion, and the diagnosis of stenosis cannot be ruled out even if there is no presence of notch.