External Iliac Vein Thrombosis Research Articles

Providing End-of-Life Care in the Community: What Are the Challenges in Malaysia?

A 72-year-old woman with metastatic lung cancer to bone and brain and with left external iliac vein thrombosis was under the care of a community palliative care provider. She experienced an acute pain crisis due to acute limb ischemia of the left lower limb. Goals-of-care discussions were held with the patient and her family; she prioritized symptom control and end-of-life care at home. The family and patient were aware of her short prognosis. Her complex pain was managed by the community palliative team, and her family was empowered to give subcutaneous injections. We illustrate a case showing the importance of community health services with palliative care support in providing symptom management and support to patient and family caregivers throughout the course of a life-limiting illness. It also highlights family caregivers' potential psychological distress in delivering subcutaneous injections in terminal care for a patient at home.

Thrombectomy in deep vein thrombosis: a definitive treatment

Background: The development of blood clots (thrombi) in the deep veins is known as deep vein thrombosis (DVT). It frequently affects the deep pelvic veins or the deep leg veins (such as the calf veins, femoral vein, or popliteal vein). It is a potentially fatal condition that may result in morbidity and mortality that can be prevented. Aim was to assess the effectiveness of thrombectomy in treating patients with DVT.Methods: The 196 patients with DVT reporting to VKP’s VJ hospital, Tirunelveli, Tamil Nadu, were selected for this retrospective study. Thrombectomy was chosen as the treatment modality in this study.Results: Most patients were in the age group between 41 to 60 years (59.5%), with male predominance noted (77.4%). Pain and swelling are the most typical clinical features, 64.6% of patients presented with this sign. In patients with chronic and sub-acute DVT, 25% and 10.2% had residual thrombus visualized in doppler. Late complication, varicose veins were seen higher in patients with common iliac vein thrombosis (2/3) 66.7%, 52.6% (10/19) in external iliac vein thrombosis and 34.8% (8/23) in popliteal vein thrombosis. Late complication recurrence was seen higher in patients with partial occlusion (5/14) 35.7%, 21.4% (3/14) had varicose veins.Conclusions: The best course of treatment for DVT patients is thrombectomy, which can restore venous patency, stop DVT from returning, alleviate PTS, and prevent pulmonary embolism.

May\u2013Thurner syndrome, a diagnosis to consider in young males with no risk factors: a case report and review of the literature

BackgroundMay–Thurner syndrome is an anatomical condition characterized by compression of the left common iliac vein by the right common iliac artery, causing venous outflow obstruction. It is an uncommon cause of deep vein thrombosis and is more prevalent among women. This paper highlights the importance of considering May–Thurner syndrome in young males without risk factors presenting with left lower limb pain, as endovascular treatment may be required.Case presentationA 23 year-old Caucasian male presented with a 1-week history of left lower limb pain, edema, and pallor. He was found to have an unprovoked deep vein thrombosis on Doppler ultrasound involving the left fibular, soleus, gastrocnemius, popliteal, femoral, common femoral, and external iliac veins. A heparin infusion was commenced as the initial treatment for deep vein thrombosis. Further investigation with computer tomography pulmonary angiogram and computer tomography venography of the abdomen and pelvis showed bilateral pulmonary emboli and left common iliac vein compression with left common, internal, and external iliac vein thrombosis. He was diagnosed with May–Thurner syndrome despite having no risk factors. A retrievable Cook Celect Platinum inferior vena cava filter was placed, and thrombus of the left common femoral, external, and common iliac veins was treated successfully with AngioJet thrombectomy, thrombolysis using 200,000 units of urokinase, angioplasty and stenting using two Cook Zilver Vena venous self-expanding stents. Therapeutic enoxaparin was commenced on discharge. His filter was removed after 10 weeks. Hematological follow-up 4 months later showed an overall negative thrombophilia screen, and anticoagulation was switched to apixaban. He has had no recurrent thrombosis.ConclusionsClinicians should have a low threshold to investigate for May-Thurner syndrome in patients with left lower limb venous thrombotic events regardless of risk factors, as endovascular treatment may be required to minimize the long-term sequelae of deep vein thrombosis. Duplex ultrasound can be used initially for diagnosis, and computer tomography venography used subsequently if the common iliac vein is not visualized on ultrasound. Endovascular treatment is preferred over anticoagulation alone, especially in otherwise fit patients presenting early, the aim being to reduce the chances of chronic venous hypertension in the lower limb.

