External Iliac Vein Research Articles

Stasis Leg Ulcers: Venous System Revises by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging.

Objectives: The distribution of venous pathology in stasis leg ulcers is unclear. The main reason for this uncertainty is the lack of objective diagnostic tools. To fill this gap, we assessed the effectiveness of triggered angiography non-contrast-enhanced (TRANCE)-magnetic resonance imaging (MRI) in determining the venous status of patients with stasis leg ulcers. Methods: This prospective observational study included the data of 23 patients with stasis leg ulcers who underwent TRANCE-MRI between April 2017 and May 2020; the data were retrospectively analyzed. TRANCE MRI utilizes differences in vascular signal intensity during the cardiac cycle for subsequent image subtraction, providing not only a venogram but also an arteriogram without the use of contrast agents or radiation. Results: TRANCE MRI revealed that the stasis leg ulcers of nine of the 23 patients could be attributed to valvular insufficiency and venous occlusion (including deep venous thrombosis [DVT], May–Thurner syndrome, and other external compression). Moreover, TRANCE MRI demonstrated no venous pathology in five patients (21.7%). We analyzed TRANCE MRI hemodynamic parameters, namely stroke volume, forward flow volume, backward flow volume, regurgitant fraction, absolute volume, mean flux, stroke distance, and mean velocity, in the external iliac vein, femoral vein, popliteal vein, and great saphenous vein (GSV) in three of the patients with valvular insufficiency and three of those with venous occlusion. We found that the mean velocity and stroke volume in the GSV was higher than that in the popliteal vein in all patients with venous valvular insufficiency. Conclusions: Stasis leg ulcers may have no underlying venous disease and could be confirmed by TRANCE-MRI. TRANCE MRI has good Interrater reliability between Duplex study in greater saphenous venous insufficiency. It also potentially surpasses existing diagnostic modalities in terms of distinguishable hemodynamic figures. Accordingly, TRANCE-MRI is a safe and useful tool for examining stasis leg ulcers and is extensively applied currently.

Clinico-Radiological Evaluation of Modified Stoppa Approach in Treatment of Acetabulum Fractures.

BackgroundThe aim of our study was to evaluate the efficacy of Modified Stoppa approach for surgical treatment of acetabulum fractures by analyzing clinical and radiological outcomes. Also, we assess intraoperative and postoperative complications of fracture treated by using Modified Stoppa approach.ObjectivesTo evaluate clinical outcomes of Modified Stoppa approach by using Merle d'Aubigne hip score. To evaluate the radiological reduction quality of Modified Stoppa approach by using the criteria of Matta, and to assess complications of Modified Stoppa approach. MethodThirty-two patients participated in this study (mean age 40 years; range 18-60 years) and the male to female ratio was 4:1, patients who underwent surgical intervention for acetabular fracture by using Modified Stoppa approach from Oct 2017 to April 2019 were included. Out of 32 patients, two were lost in follow up, leaving 30 of 32 patients for clinico-radiological analysis. We classified the fracture pattern according to Judet and Letournel classification based on preoperative X-ray AP view, Judet View, and 3D-CT pelvis. Operative time, blood loss, reduction quality, and perioperative complications were assessed in each patient. Clinical outcomes were assessed by Merle d’Aubigne hip score and radiological outcomes by criteria of Matta. ResultsOut of 30 acetabulum fractures in 30 patients, three (10%) were categorized as anterior column fracture, one (3.3%) as transverse with posterior wall, one (3.33%) as T-type, six (20%) as anterior column with posterior hemi-transverse and 19 (63.33%) as both column fractures. In our study, most patients have trauma due to road traffic accident (RTA) in 25 (83.3%) and fall from stairs in three (10%) patients. Timing of surgery after trauma was average 5.83 days (range three to 15 days), Mean surgical time determined to be 214.66 min (range 150-350 min) and mean intraoperative loss 683.33 ml (range 230-1250 ml). Clinical outcomes by Merle d’Aubigne hip score was excellent in 13 (43.33%), good in 15 (50%), fair in two (6.66%) patients whereas poor results in 0 (0%) patient (p=0.001). Quality of reduction by Matta criteria was found to be an anatomical reduction in 26 (86.6%), imperfect reduction in three (10%), and poor reduction in one patient (3.33%) (p<0.001). Radiological grading by Matta criteria was excellent in 24 (80%), good in five (16.66%), and fair in one (3.33%) patient, and no patients met criteria for poor results (p<0.001). In operative complications one patient developed an external iliac vein injury which was repaired by a vascular surgeon, one patient had a superficial infection for which debridement, regular dressing, and IV antibiotics given and resolve in one month, obturator nerve injury in one patient which was resolve in five to six months, lateral femoral cutaneous nerve injury in one patient which resolved within three months and one patient urinary bladder injury which was repaired by a general surgeon. ConclusionOur experience with Modified Stoppa approach for surgical treatment of acetabulum fracture in 30 patients is excellent and effective for better visualization to anterior column, quadrilateral plate, and up to sacroiliac joint. This approach provides better visibility of the fracture site which allows for good to an excellent reduction of fracture and fixation. Although Stoppa approach is cosmetic surgery in terms of scar size, there is less complication rate than the ilioinguinal approach.

