Chronic Iliac Vein Occlusion and Painful Nonhealing Ulcer Induced by High Venous Pressures from an Arteriovenous Malformation

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.

Successful Treatment of Acquired Arteriovenous Fistulas after Iliac Vein Thrombosis

“…It is likely that arteriovenous malformations result from vasculogenesis, differentiation of mesodermal precursors into endothelial cells, and angiogenesis. 5 Treatment of these patients suffering from DVT in combination with AVF includes compression, surgical fistula ligation, embolization, sclerotherapy, and recanalization with bare stent as summarized in Table. Link et al 5,6 treated only the fistula by embolization with no consideration of recanalization with stent of the iliac vein, which was not sufficient for ulcer healing, thus prompting subsequent sclerotherapy. Coelho et al 9 performed embolization and stent-graft deployment in the internal iliac artery in an attempt to seal the arterial component of the AVF, with marginal success.…”

May-Thurner syndrome and iliac arteriovenous fistula in an elderly woman

“…Mihmanli et al 9 described a case of MTS and AVF diagnosed by computed tomography, but their patient had minimal compression of the left iliac vein on our review of the imaging, and they do not discuss treatment. Link and Granchi 10 treated a patient with nonhealing ulcers who reportedly had MTS and AVF. The question of true MTS vs venous occlusive disease remains, though, as none of their imaging was sufficient to confirm.…”

Late Complications of Deep Venous Thrombosis: Painful Swollen Extremities and Non Healing Ulcers

“…An arteriogram showed a large pelvic AVM with outflow to the deep pelvic veins and to the distal veins in the left lower extremity. Occlusion of the AVM was performed with injectable ethyl vinyl alcohol polymer dissolved in DMSO (Onyx, EV3 Neurovascular, Irvine, CA) (Link 2011). The pain in the ulcerated areas improved but persisted despite compression dressings being applied weekly.…”