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Skeik N, Adamek A, Manunga J. Spontaneous iliac vein rupture and thrombosis in patients with May-Thurner syndrome: A narrative review. Vasc Med 2023; 28:361-367. [PMID: 37248994 DOI: 10.1177/1358863x231175697] [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: 05/31/2023]
Abstract
Spontaneous iliac vein rupture (SIVR) is extremely rare and can lead to serious complications, including death. Etiologies include inflammatory processes and hormonal and mechanical triggers, with concomitant May-Thurner syndrome (MTS) being a rare cause. Management can be challenging due to the difficult balance between reducing thrombotic burden and life-threatening hemorrhage that can result from aggressive anticoagulation. Furthermore, surgical interventions are associated with high mortality, making conservative management more desirable. We report a case of SIVR with retroperitoneal hematoma and concurrent MTS that was successfully managed using conservative measures. We further provide a narrative review of the current literature addressing the diagnosis, management, and outcome of SIVR focusing on cases with concurrent MTS.
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Affiliation(s)
- Nedaa Skeik
- Section of Vascular & Endovascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Andrew Adamek
- Minneapolis Heart Institute Research Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Jesse Manunga
- Section of Vascular & Endovascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
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2
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Zhui L, Yangyang F, Miao W, Hong C, Qiu Z, Wen H, Wei R, Yu Z. Clinical characteristics and treatment outcomes of 68 patients with spontaneous iliac vein rupture: A case report and systematic review. Heliyon 2023; 9:e16382. [PMID: 37255985 PMCID: PMC10225893 DOI: 10.1016/j.heliyon.2023.e16382] [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: 01/13/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023] Open
Abstract
Objective Spontaneous iliac vein rupture (SIVR) is a rare but life-threatening condition with limited understanding regarding its clinical presentation, pathogenesis, diagnosis, management, and risk factors for mortality. This study aims to address this gap by providing comprehensive insights into SIVR through personal case reports and a systematic review of previous cases. Methods We detail a case of right SIVR caused by inappropriate positioning of the stent in the inferior vena cava and systematically reviewed previous cases. Logistic regression analysis was used to identify risk factors for mortality. Results Our SIVR case was successfully managed with percutaneous mechanical thrombectomy and covered stent placement. In the systematic review, 68 patients were included in the analysis with an average age of 62.01 ± 13.25 years; 86.76% were female, 91.17% had left iliac vein rupture, 55.88% presented hemodynamic instability, 76.47% had lower abdomen or iliac fossa pain, 67.64% had deep venous thrombosis (DVT), and 32.35% had May‒Thurner syndrome (MTS). The mortality rates of conservative treatment and open surgery were 2.94% and 17.65%, respectively. All 12 patients receiving endovascular treatment survived. The factors associated with a worse outcome were younger age (52.86 ± 12.96 years, OR: 1.085, 95% CI: 1.002-1.174) and SIVR patients without DVT (OR:10.111, 95% CI: 1.637-62.443). Conclusion This first systematic review on SIVR shows that SIVR should be highly suspected in elderly females who develop lower extremity DVT and concurrent lower abdominal pain, particularly those with a retroperitoneal mass and unstable hemodynamics. Thrombosis secondary to MTS may be the main cause of SIVR. Angiography and endovascular therapy should be prioritized for DVT patients with unexplained retroperitoneal hematoma. This study classifies SIVR into two types: iliac vein rupture alone and iliac vein rupture with DVT. These findings provide critical insights for clinicians to accurately diagnose and manage SIVR, thereby improving patient outcomes.
