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Schlager O, Wolf F, Mueller M, Gschwandtner ME, Loewe C, Koppensteiner R, Beitzke D, Willfort-Ehringer A. Closure of Post-thrombotic Iliac Arteriovenous Fistulas by Iliac Vein Recanalization. J Endovasc Ther 2024; 31:157-163. [PMID: 35980088 PMCID: PMC10773157 DOI: 10.1177/15266028221113745] [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: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to report the closure of iliac arteriovenous fistulas associated with a post-thrombotic iliac vein occlusion by iliac venous stent recanalization. CASE REPORT An 80-year-old woman presented with a worsening painful swelling of her left leg after an iliofemoral deep vein thrombosis 6 months ago. Duplex ultrasound and magnetic resonance venography revealed a post-thrombotic obstruction of her iliac veins as well as several arteriovenous fistulas between branches of her left external and internal iliac arteries and adjacent diseased venous segments. In a first attempt, coil embolization did not sustainably close these iliac arteriovenous fistulas. Direct stent recanalization of the chronically diseased iliofemoral venous segment, however, resulted in an immediate closure of arteriovenous shunt flow and subsequent improvement of clinical symptoms. Six months after iliac vein stent recanalization, still no fistulas could be detected any more, venous stents were fully patent, and the patient was free of symptoms. CONCLUSION Post-thrombotic iliofemoral obstructions might be associated with the development of arteriovenous fistulas. Direct stent recanalization of the chronically occluded veins results in closure of related arteriovenous fistulas. CLINICAL IMPACT This case suggests that the combined occurrence of post-thrombotic venous obstructions with arteriovenous fistulas, which are related to aforementioned venous lesions, should be evaluated for primary venous stent recanalization rather than fistula embolization.
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Affiliation(s)
- Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Florian Wolf
- Division of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Markus Mueller
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Michael E. Gschwandtner
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Renate Koppensteiner
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Kim TH, Yeon JW, Kim HJ, Jang SK. Ilio-Iliac Arteriovenous Fistula with May-Thurner Syndrome: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:235-239. [PMID: 38362386 PMCID: PMC10864154 DOI: 10.3348/jksr.2023.0049] [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: 05/01/2023] [Revised: 06/19/2023] [Accepted: 08/10/2023] [Indexed: 02/17/2024]
Abstract
An ilio-iliac arteriovenous fistula (AVF) is rare. Common factors leading to ilio-iliac AVF include congenital malformations, iatrogeny, and trauma. There is limited documentation in the literature of cases involving ilio-iliac AVF with May-Thurner syndrome. Here, we present a case of an ilio-iliac AVF with May-Thurner syndrome in an 80-year-old male. CT and angiography confirmed extensive ilio-iliac AVF. Successful endovascular procedures for ilio-iliac AVF were performed using several variable-sized coils and 1400-2000 µm gelatin particles. After embolization, follow-up abdominopelvic CT revealed an improvement in edema in the left leg.
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Nakajima Y, Aramaki N, Kishi K, Tamura M, Nakatsuka S, Jinzaki M, Inoue M. Secondary arteriovenous malformation due to subclavian vein occlusion. Radiol Case Rep 2022; 17:3591-3594. [PMID: 35923329 PMCID: PMC9340079 DOI: 10.1016/j.radcr.2022.06.094] [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: 06/02/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 11/24/2022] Open
Abstract
An 80-year-old man underwent rectal resection and insertion of a central venous catheter through the left subclavian vein 16 years earlier. Following surgery, he developed edema of his left upper limb that became exacerbated and infected. Computed tomography showed occlusion of the subclavian vein and multiple arteriovenous shunts from the branches of the axillary artery to the venous sac of the axillary vein. Angiography confirmed numerous shunts between the branches of the axillary artery and vein and dilated collateral veins. Embolization of the venous sac was performed using coils, alcohol, and glue. Postprocedural angiography showed complete eradication of the nidus.
