Medically Challenging Case: Lumbosacral Radiculopathy Secondary to Occlusion of Right Iliac Vein Kissing Stent in the Context of Variant Course of Right Iliac Vein between Psoas Muscle and Spine and Factor V Leiden Mutation

Abstract

Background: The variant course of the right iliac vein between the right psoas muscle and spine and its significance has not been reported and lumbosacral radiculopathy is not a known complication after occlusion of the right iliac vein stent in such condition. Case Report: The patient is a 38-year-old woman with Factor V Leiden mutation, multiple deep vein thrombosis, including in her bilateral iliac veins, and a variant course of the right iliac vein between the psoas muscle and spine, who presented with radicular pain and weakness after stenting of the bilateral iliac veins. She was found to have complete occlusion of the right common iliac through the femoral vein stent that was compressing her lumbosacral spinal roots and resulted in lumbosacral radiculopathy. Her pain and weakness significantly improved after an epidural steroid injection. Conclusion: Lumbosacral radiculopathy is a rare complication after occlusion of the right iliac vein stenting in the setting of a variant course of the right common iliac vein between the psoas muscle and spine and Factor V Leiden mutation. The risks and benefits of implanting a kissing stent in a similar scenario should be weighed carefully for patients at high risk for stent occlusion. Additionally, patients should be assessed for variable anatomy as part of the presurgical workup to hopefully prevent this undesired outcome. Key words: Lumbosacral radiculopathy, iliac vein stenting, Factor V Leiden, deep venous thrombosis, variant course