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Affiliation(s)
- Li Zhui
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Yangyang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Miao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cui Hong
- Department of Anesthesia, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zeng Qiu
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huang Wen
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ren Wei
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhao Yu
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Qi HS, Kwan KJS, Li HL. Successful Management of Spontaneous Iliac Vein Rupture with Double Bare Stent Technique: A Case Report and Review of Literature. Vasc Endovascular Surg 2023; 57:257-263. [PMID: 36239775 DOI: 10.1177/15385744221130855] [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
Spontaneous rupture of the iliac vein is a rare cause of retroperitoneal hematoma. A misdiagnosis may delay the treatment and consequently put the patient in a life-threatening emergency. We report the case of a 73-year-old woman who presented with hemorrhagic shock from bleeding caused by a large left retroperitoneal hematoma. She was successfully treated with an endovascular approach by using a double bare stent technique. An extensive review of the literature was conducted and a total 44 articles with 50 patients were identified. Among these patients, 88.2% were women, 94.1% presented with a left-sided rupture, and the mortality rate was 13.7%. Spontaneous iliac vein rupture was more likely to occur in the left side in female patients. Conservative treatment was an option in hemodynamically stable patients. Exploratory laparotomy and surgical iliac vein repair was necessitated in most patients. Endovascular treatment including placement of covered stent and coil embolization had been widely used to treat spontaneous vein rupture since 2003. Double bare stent technique was also an effective alternative if a suitable covered stent was unavailable.
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Affiliation(s)
- Hao-Shan Qi
- Division of Vascular Surgery, Department of Surgery, 12648Qingdao Municipal Hospital, China
| | | | - Hai-Lei Li
- Division of Vascular Surgery, Department of Surgery, 444333University of Hong Kong - Shenzhen Hospital, China
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4
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Kooiman AL, Bakas JM, van Fessem JMK, Boellaard WPA, Cornelissen SAP, van Rijn MJE. Spontaneous Iliac Vein Ruptures: A Systematic Review. Vasc Endovascular Surg 2023:15385744231163707. [PMID: 36913198 DOI: 10.1177/15385744231163707] [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: 03/14/2023]
Abstract
INTRODUCTION Spontaneous iliac vein rupture is a rare, but frequently lethal condition. It is important to timely recognize its clinical features and immediately start adequate treatment. We aimed to increase awareness to clinical features, specific diagnostics, and treatment strategies of spontaneous iliac vein rupture by evaluating the current literature. METHODS A systematic search was conducted in EMBASE, Ovid MEDLINE, Cochrane, Web of Science, and Google Scholar from inception until January 23, 2023, without any restrictions. Two reviewers independently screened for eligibility and selected studies describing a spontaneous iliac vein rupture. Patient characteristics, clinical features, diagnostics, treatment strategies, and survival outcomes were collected from included studies. RESULTS We included 76 cases (64 studies) from the literature, mostly presenting with left-sided spontaneous iliac vein rupture (96.1%). Patients were predominantly female (84.2%), had a mean age of 61 years, and frequently presented with a concomitant deep vein thrombosis (DVT) (84.2%). After various follow-up times, 77.6% of the patients survived, either after conservative, endovascular, or open treatment. Endovenous or hybrid procedures were frequently performed if the diagnose was made before treatment, and almost all survived. Open treatment was common if the venous rupture was missed, for some cases leading to death. CONCLUSION Spontaneous iliac vein rupture is rare and easily missed. The diagnose should at least be considered for middle-aged and elderly females presenting with hemorrhagic shock and concomitant left-sided DVT. There are various treatment strategies for spontaneous iliac vein rupture. An early diagnose brings options for endovenous treatment, which seems to have good survival outcomes based on previously described cases.