Clinical characteristics and risk factors of proximal deep venous thrombosis in patients with fractures

Objective To investigate the clinical characteristics and risk factors of perioperative deep venous thrombosis(DVT) in fracture patients. Methods A retrospective case control study was conducted to analyze the clinical data of 147 patients with DVT diagnosed by color Doppler ultrasound or lower extremity deep venography from July 2015 to November 2017 in Honghui Hospital Affiliated to Xi'an Jiaotong University College of Medicine. The patients were divided into proximal thrombosis group (including the popliteal vein) and distal thrombosis group according to the involvement site with the popliteal vein as reference. The proximal thrombosis group (56 patients) included 31 males and 25 females, aged 38-89 years, with an average age of 67.8 years. There were three patients with pelvic and acetabular fractures, 39 with hip fractures, 10 with femoral shaft fractures, three with periarticular fractures, and one with tibia and fibula fracture. According to the site of involvement, four patients had proximal vein thrombosis, and the other 52 patients had proximal combined with distal thrombosis. There were 44 patients with left thrombosis and 12 with right thrombosis. Thrombosis at femoral vein and above was found in 20 patients (7 with external iliac vein thrombosis), and thrombosis at popliteal vein was found in 36 patients. The distal thrombosis group (91 patients) consisted of 51 males and 40 females, aged 21-92 years, with an average of 63.6 years. There were 12 patients with pelvic and acetabular fractures, 39 with hip fractures, four with femoral shaft fractures, 16 with fractures surrounding knee joint, 12 with tibia and fibula fractures, and eight with ankle joint fractures. There were 43 patients with left thrombosis and 48 with right thrombosis. The gender, age, fracture location, time from injury to operation, operation time, blood transfusion rate, thrombus side, D-dimer level before and after operation, and internal medical diseases were compared between the two groups. The risk factors with statistical significance were screened for multivariate Logistic regression analysis. Results In proximal thrombosis group, 70% (39/56) had hip fracture and 18% (10/56) had femoral shaft fracture, while 43% (39/91) had hip fracture and 4% (4/91) had femoral shaft fracture in distal thrombosis group (P 0.05). Logistic regression analysis showed that hip fracture and femoral shaft fracture, left lower limb, blood transfusion, high D-dimer level before and after operation were risk factors for proximal thrombosis. Conclusions Proximal venous thrombosis is often combined with distal venous thrombosis. Hip fracture, femoral shaft fracture, left lower limb, blood transfusion, preoperative and postoperative high D-dimer levels have significant effects on proximal thrombosis. Key words: Venous thrombosis; Fractures, bone; Risk factors

Treatment of the Lymphocele After Kidney Transplantation: A Single-center Experience.

Lymphocele is one of the most common complications after kidney transplantation. It is usually asymptomatic, but can cause pressure on the kidney transplant, ureter, bladder, and adjacent vessels with deterioration of graft function, ipsilateral leg edema, and external iliac vein thrombosis. Peritoneal fenestration is a well-established method for treatment. In this report, we present the incidence of symptomatic lymphocele requiring treatment (LRT), demographic and surgical factors that influenced lymphocele formation, its clinical presentation, and 2 types of treatment: open and laparoscopic intraperitoneal drainage in the experience of our center. We retrospectively analyzed all kidney transplantations performed between January 2007 and December 2014 in Gdansk Transplantation Center (n= 740) and selected patients with LRT. LRT occurred in 59 cases (8%). All other patients transplanted during the same time (n= 681) were treated as a control group in the univariate and multivariate analysis of risk factors of the lymphocele formation. Surgical intraperitoneal drainage was performed in an open method in 53 cases and laparoscopically in 6 patients. We observed recurrence of lymphocele in 11 cases (18.6%). Acute rejection episodes (ARE) and delayed graft function (DGF) were more frequent in patients with LRT. ARE and age were independent risk factors for LRT in multivariate analysis. The mean estimated glomerular filtration rate by the Modification of Diet in Renal Disease method at 1 month after the fenestration was higher than before the operation (51.7 and 43.6mL/min, respectively). Fenestration is a safe and effective method of treatment of symptomatic lymphocele. ARE, DGF, and older age were associated with a greater risk of LRT.

