Iatrogenic Venous Compression Syndrome due to Surgical Lumbar Hardware

Abstract

Abstract: Background: The Iliac vein compression syndrome (IVCS) is most commonly due to May-Thurner variant, an anatomic variant where in the right common iliac artery overlies the left common iliac vein and compresses it against the lumbar spine. The compression of the common venous outflow tract of the left lower extremity may cause discomfort, swelling, or deep vein thrombosis in the iliofemoral veins. The role of the pelvic surgery particularly the lumbar hardware in the development of symptomatic Venous compression syndrome in patients with May-Thurner syndrome is not well understood. The incidence is presumably very low. Herein, we present six patients who developed IVCS after Lumbar hardware. Method: The cases were diagnosed between Nov. 2016 to Oct. 2019 in the Outpatient Cath Lab of McKinney, TX. The patient’s medical records were retrospectively analyzed looking for risk factors, clinical features, venogram findings, and post venogram. The evaluation of each case was described, and common trends were later presented in a cross-case analysis. Conclusion: The cases presented in this report suggest that the hardware used in lumbar/spinal surgery could lead to an IVCS. Patient’s symptoms are unspecific. Venogram/venoplasty is the gold standard for diagnosis and treatment. It is imperative having a high level of suspicion and familiarizing with the natural history of IVCS due to the invasive nature of venogram and the relevance of an early diagnosis to reduce the occurrences of complications. Keywords: Venous disease, Iliac vein compression, May-Thurner syndrome, Lumbar surgery complications, Unexplained edema of left leg, May-Thurner Syndrome, Lumbar hardware, Venous compression, IVUS, Venogram, Angioplasty