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Affiliation(s)
- Alexander L Kooiman
- Department of Vascular Surgery, 273243Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jay M Bakas
- Department of Vascular Surgery, 273243Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joris M K van Fessem
- Department of Anesthesiology, 273243Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem P A Boellaard
- Department of Urology, 273243Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sandra A P Cornelissen
- Department of Radiology and Nuclear Medicine, 273243Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marie Josee E van Rijn
- Department of Vascular Surgery, 273243Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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5
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Nishimoto Y, Toma M, Iwasa K, Sato Y. Successful staged management of a spontaneous iliac vein rupture associated with May-Thurner syndrome: a case report. Eur Heart J Case Rep 2021; 5:ytab316. [PMID: 34514304 PMCID: PMC8422344 DOI: 10.1093/ehjcr/ytab316] [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: 03/19/2021] [Revised: 04/20/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Spontaneous iliac vein ruptures have only been reported in approximately 50 cases. An accurate preoperative diagnosis is difficult even with contrast-enhanced computed tomography (CT), and the operative mortality and morbidity rates are quite high. The cause of spontaneous iliac vein ruptures and their optimal diagnosis and management remain unclear. CASE SUMMARY A 69-year-old woman without a history of prior trauma presented with low back pain, left lower limb swelling, and hypovolaemic shock. An initial contrast-enhanced CT revealed a large retroperitoneal haematoma without arterial extravasation. Her blood pressure dropped again under a noradrenaline administration. A second venous phase contrast-enhanced CT revealed venous extravasation in the external iliac vein with a suspected compression of the common iliac vein (May-Thurner syndrome) and deep vein thrombosis (DVT). Her haemodynamics were stabilized whilst a laparotomy was arranged. An inferior vena cava (IVC) filter was placed due to concerns about rebleeding with initiating anticoagulation therapy. Given the failed conservative management, elective endovascular treatment (EVT) was performed including percutaneous Fogarty venous thrombectomy and placement of self-expanding and covered stents. After the intervention, the lower limb swelling significantly improved under oral anticoagulation therapy, and the IVC filter was retrieved. At the 3-month follow-up, the lower limb swelling completely disappeared, and the contrast-enhanced CT demonstrated the complete disappearance of the retroperitoneal haematoma and DVT. DISCUSSION This case provided not only the potential value of the venous phase contrast-enhanced CT in diagnosing a spontaneous iliac vein rupture but also the potential benefit of conservative management followed by elective EVT.
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Affiliation(s)
- Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki 660-8550, Japan
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki 660-8550, Japan
| | - Kohei Iwasa
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki 660-8550, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki 660-8550, Japan
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Srisajjakul S, Prapaisilp P, Bangchokdee S. Imaging features of vascular compression in abdomen: Fantasy, phenomenon, or true syndrome. Indian J Radiol Imaging 2021; 27:216-224. [PMID: 28744083 PMCID: PMC5510320 DOI: 10.4103/ijri.ijri_7_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Vascular structures in the abdomen can compress or be compressed by adjacent structures. Classic imaging findings of vascular compressions, including median arcuate ligament syndrome, superior mesenteric artery syndrome, nutcracker syndrome, portal biliopathy, May-Thurner syndrome, and ureteropelvic junction obstruction will be discussed here. It is important to correlate imaging findings and clinical data to identify asymptomatic vascular compression which requires no treatment, intermittent vascular compression with nonspecific or vague clinical manifestation, and the subset of patients with true syndromes who will benefit from treatment.
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Affiliation(s)
- Sitthipong Srisajjakul
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patcharin Prapaisilp
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Endovascular Repair of Spontaneous Iliac Vein Rupture. Ann Vasc Surg 2020; 73:510.e25-510.e28. [PMID: 33373771 DOI: 10.1016/j.avsg.2020.11.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/09/2020] [Accepted: 11/24/2020] [Indexed: 11/20/2022]
Abstract
Spontaneous iliac vein rupture is a relatively rare but fatal disease. Herein, 2 cases are reported. The two middle-aged and elderly females complaining of abdominal pain were admitted without any history of trauma. The computed tomography image both showed one huge hematoma in the lower abdominal cavity and the left external iliac venous thrombus. Venogram showed ruptures of the left external iliac vein and stenosis of the left common iliac vein after percutaneous mechanical thrombectomy. Stent grafts were implanted by endovascular technique. Favorable outcomes were achieved in both cases.
