Arterial impressions in pelvic phlebography

Post-thrombotic Inferior Vena Caval Obstruction: A Review of 24 Patients

“…There is little doubt that if cavography were performed more often in the investigation of the obscure case of unilateral or bilateral leg swelling and in cases of recurrent varicose veins and ulcers, many more cases of chronic caval obstruction would be diagnosed. It is a safe procedure (Farifias, 1947;Lea Thomas and Fletcher, 1967;Fletcher and Lea Thomas, 1968) and in this series no complications were encountered in its use.…”

“…It is known that bilateral leg swellin,g and superficial collateral veins are not necessarily present (Keen, 1940), but it is not generally realized how inconstant these physical signs are. The collateral circulation that develops in inferior vena caval obstruction has been well documented (Robinson, 1949;Filler and Edwards, 1962;Fletcher and Lea Thomas, 1968), and it has been shown that superficial collaterals develop only if the thrombotic process extends into the external iliac and upper femoral veins (Fig. 2).…”

“…It has been suggested that compression of the left common iliac vein by the right common iliac artery might be an aetiological factor in the development of iliofemoral thrombosis and account for ihe predominant left-sided incidence of this condition (May and Thurner, 1957;Goldstein, Van Hoorn, and van der Stricht, 1964;Cockett and Lea Thomas, 1965;Cockett, Lea Thomas, and Negus, 1967;Negus, Fletcher, Cockett, and Lea Thomas, 1968;Lea Thomas, Andress, and Fletcher, 1968). When the right common iliac artery -rises from a high bifurcation of the aorta it overlies the lower inferior vena cava and may possibly be associated with a secondary thrombosis within the cava (Cockett, 1967;Lea Thomas et al, 1968).…”

“…When the right common iliac artery -rises from a high bifurcation of the aorta it overlies the lower inferior vena cava and may possibly be associated with a secondary thrombosis within the cava (Cockett, 1967;Lea Thomas et al, 1968). Case 12 falls into this group, as aortography was performed as well as cavography, and showed a high centrally placed aortic bifurcation.…”

“…In two patients the upper end of the obstruction was shown by injecting contrast medium into a *Lecturer in Surgery, St. Thomas catheter passed from the arm into the inferior vena cava through the right atrium. The techniques employed have been described in detail elsewhere (Lea Thomas and Fletcher, 1967;Fletcher and Lea Thomas, 1968;Lea Thomas, 1969).…”