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Hoshino Y, Yokoi H. Post-thrombotic syndrome of the lower extremity associated with arteriovenous fistula : Three case reports. J Vasc Surg Cases Innov Tech 2022; 8:629-633. [PMID: 36248396 PMCID: PMC9556590 DOI: 10.1016/j.jvscit.2022.08.004] [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: 04/08/2022] [Accepted: 08/05/2022] [Indexed: 11/02/2022] Open
Abstract
The post-thrombotic syndrome is a serious complication of deep vein thrombosis. Post-thrombotic iliac venous occlusion (PTIVO) is rarely associated with an arteriovenous fistula (AVF); however, the underlying mechanism remains unclear. We reported three PTIVO cases associated with an AVF, two symptomatic cases treated with venous stenting, and one asymptomatic case followed up conservatively. The essential imaging findings to diagnose PTIVO with an AVF were the presence of an arterial waveform on ultrasound examination and early opacification on contrast-enhanced computed tomography in the iliofemoral veins. Venous stenting resulted in the disappearance of the AVF, drastic improvement in symptoms, and an excellent long-term outcome.
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Kato T, Fuke M, Nagai F, Nomi H, Kanzaki Y, Yui H, Maruyama S, Nagae A, Sakai T, Saigusa T, Ebisawa S, Okada A, Motoki H, Kuwahara K. Successful endovascular treatment with a stent graft for chronic deep vein thrombosis with multiple arteriovenous fistulas: a case report. J Med Case Rep 2022; 16:257. [PMID: 35778762 PMCID: PMC9250182 DOI: 10.1186/s13256-022-03480-x] [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: 04/20/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Deep vein thrombosis with arteriovenous fistulas is rare, with few therapeutic options available for chronic-phase deep vein thrombosis. Moreover, the effectiveness of endovascular treatment for chronic-phase deep vein thrombosis with arteriovenous fistulas has not been established. We describe herein a case of successful endovascular treatment for chronic deep vein thrombosis with multiple arteriovenous fistulas. Case presentation We describe the case of a 72-year-old Asian woman who had begun experiencing left leg swelling and intermittent claudication 2 years prior. Enhanced computed tomography revealed left common iliac vein occlusion with vein-to-vein collateral formation and several arteriovenous fistulas. Angiography and ultrasound showed the arteriovenous fistulas to run from the common and internal iliac arteries to the external iliac and superficial femoral veins. We opted against surgical repair for the arteriovenous fistulas due to their complex nature and complicated morphology. Since her condition was progressive, endovascular treatment with a stent graft was performed for the deep vein thrombosis, after which her symptoms gradually improved. Four months following the procedure, enhanced computed tomography confirmed remarkable reduction of the vein-to-vein collaterals and arteriovenous fistulas. Conclusions In the present case, enhanced computed tomography with a stent graft was effective in improving symptoms. This strategy may therefore be a treatment option for intractable chronic deep vein thrombosis with arteriovenous fistulas.
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Affiliation(s)
- Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Megumi Fuke
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Fumio Nagai
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hidetomo Nomi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yusuke Kanzaki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hisanori Yui
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shusaku Maruyama
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Ayumu Nagae
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takahiro Sakai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Kota PB, Kota AA, Agarwal S, Keshava SN. De novo arteriovenous malformations in post-thrombotic limbs. BMJ Case Rep 2022; 15:e244576. [PMID: 35331999 PMCID: PMC8948383 DOI: 10.1136/bcr-2021-244576] [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] [Accepted: 09/09/2021] [Indexed: 06/14/2023] Open
Abstract
A 50-year-old woman presented with progressive, painful and disabling swelling of the left lower limb following a left ovarian cyst excision 2 years ago. She had gross oedema of the left lower limb with multiple pubic varices. Contrast-enhanced CT and digital subtraction imaging revealed diffuse arteriovenous malformation (AVM) with feeders from the left internal iliac artery and a short segment significant stenosis of the proximal left common iliac vein. She underwent angioplasty and stenting of the left iliac vein. Her symptoms dramatically improved following the procedure and her limb swelling regressed within 6 months. The occurrence of post-thrombotic AVMs has been long established in the dural and portal systems. This report deals with an analogous phenomenon following iatrogenic deep venous thrombosis of the left lower limb, its pathogenesis, natural history and a review of treatment options.