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Molière S, Rotaru-Hincu N. Pelvic hematoma due to spontaneous left iliac vein rupture in May-Thurner syndrome. Diagn Interv Imaging 2020; 101:55-56. [DOI: 10.1016/j.diii.2019.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/11/2019] [Accepted: 05/15/2019] [Indexed: 11/28/2022]
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Xu F, Tian Z, Huang X, Xiang Y, Yao L, Zou C, Fu C, Wang Y. A case report of May-Thurner syndrome induced by anterior lumbar disc herniation: Novel treatment with radiofrequency thermocoagulation. Medicine (Baltimore) 2019; 98:e17706. [PMID: 31689801 PMCID: PMC6946357 DOI: 10.1097/md.0000000000017706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Lumbar degeneration-related May-Thurner syndrome (dMTS) is characterized by venous compression induced by degenerated lower lumbar structures. Treatment strategies for May-Thurner syndrome (MTS) include clearing the thrombus and correcting venous compression. Despite having different etiological factors from other MTS types, treatments for dMTS are similar, including endovascular angioplasty and continuous anticoagulation therapies. Thus, a particular treatment was designed herein to focus on compressive lumbar structures instead of intravenous management. PATIENT CONCERNS A 59-year-old female patient with dMTS, which was induced by inferior vena cava (IVC) stenosis compressed by L4-5 anterior disc herniation. DIAGNOSIS The patient was diagnosed with IVC stenosis and L4-5 lumbar disc herniation based on abdominal computed tomography, ultrasound, and lumbar magnetic resonance imaging findings. INTERVENTIONS Radiofrequency thermocoagulation (RF) was applied to the patient to decrease the compression caused by anterior disc herniation. OUTCOMES After surgery, the patient's swelling started to improve within 5 hours and completely diminished after 48 hours. Postsurgical abdominal ultrasound showed that her IVC patency increased by 20%. On follow-up, her leg symptoms did not recur at 12 months after surgery. LESSONS We provided a novel idea in the treatment of dMTS, in which we shifted the treatment focus from endovascular patency restoration to extravascular decompression. Our case proved that RF was effective in treating dMTS, which is a complementary treatment modality to angioplasty.
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Affiliation(s)
- Feng Xu
- Department of Spine Surgery, The First Hospital of Jilin University
| | - Zhisen Tian
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University
| | | | - Yipeng Xiang
- Department of Spine Surgery, The First Hospital of Jilin University
| | - Liyu Yao
- Department of Pediatrics Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Congcong Zou
- Department of Spine Surgery, The First Hospital of Jilin University
| | - Changfeng Fu
- Department of Spine Surgery, The First Hospital of Jilin University
| | - Yuanyi Wang
- Department of Spine Surgery, The First Hospital of Jilin University
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10
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May-Thurner syndrome: an uncommon and incidental finding in a postpartum female. Pol J Radiol 2019; 84:e365-e367. [PMID: 31969951 PMCID: PMC6964327 DOI: 10.5114/pjr.2019.89193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 09/11/2019] [Indexed: 12/16/2022] Open
Abstract
May-Thurner syndrome or Cockett syndrome is a pathological condition that arises due to extrinsic compression on iliocaval venous territory, leading to venous outflow obstruction. Here, author presents an incidental finding of left common iliac vein extrinsic compression by right common iliac artery with collateral vessels in the pelvis in a postpartum female.
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May-Thurner Syndrome with Large Abdominal Varicosity, Treated Successfully Using Multiple Approaches. Case Rep Vasc Med 2019; 2019:7079307. [PMID: 31183243 PMCID: PMC6515053 DOI: 10.1155/2019/7079307] [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: 01/17/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 11/22/2022] Open
Abstract
May-Thurner syndrome (MTS) is a venous outflow obstruction disorder characterized by compression of the left common iliac vein by an overriding right common iliac artery. MTS primarily affects young to middle-aged women, although many patients remain entirely asymptomatic. Anatomic variations of MTS, while uncommon, have been described. Treatment usually involves endovascular management, including thrombolysis and/or thrombectomy with or without inferior vena cava filter placement, followed by angioplasty and stenting of the left common iliac vein. We report a unique case of a 31-year-old woman who presented with MTS-related deep vein thrombosis accompanied by symptomatic abdominal and pelvic varicosities. The varicosities were treated successfully using multiple procedures, resulting in complete resolution of all symptoms. Our case discusses a treatment approach for an unusual presentation of MTS-related postthrombotic syndrome, and provides a brief literature review of MTS complications and management.
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Ginjupalli M, Tripathy U, Gonzalez S, Moinuddeen K, Mohiuddin I. A Novel Use of Aortic Stent Graft Components in Massive Venous Retroperitoneal Hematoma. Methodist Debakey Cardiovasc J 2018; 14:e1-e3. [PMID: 30038700 DOI: 10.14797/mdcj-14-2-e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Venous retroperitoneal hematoma (VRH) can present as a sudden-onset life-threatening condition. Unlike arterial hematoma, VRH is difficult to treat because of anatomic and structural considerations. Moreover, because VRH is rare and iatrogenic, there are no commercially available devices to treat this problem. We present a novel use of aortic stent graft components to treat a large, life-threatening VRH.
