Iliac Vein Compression as Risk Factor for Left- versus Right-Sided Deep Venous Thrombosis: Case-Control Study

Narayan, Anand K.; Eng, John; Carmi, Lemore; McGrane, Siobhan; Ahmed, Muneeb; Sharrett, A. Richey; Streiff, Michael B.; Coresh, Josef; Powe, Neil R.; Hong, Kelvin

doi:10.1148/radiol.12111580

Cited by 79 publications

(64 citation statements)

References 17 publications

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“…With increasingly sensitive techniques like IVUS to identify iliac compression, diagnoses are made more frequently and in a more diverse cohort of patients, yet the finding's correlation with clinical VTE is not well established . One case–control study of 230 patients demonstrated only a signal for increased left‐sided DVT when the degree of stenosis exceeded 70% of vessel diameter on CT venography …”

Section: Discussionmentioning

confidence: 99%

Acute pulmonary embolism unmasking underlying chronic thromboembolic pulmonary hypertension and iliac vein compression syndrome

Brener

Parikh

Sethi

2019

Cathet Cardio Intervent

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We describe the case of a 72‐year‐old gentleman who was referred to our institution for management of cardiogenic shock from a massive pulmonary embolism. Right heart catheterization revealed a low cardiac index and markedly elevated pulmonary pressures, suggested long‐standing venous thromboembolic (VTE) disease that evolved into chronic thromboembolic pulmonary hypertension (CTEPH). The patient was cannulated to veno‐arterial extra‐corporeal membrane oxygenation and eventually treated with pulmonary embolectomy and thromboendarterectomy. Subsequently discovered inferior vena cava clot and left iliac deep vein thrombosis were treated with suction and mechanical thrombectomy. Intravascular ultrasound of the left lower extremity venous system identified iliac vein compression syndrome (IVCS) as the culprit of the patient's VTE and CTEPH. A left iliac stent was placed and the patient was discharged on Warfarin for anticoagulation. The case illustrates the rapidly expanding armamentarium for VTE treatment and proposes IVCS as a new, potentially underrecognized risk factor for CTEPH.

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Section: Discussionmentioning

confidence: 99%

Acute pulmonary embolism unmasking underlying chronic thromboembolic pulmonary hypertension and iliac vein compression syndrome

Brener

Parikh

Sethi

2019

Cathet Cardio Intervent

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“…We do not confuse iliac vein compression syndrome with the original May‐Thurner description which indicates anatomical spur‐like formations at the lesion of the LCIV by the overlying RCIA . Iliac vein compression syndrome could cause left unilateral leg swelling and left‐sided deep venous thrombosis in elderly patients …”

mentioning

confidence: 86%

Chronic unilateral leg swelling caused by iliac vein compression (Cockett's) syndrome in an elderly patient

Sugawara

Matsuura

Ishii

et al. 2017

J of Gen and Family Med

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“…11 Furthermore, a recent case-control study suggested that compression greater than 70% is required in order to be an associated factor for left sided DVTs. 12 Although MTS has been shown to be present in about 20% of the population, it is thought to account for only 2% to 3% of all lower extremity DVTs. 10 There are over 30 known associated risk factors for the development of the initial VTE, which are classified into genetic, acquired, environmental, and mixed factors.…”

Section: Risk Factorsmentioning

confidence: 99%

Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

Marchand

Boucher

O’Shaughnessy

2015

Journal of Chiropractic Medicine

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Objective: The purpose of this case report is to describe a patient who presented with acute musculoskeletal symptoms but was later diagnosed with multiple deep vein thrombosis (DVT). Clinical Features: An 18-year-old female presented to a chiropractic clinic with left lumbosacral pain with referral into the posterior left thigh. A provisional diagnosis was made of acute myofascial syndrome of the left piriformis and gluteus medius muscles. The patient received 3 chiropractic treatments over 1 week resulting in 80% improvement in pain intensity. Two days later, a sudden onset of severe abdominal pain caused the patient to seek urgent medical attention. A diagnostic ultrasound of the abdomen and pelvis were performed and interpreted as normal. Following this, the patient reported increased pain in her left leg. Evaluation revealed edema of the left calf and decreased left lower limb sensation. A venous Doppler ultrasound was ordered. Intervention and Outcomes: Doppler ultrasound revealed reduction of the venous flow in the femoral vein area. An additional ultrasonography evaluation revealed an extensive DVTs affecting the left femoral vein and iliac axis extending towards the vena cava. Upon follow-up with a hematologist, the potential diagnosis of May-Thurner syndrome was considered based on the absence of blood dyscrasias and sustained anatomical changes found in the left common iliac vein at its junction with the right common iliac artery. A week following discharge, she presented with chest pain and was diagnosed with venous thromboembolism. The patient was successfully treated with anticoagulation therapy and insertion of a vena cava filter. Conclusion: Although DVTs are common in the general population, presence in low-risk individuals may be overlooked. In the presence of subtle initial clinical signs such as those described in this case report, clinicians should keep a high index of suspicion for a DVT.Rapid identification of such clinical signs in association with a lack of objective examination findings warrants further evaluation due to potentially negative outcomes.

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Iliac Vein Compression as Risk Factor for Left- versus Right-Sided Deep Venous Thrombosis: Case-Control Study

Cited by 79 publications

References 17 publications

Acute pulmonary embolism unmasking underlying chronic thromboembolic pulmonary hypertension and iliac vein compression syndrome

Acute pulmonary embolism unmasking underlying chronic thromboembolic pulmonary hypertension and iliac vein compression syndrome

Chronic unilateral leg swelling caused by iliac vein compression (Cockett's) syndrome in an elderly patient

Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

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