Left Iliac Vein Occlusion: Its Clinical Spectrum

Murray, J. D.; Brennan, Frank J.; Hall, Lee D.; Berry, J; Hatter, Douglas G.; Hemp, James; Reeves, T R; Velling, Thomas E.; Bergan, John J.

doi:10.1007/s100169910098

Cited by 11 publications

(6 citation statements)

References 17 publications

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“…This approach required sacrificing the left common iliac vein because the transverse processes could get stuck to the left common iliac vessels, thus leading to uncontrollable vascu-lar injury. Even though there have been no reported complications after left iliac vein ligation, left iliac vein occlusion can lead to an unpredictable spectrum of symptoms ranging from no symptoms to severe phlegmasia cerulea dolens 6) . Therefore, we tried to find the best way to preserve the left common iliac vein during the anterior L5 vertebral body removal in cases wherein the L5 transverse processes are not involved in the tumor.…”

Section: Discussionmentioning

confidence: 99%

Surgical Technique of Vertebral Body Removal and Anterior Reconstruction in L5 Spondylectomy

Sangsin

Murakami

Shimizu

et al. 2018

Spine Surg Relat Res

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Introduction: L5 spondylectomy for the treatment of spinal tumor is a technically demanding surgery because of the complex anatomy of major vessels, the obscurity of the posterior exposure from the iliac wings, and the increased comparative size of the L5 vertebral body. In this study, we present a surgical technique of L5 spondylectomy, vertebral body removal, and anterior reconstruction for a case with solitary spinal metastatic renal cell carcinoma (RCC). Technical Note: A 54-year-old man underwent right total nephrectomy for RCC one year ago. At the one-year postoperative follow-up, CT scan and MRI revealed a solitary L5 spinal metastasis. A two-stage posteroanterior approach was performed. To facilitate vertebral body removal, transverse processes were separated from the vertebral body by using the posterior approach. On the basis of the anterior approach, the vertebral body was removed via the interval space between the left common iliac vessels. Reconstruction was performed by using a liquid-nitrogen-frozen, tumor-bearing bone mixed with an autogenous bone graft in an expandable titanium cage. Results: No intraoperative complications were observed. Postoperatively, the patient exhibited muscle weakness in the tibialis anterior and extensor hallucis longus bilaterally but improved with time. Seven months after the operation, the patient was able to walk independently. At the recent 2.5-year follow-up, the local recurrence of lesions was nonexistent. The bone graft had fused with the adjacent vertebrae. Conclusion: This report described a novel technique for L5 spondylectomy that can facilitate safe L5 vertebral body removal and demonstrated the effectiveness of liquid-nitrogen-frozen, tumor-bearing bone mixed with autogenous bone graft in anterior reconstruction both in terms of oncologic safety and biological healing.

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Section: Discussionmentioning

confidence: 99%

Surgical Technique of Vertebral Body Removal and Anterior Reconstruction in L5 Spondylectomy

Sangsin

Murakami

Shimizu

et al. 2018

Spine Surg Relat Res

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“…The first person credited with documenting the discrepancy between right and left iliac venous obstruction was Virchow, who in 1851 observed that the incidence of left iliofemoral venous thrombosis was five times as great as right iliofemoral thrombosis. 1,2 Other investigators who later studied this phenomenon discovered that the etiology behind the increased involvement of the left iliac vein was due to external compression of the left iliac vein.…”

Section: Anatomy and Etiology Of Left Iliofemoral Venous Obstructionmentioning

confidence: 99%

“…2 In addition to the more common anatomic compression of the left iliac vein by the right iliac artery, Cockett described several other anatomic variations that can create iliocaval obstruction, including compression of the distal vena cava by the aortic bifurcation, compression of the right external iliac vein by the right external iliac artery, and compression of the left external iliac vein by the iliac artery at the inguinal ligament. 1 Other etiologies that can cause iliofemoral occlusion include tumor compression, retroperitoneal fibrosis, radiation therapy, and iatrogenic injury.…”

Section: Anatomy and Etiology Of Left Iliofemoral Venous Obstructionmentioning

confidence: 99%

“…Acute iliac thrombosis that results in phlegmasia cerulea dolens may require immediate anticoagulation and lysis to restore patency of outflow vessels and prevent venous gangrene and limb amputation. 1 However, the underlying etiology of the obstruction prevents most iliac veins from recanalizing with anticoagulation treatment alone and usually results in chronic obstruction and an increased risk of developing postthrombotic syndrome.…”

Section: Treatmentmentioning

confidence: 99%

“…14 Although results for patients with primary disease are better than those with postthrombotic obstruction, 6 cumulative secondary patency rates for the absence of recurrent stenoses greater than 50% have been reported at 93% at four years and 85% at 42 months. 13 Some authors recommend lytic therapy to help restore patency prior to venoplasty and stent placement, especially in young patients with acute symptoms, 1,2,7 because after thrombolysis, the cause of the obstruction can be easily identified and repaired. However, chronic obstructions can usually be treated with angioplasty and stenting alone, and furthermore, lytic therapy is rarely successful if the thrombosis has been present for more than one month.…”

Section: Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

May-Thurner Syndrome Presenting With Venous Claudication

Sulzdorf

2006

Journal of Diagnostic Medical Sonography

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Recognizing venous outflow obstruction is challenging and depends on the health care practitioner possessing a high degree of clinical suspicion, and being aware of the typical signs, symptoms, and hemodynamic findings associated with this disease. Iliofemoral thrombosis rarely recanalizes, especially if due to an underlying compression syndrome. If left untreated, the obstruction often results in worsening symptoms that become increasingly difficult and expensive to treat. Because venous and arterial Doppler examinations are often ordered for symptoms of lower extremity swelling and pain,

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Endovascular Treatment Options in the Management of Lower Limb Deep Venous Thrombosis

Nazir

Ganeshan

Nazir

et al. 2009

Cardiovasc Intervent Radiol

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Lower limb deep vein thrombosis (DVT) is a common cause of significant morbidity and mortality. Systemic anticoagulation therapy is the mainstay of conventional treatment instituted by most physicians for the management of DVT. This has proven efficacy in the prevention of thrombus extension and reduction in the incidence of pulmonary embolism and rethrombosis. Unfortunately, especially in patients with severe and extensive iliofemoral DVT, standard treatment may not be entirely adequate. This is because a considerable proportion of these patients eventually develops postthrombotic syndrome. This is characterized by chronic extremity pain and trophic skin changes, edema, ulceration, and venous claudication. Recent interest in endovascular technologies has led to the development of an assortment of minimally invasive, catheter-based strategies to deal with venous thrombus. These comprise catheter-directed thrombolysis, percutaneous mechanical thrombectomy devices, adjuvant venous angioplasty and stenting, and inferior vena cava filters. This article reviews these technologies and discusses their current role as percutaneous treatment strategies for venous thrombotic conditions.

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Left Iliac Vein Occlusion: Its Clinical Spectrum

Cited by 11 publications

References 17 publications

Surgical Technique of Vertebral Body Removal and Anterior Reconstruction in L5 Spondylectomy

Surgical Technique of Vertebral Body Removal and Anterior Reconstruction in L5 Spondylectomy

May-Thurner Syndrome Presenting With Venous Claudication

Endovascular Treatment Options in the Management of Lower Limb Deep Venous Thrombosis

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