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Extensive Deep Venous Thrombosis Resulting from Anterior Lumbar Spine Surgery in a Patient with Iliac Vein Compression Syndrome: A Case Report and Literature Review.

Reddy D, Mikhael MM, Shapiro GS, Farrell T - Global Spine J (2014)

Bottom Line: A subsequent venogram showed compression of the left common iliac vein by the right common iliac artery, consistent with May-Thurner syndrome.The condition can predispose patients to extensive iliac vein DVT.The contributing anatomy and subsequent clot often require catheter-directed thrombolysis and stenting to achieve a favorable outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois, United States.

ABSTRACT
Study Design Case report. Objective Although May-Thurner syndrome or iliac vein compression syndrome is covered in the vascular literature, it remains absent from the orthopedic and neurosurgery literature and has not been previously reported to occur in concordance with spine surgery. We review the salient points of disease presentation, diagnosis, and treatment. Methods A 33-year-old woman was followed postoperatively via clinical and radiographic findings. Her presentation, operative treatment, postoperative extensive deep venous thrombosis (DVT) formation, and management are described. Results We present a unique case of a healthy 33-year-old woman who developed an extensive left iliac vein DVT after anterior lumbar spine fusion. Although she had multiple risk factors for thrombosis, the size of the thrombus was atypical. A subsequent venogram showed compression of the left common iliac vein by the right common iliac artery, consistent with May-Thurner syndrome. Conclusions May-Thurner syndrome or iliac vein compression syndrome is a rare diagnosis that is absent from the spine literature. The condition can predispose patients to extensive iliac vein DVT. The contributing anatomy and subsequent clot often require catheter-directed thrombolysis and stenting to achieve a favorable outcome.

No MeSH data available.


Related in: MedlinePlus

Iliac vein compression syndrome.
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FI1400067-6: Iliac vein compression syndrome.

Mentions: May-Thurner syndrome or IVCS is an anatomic variant that results in compression of the left iliac vein by the right iliac artery. In 1851, Virchow described a similar compression phenomenon.1 However, it was not until 1957 that May and Thurner described a syndrome in which compression between the L5 vertebral body and the right iliac artery caused compression of the left iliac vein. They postulated that in response to repetitive trauma to the vein at the site of bony contact, thickening of the vascular endothelium leads to a “spur” of intimal proliferation in the vein wall and increased compression and obstruction of the vein over time.2 This cycle ends with an increased predisposition to form DVT in the left lower extremity. Fig. 6 illustrates the anatomic compression of the left iliac vein by the crossing right iliac artery and the resultant lateral, double lumen, and webbing spur patterns. In detailed dissections of 430 cadavers and examinations of the vascular histopathology, May and Thurner found compression of the left iliac vein between the right iliac artery and the L5 vertebral body in 22% of their specimens. Spurs were categorized as lateral with two spurs encroaching toward the lumen, central with a single septation across the lumen, or partial obliteration corresponding to webbing across the lumen.2


Extensive Deep Venous Thrombosis Resulting from Anterior Lumbar Spine Surgery in a Patient with Iliac Vein Compression Syndrome: A Case Report and Literature Review.

Reddy D, Mikhael MM, Shapiro GS, Farrell T - Global Spine J (2014)

Iliac vein compression syndrome.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4516724&req=5

FI1400067-6: Iliac vein compression syndrome.
Mentions: May-Thurner syndrome or IVCS is an anatomic variant that results in compression of the left iliac vein by the right iliac artery. In 1851, Virchow described a similar compression phenomenon.1 However, it was not until 1957 that May and Thurner described a syndrome in which compression between the L5 vertebral body and the right iliac artery caused compression of the left iliac vein. They postulated that in response to repetitive trauma to the vein at the site of bony contact, thickening of the vascular endothelium leads to a “spur” of intimal proliferation in the vein wall and increased compression and obstruction of the vein over time.2 This cycle ends with an increased predisposition to form DVT in the left lower extremity. Fig. 6 illustrates the anatomic compression of the left iliac vein by the crossing right iliac artery and the resultant lateral, double lumen, and webbing spur patterns. In detailed dissections of 430 cadavers and examinations of the vascular histopathology, May and Thurner found compression of the left iliac vein between the right iliac artery and the L5 vertebral body in 22% of their specimens. Spurs were categorized as lateral with two spurs encroaching toward the lumen, central with a single septation across the lumen, or partial obliteration corresponding to webbing across the lumen.2

Bottom Line: A subsequent venogram showed compression of the left common iliac vein by the right common iliac artery, consistent with May-Thurner syndrome.The condition can predispose patients to extensive iliac vein DVT.The contributing anatomy and subsequent clot often require catheter-directed thrombolysis and stenting to achieve a favorable outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois, United States.

ABSTRACT
Study Design Case report. Objective Although May-Thurner syndrome or iliac vein compression syndrome is covered in the vascular literature, it remains absent from the orthopedic and neurosurgery literature and has not been previously reported to occur in concordance with spine surgery. We review the salient points of disease presentation, diagnosis, and treatment. Methods A 33-year-old woman was followed postoperatively via clinical and radiographic findings. Her presentation, operative treatment, postoperative extensive deep venous thrombosis (DVT) formation, and management are described. Results We present a unique case of a healthy 33-year-old woman who developed an extensive left iliac vein DVT after anterior lumbar spine fusion. Although she had multiple risk factors for thrombosis, the size of the thrombus was atypical. A subsequent venogram showed compression of the left common iliac vein by the right common iliac artery, consistent with May-Thurner syndrome. Conclusions May-Thurner syndrome or iliac vein compression syndrome is a rare diagnosis that is absent from the spine literature. The condition can predispose patients to extensive iliac vein DVT. The contributing anatomy and subsequent clot often require catheter-directed thrombolysis and stenting to achieve a favorable outcome.

No MeSH data available.


Related in: MedlinePlus