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Kaltenmeier CT, Erben Y, Indes J, Lee A, Dardik A, Sarac T, Ochoa Chaar CI. Systematic review of May-Thurner syndrome with emphasis on gender differences. J Vasc Surg Venous Lymphat Disord 2018; 6:399-407.e4. [DOI: 10.1016/j.jvsv.2017.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 11/02/2017] [Indexed: 02/08/2023]
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Singh B, Bharadwaj P, Bajaj N, Chadha D. Endovascular management of a case of spontaneous retroperitoneal haematoma complicated with deep vein thrombosis and pulmonary embolism. BMJ Case Rep 2017; 2017:bcr-2017-222217. [PMID: 29196310 DOI: 10.1136/bcr-2017-222217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Spontaneous retroperitoneal haematoma (SRH) can be a life-threatening emergency presenting with hypovolaemic shock. SRH has been rarely reported with May-Thurner syndrome (MTS) where it occurs due to rupture of the iliac vein or venous collaterals. We report a case of MTS that presented with deep venous thrombosis of the left lower limb complicated by bilateral pulmonary embolism (PE) and a large pelvic haematoma. The simultaneous occurrence of a large pelvic haematoma and PE offered a therapeutic challenge. Successful endovascular management of the case is discussed in this report.
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Affiliation(s)
- Balbir Singh
- Department of Cardiology, Military Hospital (CTC), Pune, Maharashtra, India
| | - Prashant Bharadwaj
- Department of Cardiology, Military Hospital (CTC), Pune, Maharashtra, India
| | - Nitin Bajaj
- Department of Cardiology, Command Hospital, Udhampur, India
| | - Davinder Chadha
- Department of Cardiology, Command Hospital, Bangalore, Karnataka, India
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15
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Chen YC, Huang CL, Huang JW. Endovascular Stent Can Be the Treatment of Choice for Spontaneous Iliac Vein Rupture: A Case Report. Vasc Endovascular Surg 2017; 52:131-134. [PMID: 29187071 DOI: 10.1177/1538574417739090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Spontaneous iliac vein rupture is a rare but lethal disease. Most patients suffer from shock status in the emergency department. Until now, open laparotomy combined with primary suture is the most common treatment of iliac vein rupture. However, there is high mortality and morbidity in the patients who underwent open laparotomy. CASE PRESENTATION A 71-year-old woman denied trauma history and sustained hypovolemic shock. The abdominal computed tomography showed one huge retroperitoneal hematoma. The emergency angiography revealed one obvious rupture point on the left external iliac vein. We repaired the lesion with endovascular stent and open laparotomy for abdominal decompression. The patient progressed well and was discharged. CONCLUSION Endovascular repair is an effective and safe treatment. Compared with open laparotomy and primary suture, stent leads to fewer complications and a lower mortality rate.
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Affiliation(s)
- Yen-Cheng Chen
- 1 Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chien-Lin Huang
- 2 Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jiann-Woei Huang
- 2 Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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16
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May-Thurner syndrome presenting as spontaneous left iliac vein rupture. J Vasc Surg Venous Lymphat Disord 2016; 4:479-81. [DOI: 10.1016/j.jvsv.2016.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 03/23/2016] [Indexed: 11/17/2022]
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17
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Mousa AY, AbuRahma AF. May–Thurner Syndrome: Update and Review. Ann Vasc Surg 2013; 27:984-95. [DOI: 10.1016/j.avsg.2013.05.001] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 01/27/2023]
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19
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Sadaghianloo N, Jean-Baptiste E, Haudebourg P, Declemy S, Mousnier A, Hassen-Khodja R. Successful treatment of a spontaneous rupture of the left external iliac vein in a man. Vascular 2013; 22:68-70. [DOI: 10.1177/1708538112474255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Spontaneous rupture of the external iliac vein associated with a May–Thurner syndrome is infrequent, particularly in men. We report a case of previously healthy 73-year-old man with a left iliac vein thrombosis, who presented a large lower left abdominal hematoma of sudden-unset. Emergent laparotomy revealed a 3-cm longitudinal tear in the left external iliac vein, which was repaired primarily. Patient's recovery was uneventful. Possible etiological factors have been identified as venous hypertension due to iliac vein thrombosis associated with Cockett syndrome, as well as inflammatory venous wall. Some other estrogenic factors could explain female preponderance of the event.