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Affiliation(s)
- Prajna Bhargavi Kota
- Department of Vascular Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Albert Abhinay Kota
- Department of Vascular Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Sunil Agarwal
- Department of Vascular Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Shyamkumar N Keshava
- Department of Interventional Radiology, Christian Medical College and Hospital Vellore, Vellore, India
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Ke Z, Li Q, Yang C. Successful treatment of acquired arteriovenous fistula following iliac vein thrombosis. Vascular 2021; 30:171-175. [PMID: 33761810 DOI: 10.1177/1708538121995298] [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
OBJECTIVES Cases of arteriovenous fistula following iliac vein thrombosis are uncommon. The pathogenesis of its formation remains unclear. We present the efficacy of left common iliac vein recanalization in acquired arteriovenous fistula treatment. METHODS A 71-year-old man presented with severe lower left limb edema and was diagnosed with acquired arteriovenous fistula following iliac vein thrombosis. Treatment by recanalizing the left common iliac vein with bare stents was selected over embolizing the arteriovenous fistula, leading to an excellent clinical outcome.Results and Conclusions: Acquired arteriovenous fistula should be considered in some patients with post-thrombotic syndrome. Endovascular recanalization without embolization of the arteriovenous fistula can effectively treat iliac vein thrombosis associated with arteriovenous fistula.
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Affiliation(s)
- Zunxiang Ke
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qin Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Yang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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8
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Chen X, Chen G. Endovascular Treatment of Nonthrombotic Iliac Vein Compression Syndrome Complicated by Arteriovenous Fistula: A Report of 2 Cases. J Vasc Interv Radiol 2021; 32:621-624. [PMID: 33454180 DOI: 10.1016/j.jvir.2020.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Xiaomao Chen
- Department of Interventional Radiography, Guangzhou First People's Hospital, the Second Affiliated Hospital of South China University of Technology, No.1 Panfu Road, Guangzhou, Guangdong, P. R. China, 510180
| | - Guodong Chen
- Department of Interventional Radiography, Guangzhou First People's Hospital, the Second Affiliated Hospital of South China University of Technology, No.1 Panfu Road, Guangzhou, Guangdong, P. R. China, 510180
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Successful Treatment of Acquired Arteriovenous Fistulas after Iliac Vein Thrombosis. Ann Vasc Surg 2020; 62:499.e15-499.e20. [DOI: 10.1016/j.avsg.2019.06.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/22/2019] [Accepted: 06/30/2019] [Indexed: 11/20/2022]
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10
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Endovascular Management of Acquired Hepatic Arterial–Portal Venous Malformations. Cardiovasc Intervent Radiol 2019; 43:466-477. [DOI: 10.1007/s00270-019-02380-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/14/2019] [Indexed: 12/28/2022]
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Yuan H, Sun J, Zhou Z, Qi H, Wang M, Dong D, Wu X. Diagnosis and treatment of acquired arteriovenous fistula after lower extremity deep vein thrombosis. INT ANGIOL 2019; 38:10-16. [DOI: 10.23736/s0392-9590.19.04063-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Ilio-Iliac Arteriovenous Fistulae—An Unusual Diagnosis with an Even More Unusual Clinical Presentation. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2018.01.080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Che H, Li L, Song F, Yang M. Is May-Thurner Syndrome Combined with Left Iliac Arteriovenous Fistularare or Neglected?: Cases Report and Literature Review. Ann Vasc Surg 2018; 51:328.e13-328.e18. [PMID: 29777852 DOI: 10.1016/j.avsg.2018.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/30/2018] [Accepted: 03/05/2018] [Indexed: 11/29/2022]
Abstract
May-Thurner syndrome (MTS) is a condition in which the left common iliac vein is compressed by the right common iliac artery, which may cause swelling, pain or deep venous thrombosis of the left lower extremity.1 Postthrombotic syndrome, nonthrombotic chronic venous insufficiency, and recurrence after venous thrombosis are also possible complications. Although MTS combined with left iliac arteriovenous fistula is rarely reported, we treated 3 such cases in the past year.
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Affiliation(s)
- Haijie Che
- Department of Vascular Surgery, YanTai Yuhuangding Hospital, YanTai, ShanDong, China
| | - Lubin Li
- Department of Vascular Surgery, YanTai Yuhuangding Hospital, YanTai, ShanDong, China
| | - Fubo Song
- Department of Vascular Surgery, YanTai Yuhuangding Hospital, YanTai, ShanDong, China
| | - Mu Yang
- Department of Vascular Surgery, YanTai Yuhuangding Hospital, YanTai, ShanDong, China.
