A 57-year old patient presented with approximately 80% stenosis of the left external iliac vein due to compression by the renal graft after kidney transplantation. The initial clinical manifestation of this vascular complication was progressive edema of the left lower limb, starting in the foot during the immediate postoperative period and reaching the thigh. Renal function also deteriorated during the first four months after transplantation. Venous Doppler ultrasound findings were suggestive of a diagnosis of extrinsic compression by the kidney graft and so phlebography was ordered, confirming stenosis of the left external iliac vein. The patient was initially treated with balloon angioplasty, but there was still residual stenosis so a stent was inserted, eliminating the stenosis. The edema reduced over time and the patient's renal function improved. While vascular complications are rare, and potentially severe, events, success rates are good if treatment is started early.
May-Thurner Syndrome is a clinical condition which causes a variety of vascular symptoms, resulting from pelvic and lower extremity venous flow obstruction caused by the compression of the iliac vein by overlying iliac artery. Treatment paradigms have changed as experience with endovascular modalities has evolved, making traditional surgical treatment strategies essentially obsolete and a endovascular treatment with angioplasty and stenting along selective thrombolysis has become the standard for symptomatic the syndrome. The objective of this present study is to show the therapeutic approach in treatment when there's no presence of Deep Venous Thrombosis (DVT) symptoms. To accomplish this purpose, a systematic review of articles about May-Thurner Syndrome and its management therapies,
Post-Revascularization Syndrome (PRS), also described as, Ischemic Reperfusion Injury (IRI), is the main cause of failure in the revascularization of limbs. The etiology of Port-Revascularization Syndrome is not fully known, but it is accepted as a multifactorial chain with a time-dependent molecular and structural change of the affected tissues. Current clinical treatments of PRS are supportive only notwithstanding numerous intervention strategies have been proposed aiming at reducing IRI. The present perspective aimed to explain all the available treatments in studies of IRI, and their potential effects in the future medicine. Since there are almost no articles covering this topic, we believe that this perspective will clarify the necessity of more researchers and studies on IRI. Our main findings leads to believe that there are many possible therapies for ischemic reperfusion injury, but most of them are still not used in practical scenarios because of it small samples studies, or in vitro techniques or the clinical trials are still not concluded. Although, significant work remains to be done. Contact information:Modesto Leite Rolim Neto. modestorolim@yahoo.com.br KeywordsPost-Revascularization Syndrome; Treatment; Review.Post-Revascularization Syndrome (PRS), also described as, Ischemic Reperfusion Injury (IRI), is the main cause of failure in the revascularization of limbs and the transfer of free flaps with 'non reflow' phenomenon [1]. It involves microcirculatory collapse during revascularization following an ischemic insult, that constitutes an acute inflammatory process by which cells are damaged first by temporary ischemia, hypoxia and accumulation of toxic metabolites and later by reperfusion [2,3]. It may result from thrombotic occlusion, embolism, trauma or surgical intervention through tourniquet application and subsequent restoration of blood flow.
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