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Affiliation(s)
- Nirvana Sadaghianloo
- Université de Nice Sophia Antipolis, Nice, France
- Service de chirurgie vasculaire, Pôle cardio-vasculaire, thoracique et métabolique du Haut Pasteur, CHU de Nice, Nice, France
| | - Elixène Jean-Baptiste
- Université de Nice Sophia Antipolis, Nice, France
- Service de chirurgie vasculaire, Pôle cardio-vasculaire, thoracique et métabolique du Haut Pasteur, CHU de Nice, Nice, France
| | | | - Serge Declemy
- Université de Nice Sophia Antipolis, Nice, France
- Service de chirurgie vasculaire, Pôle cardio-vasculaire, thoracique et métabolique du Haut Pasteur, CHU de Nice, Nice, France
| | - Aurélien Mousnier
- Université de Nice Sophia Antipolis, Nice, France
- Service de chirurgie vasculaire, Pôle cardio-vasculaire, thoracique et métabolique du Haut Pasteur, CHU de Nice, Nice, France
| | - Réda Hassen-Khodja
- Université de Nice Sophia Antipolis, Nice, France
- Service de chirurgie vasculaire, Pôle cardio-vasculaire, thoracique et métabolique du Haut Pasteur, CHU de Nice, Nice, France
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May-thurner syndrome: a case report and review of the literature. Case Rep Vasc Med 2013; 2013:740182. [PMID: 23509664 PMCID: PMC3590570 DOI: 10.1155/2013/740182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 01/21/2013] [Indexed: 02/07/2023] Open
Abstract
May-Thurner syndrome (MTS) has been recognized as a clinical entity for almost six decades. The true incidence rate of MTS is unknown and perhaps ranges from 22 to 32% according to the autopsy studies in the early twentieth century. However, MTS related deep venous thrombosis (DVT) accounts for only 2%-3% of all lower limb DVTS. In MTS, the left common iliac vein is compressed against the fifth lumbar vertebrae by the right common iliac artery, as it crosses in front of the vein. Chronic pulsation of the artery is thought to cause elastin, collagen deposition, and intimal fibrosis leading to formation of venous spur and venous thrombosis. MTS can present as acute or chronic DVT leading to pulmonary embolism (PE), chronic leg pain, chronic ulcers, or skin pigmentation changes. In this case report we have described an interesting case of a 28-year-old Caucasian female who presented for evaluation of shortness of breath (SOB) associated with cough for one week. SOB was found to be secondary to massive bilateral pulmonary embolism resulting from extensive MTS related DVT of the left lower extremity. Patient underwent pharmacomechanical treatment with local thrombolysis, thrombectomy, and venoplasty along with stent placement that extended to inferior vena caval junction. Subsequently patient was discharged on coumadin. MTS should be considered in differentials when faced with a case of unilateral DVT particularly in younger age group.
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Deng L, Jin W, Xiong G, Dai X, Shen X, Li Y, Zhang Q. Spontaneous Rupture of the Left Common Iliac Vein. Ann Vasc Surg 2011; 25:983.e5-7. [DOI: 10.1016/j.avsg.2011.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 03/10/2011] [Accepted: 05/24/2011] [Indexed: 11/25/2022]
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Mavinamane S, Ganeshram K, Rouhani Y. Look beyond the obvious: Leg swelling may be more than just a deep vein thrombosis. Eur Geriatr Med 2011. [DOI: 10.1016/j.eurger.2011.01.022] [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]
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Spontaneous retroperitoneal hematoma associated with iliac vein rupture. J Vasc Surg 2010; 52:1278-82. [DOI: 10.1016/j.jvs.2010.06.102] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Revised: 06/03/2010] [Accepted: 06/07/2010] [Indexed: 11/23/2022]
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