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Nassiri N, Crystal DT, Hoyt C, Shafritz R. Chronic refractory venous ulcer exacerbated by a congenital pelvic arteriovenous malformation successfully treated by transarterial Onyx embolization. J Vasc Surg Venous Lymphat Disord 2017; 5:417-420. [PMID: 28411709 DOI: 10.1016/j.jvsv.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/27/2016] [Indexed: 01/01/2023]
Abstract
Congenital arteriovenous malformations (AVMs) are an important but often neglected cause of lower extremity venous hypertension. A case of a chronic refractory venous stasis ulcer of the lower extremity exacerbated by a pelvic AVM is presented. Healing of the ulcer was achieved at 2 months without recurrence at 1 year after superselective ethylene vinyl alcohol copolymer (Onyx 34; ev3, Covidien, Plymouth, Minn) embolization of the AVM nidus. Chronic venous arterialization should be considered in cases of refractory, nonhealing venous ulcers. Embolotherapy in addition to standard of care therapy can be a therapeutic measure. Modification of the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification to include AVMs as a contributing pathophysiologic process is suggested.
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Affiliation(s)
- Naiem Nassiri
- Vascular Anomalies & Malformations Program (VAMP) at the Division of Vascular Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, Bristol-Myers Squibb Children's Hospital, New Brunswick, NJ.
| | | | - Catherine Hoyt
- Director for the Center for Wound Healing at Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Randy Shafritz
- Division of Vascular Surgery, Department of Surgery, The Center for Wound Healing, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ
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Transvenous Embolization of an Acquired Arteriovenous Malformation of the Arm. J Vasc Interv Radiol 2015; 26:1585-7. [DOI: 10.1016/j.jvir.2015.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/29/2015] [Accepted: 03/30/2015] [Indexed: 11/19/2022] Open
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Recanalization of the Left Common Iliac Vein for May–Thurner Syndrome Associated with Arteriovenous Fistula. EJVES Short Rep 2015. [DOI: 10.1016/j.ejvssr.2015.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Weinsheimer SM, Xu H, Achrol AS, Stamova B, McCulloch CE, Pawlikowska L, Tian Y, Ko NU, Lawton MT, Steinberg GK, Chang SD, Jickling G, Ander BP, Kim H, Sharp FR, Young WL. Gene expression profiling of blood in brain arteriovenous malformation patients. Transl Stroke Res 2013; 2:575-87. [PMID: 22184505 DOI: 10.1007/s12975-011-0103-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Brain arteriovenous malformations (BAVMs) are an important cause of intracranial hemorrhage (ICH) in young adults. Gene expression profiling of blood has led to the identification of stroke biomarkers, and may help identify BAVM biomarkers and illuminate BAVM pathogenesis. It is unknown whether blood gene expression profiles differ between 1) BAVM patients and healthy controls, or 2) unruptured and ruptured BAVM patients at presentation. We characterized blood transcriptional profiles in 60 subjects (20 unruptured BAVM, 20 ruptured BAVM, and 20 healthy controls) using Affymetrix whole genome expression arrays. Expression differences between groups were tested by ANOVA, adjusting for potential confounders. Genes with absolute fold change ≥ 1.2 (false discovery rate corrected p ≤ 0.1) were selected as differentially expressed and evaluated for over-representation in KEGG biological pathways (p ≤ 0.05). Twenty-nine genes were differentially expressed between unruptured BAVM patients and controls, including 13 which may be predictive of BAVM. Patients with ruptured BAVM compared to unruptured BAVM differed in expression of 1490 genes, with over-representation of genes in 8 pathways including MAPK, VEGF, Wnt signaling and several inflammatory pathways. These results suggest clues to the pathogenesis of BAVM and/or BAVM rupture and point to potential biomarkers or new treatment targets.
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Affiliation(s)
- Shantel M Weinsheimer
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA
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Chronic iliac vein occlusion and painful nonhealing ulcer induced by high venous pressures from an arteriovenous malformation. Case Rep Radiol 2011; 2011:514721. [PMID: 22606547 PMCID: PMC3350292 DOI: 10.1155/2011/514721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 09/25/2011] [Indexed: 11/17/2022] Open
Abstract
Chronic femoral vein compression (May-Thurner Syndrome) is a known rare cause of deep venous thrombosis. Subsequent angiogenesis and the development of arteriovenous malformation (AVM) in the setting of chronic venous thrombosis is by itself a rare and poorly understood phenomenon. We report a case in which elevated venous pressures resulting from such compression appear to have resulted in the development of a pelvic arteriovenous malformation, which was further complicated by chronic, nonhealing painful lower extremity ulcers, and the development of extensive subcutaneous venous collaterals. Following successful embolization of the pelvic AVM and ablation of veins under the ulcers with laser and sclerotherapy, the patient's ulcers healed and she became pain-free.
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