Acute Appendicitis Remains a Great Mimicker – The Pitfalls in the Differential Diagnosis and Tactics - A Case Report

Summary Acute appendicitis (AA) is the most common non-traumatic abdominal emergency. Despite the improved knowledge, experience, and technological advance, its diagnosis remains a challenge. Herein we report an example of a difficult diagnosis of acute appendicitis and comment on the possible pitfalls in the differential diagnosis and surgical tactics. We present the case of a 41-year-old man who had been admitted to another hospital with an initial diagnosis of acute appendicitis and changed to Crohn’s disease (CD). Because of a pelvic abscess, percutaneous drainage had been performed. Thrombosis of the right femoral vein had been diagnosed and treated accordingly. In an improved condition, he was referred for elective operation with a final diagnosis of neuroendocrine tumour based on cytology. At laparotomy, the appendix was found densely adherent to the right external iliac vein with a well-demarcated tumour (1 cm) at the base. Appendectomy with partial resection of the caecum with a linear stapler was performed. The histological examination revealed acute to chronic appendicitis with lymphoid follicle hyperplasia at the base. The case illustrates the necessity for broad differential diagnosis in AA and the possibility of severe vascular complications in complicated AA. Taking a detailed history and CT are of paramount importance for an accurate preoperative diagnosis, especially of CD. All emergency surgeons should also be familiar with the scenario of unexpected findings at laparotomy, especially with the management of CD and the algorithms for treatment of appendiceal malignancies. The mini-invasive drainage of right iliac fossa abscess allows for optimizing the patient’s condition and may help to avoid unnecessary extensive resections.

"External Iliac Vein Laceration-A Rare Complication of Tunneled Dialysis Catheter"

Bleeding complication from Central dialysis catheter is rare. Usually it settles in short time after procedure. If patient is on antiplatelet therapy it can sometimes last for 24-48 hours and stops with pressure dressing. We report a rare case of ongoing (>96 hour post procedure) bleeding from dialysis catheter exit site and investigation revealed the cause was iliac vein laceration.

Rapidly Progressive Invasive Urothelial Carcinoma With Flat and Infiltrative Growth Pattern in the Graft Kidney After Living-Related Kidney Transplantation: A Case Report

BackgroundBecause immunosuppression is necessary for kidney transplant recipients, malignant tumorigenesis of recipient organs is a concern; however, few studies have discussed the malignant alteration of transplanted grafts that have been functional for a long time. In addition, a urothelial carcinoma (UC) in transplanted kidney graft is a rare disease. Case reportA 62-year-old man had end-stage renal failure 31 years ago and received a kidney transplant from his father. Acute renal failure due to obstruction of the transplanted ureter was diagnosed. Ultrasound, ureterogram, and non-enhanced computed tomography scans revealed no obvious evidence of any neoplastic lesion. We treated the obstruction and hydronephrosis with transplant ureter stenting. However, the regional lymph nodes enlarged, and it became necessary to change the ureteral stent frequently because of stent stenosis; therefore, he underwent lower transplant ureteral resection and reconstruction. Histopathology confirmed a UC with a flat and infiltrative growth pattern. The patient then underwent graftectomy including right external iliac vein resection and reconstruction; however, because of numerous metastatic nodules, radical surgery could not be performed. The patient subsequently died because of septic shock after the second surgery. ConclusionWe report a case of an invasive UC with a flat and infiltrative growth pattern derived from a transplant kidney graft that occurred 31 years after a living-donor transplant that could not be treated immediately and was difficult to diagnose.