External Iliac Vein Thrombosis in an Athletic Cyclist With a History of External Iliac Artery Endofibrosis and Thrombosis

External iliac artery endofibrosis describes an intimal subendothelial fibrosis leading to wall thickening and stenosis that has been described in high-performance athletes. There are anatomical, mechanical, and probably metabolic factors that may contribute to this pathology. Ankle-brachial index (ABI) measurement with exercise testing, duplex ultrasound, computed tomography (CT) or magnetic resonance (MR) angiogram, and ultimately arteriography help to make the diagnosis. Management can be conservative, but most cases require surgical intervention. External iliac vein stenosis and thrombosis in cyclists has rarely been described in the literature. We report a case of extensive left lower limb deep venous thrombosis (DVT) including the external iliac vein diagnosed in a 57-year-old athletic cyclist with a history of external iliac artery thrombosis.

A Case of Mistaken Identity: When a Deep Vein Thrombosis is not a Thrombosis

Introduction Although rare, nonthrombotic causes of venous obstruction do occur. Their ultrasound findings can mimic deep vein thrombosis (DVT). We sought to examine the ultrasound appearance of these tumors to determine whether their differentiation from DVT was possible. Case Report Two patients, in whom a DVT was initially suspected, were subsequently diagnosed with intravascular tumors: a leiomyosarcoma and a hemangioma. The first patient presented with thigh pain, and an initial diagnosis of long saphenous vein (LSV) and common femoral vein thrombosis was made. The apparent thrombus remained unchanged despite anticoagulation. Proliferation of the lesion outside of the LSV developed, resulting in a review of the diagnosis, and surgical resection was performed. A histological diagnosis of leiomyosarcoma was made. The second patient presented with leg swelling and an initial diagnosis of External Iliac vein thrombosis was made. Further ultrasound assessments demonstrated arterialized flow within the lesion and surgical resection was performed, with a histological diagnosis of intravascular epithelioid hemangioma. Results The B-mode appearance was similar for both. The presence of arterialized flow within the lesions is helpful but may not be diagnostic because of recent reports that neovascularization may develop within thrombus. Conclusion Suspicion needs to be raised in a patient presenting with an unprovoked DVT or when conventional treatment does not result in improvement of symptoms; as well as when prolonged arterialization is identified within the thrombus. These signs can alert the clinician to a possible non-thrombotic mechanism of venous obstruction.

Utility of lower-extremity duplex sonography in patients with venous thromboembolism

We evaluated the utility of venous duplex ultrasonography (VDUS) of the lower extremities in patients with pulmonary embolism (PE) and studied the distribution of venous thrombi in deep vein thrombosis (DVT) patients with and without PE. We retrospectively reviewed medical records of all inpatients with a final diagnosis of PE or DVT between 1989 and 2000. Venous thrombosis was detected by VDUS in 229 patients (191 without PE and 38 with PE). The left leg only was involved in 50% of patients (p < 0.05), the right leg only in 33%, and both legs in 17%. The overall distribution of veins affected by DVT was: popliteal vein, 77%; superficial femoral vein, 76%; common femoral vein, 65%; posterior tibial vein, 23%; external iliac vein, 21%; common iliac vein, 9%; great saphenous vein, 7%; and inferior vena cava, 2%. A single venous site was involved in 22% of patients. External iliac vein thrombosis was more frequent in patients with DVT only (24%) than with PE and DVT (5%) (p < 0.05). The venous obstruction was partial in 14% of patients. VDUS of the asymptomatic leg was positive in 14% of patients with unilateral symptoms of DVT, all of whom also had DVT in the symptomatic leg. VDUS was positive for DVT in 90% of patients with PE and concomitant pain or edema of the leg, compared to only 20% of PE patients with no symptoms of DVT. Sonography should be the first diagnostic test for patients suspected of having PE with any sign or symptom related to DVT. VDUS of the asymptomatic leg is unnecessary in the diagnosis and management of DVT. Omitting the superficial femoral vein examination would lead to some decrease in the sensitivity of VDUS.

Transvaginal color Doppler in the detection of external iliac vein thrombosis in pregnancy.

A case is described where transvaginal color Doppler was used to demonstrate upward external iliac vein extension of thrombus at 26 weeks' gestation. Normally, transabdominal color Doppler can visualize the iliac vessels, but in advanced pregnancy the uterus obstructs the view. This technique is useful in determining of there is a 'high' deep vein thrombosis in pregnancy, and may also prove useful in the obese patient.