Three-dimensional computed tomography venogram enables accurate diagnosis and treatment of patients presenting with symptomatic chronic iliofemoral venous obstruction

ObjectiveThe last several years has witnessed an increase in the diagnosis and treatment of chronic iliofemoral venous obstructive lesions. Although intravascular ultrasound (IVUS) examination has become the gold standard in the management of chronic iliofemoral venous obstruction (CIVO), it is an invasive technique. To ascertain the usefulness of noninvasive imaging technology in diagnosing and treating CIVO in symptomatic patients, we compared three-dimensional (3D) reconstructions from computed tomography venogram (CTV) with IVUS examination. MethodsTwenty-two continuous patients who underwent IVUS interrogation during intervention for CIVO formed the study cohort. Patients who had stenting performed in the setting of chronic total occlusion of the iliofemoral segment or acute iliofemoral deep venous thrombosis were excluded. All patients underwent CTV as part of their standard preoperative work up. Minimal (smallest) luminal areas of the common iliac vein (CIV), external iliac vein (EIV), common femoral vein (CFV) and the inflow channel (segment caudal to the CFV) were obtained from 3D CTV and IVUS. Centerline length measurements were obtained from 3D CTV to estimate the length of the venous stents necessary; the inflow channel luminal area was used to predict the required stent diameter. Pearson correlation was used to evaluate the association between the luminal areas obtained from the two techniques. Agreement was ascertained by use of Bland-Altman limits of agreement. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 3D CTV in predicting luminal areas was also determined. Predicted stent diameters and lengths were compared against actual stent diameters and lengths used. ResultsPearson correlation statistic for luminal areas between 3D CTV and IVUS for the CIV was 0.89 (P < .01), for EIV was 0.77 (P < .01), and for CFV was 0.69 (P < .01). The correlation statistic for the inflow channel luminal area was 0.90 (P < .01). The sensitivity of 3D CTV in diagnosing CIVO in the CIV, EIV, and CFV were 100%, 100% and 80%, respectively. The specificity was 67%, 57%, and 86%, respectively, in the CIV, EIV, and CFV segments. The positive predictive value of 3D CTV in determining CIVO in the CIV, EIV, and CFV segments was 89%, 83%, and 92%, and the negative predictive value was 100%, 100%, and 67%, respectively. The overall accuracy was 91%, 86%, and 82% in the CIV, EIV, and CFV segments. Thus, 3D CTV is able to predict stent length within 9.5 mm of the actual stent length used. With respect to stent diameter, 3D CTV was able to predict within 2 mm of the actual stent diameter used 91% (20/22) and within 4 mm of the actual stent diameter used 100% (22/22) of the time. ConclusionsFrom a diagnostic standpoint 3D CTV does well with an overall accuracy ranging from 82% in the CFV to 91% in the CIV in predicting CIVO. It is also able to accurately predict venous stent diameter and lengths required, rendering it a good tool in the diagnosis and treatment of symptomatic CIVO.

Renal Transplantation in Mansoura, Egypt.

Renal Transplantation in Mansoura, Egypt.

Trasplante renal en paciente con pared abdominal compleja: síndrome de abdomen en ciruela pasa

Introducción. Se presenta un paciente con falla renal crónica secundaria a hidroureteronefrosis bilateral, con antecedente de síndrome de abdomen en ciruela pasa (prune belly), en quien se realiza trasplante renal.&#x0D; El objetivo de este reporte de caso es exponer una anomalía congénita, con baja incidencia mundial y en menor proporción asociado a trasplante renal, con énfasis en la dificultad para la técnica quirúrgica dada por la hipoplasia de los músculos de la pared abdominal.&#x0D; Métodos. Revisión de Historia clínica, Consentimiento Informado. Búsqueda de la literatura.&#x0D; Caso clínico. En cirugía se identifica ausencia de músculos de la pared abdominal y fibrosis de las venas Iliaca externa y común derecha. Se realiza abordaje bajo técnica de Gibson contralateral, con trasplante renal sin complicaciones. Presentó adecuada evolución en seguimiento ambulatorio.&#x0D; Discusión. El síndrome de abdomen en ciruela pasa (prune belly) es una anomalía congénita de baja incidencia, con pocos reportes asociados a trasplante renal. El reto quirúrgico está dado por la ausencia de músculos de la pared abdominal, que aumentan los riesgos por posibles complicaciones, como la lesión de los vasos epigástricos inferiores. Para el cierre de pared abdominal en trasplante renal, se describe en dos planos, que en este caso se realiza sobre fascia muscular y piel. Aun siendo un reto, el paciente presenta adecuada evolución postoperatoria.

Complications after male adjustable suburethral sling implantation.

IntroductionArgus suburethral sling implantation is a minimally invasive operation with the possibility to adjust the tension of the sling at any time after the procedure, which provides good treatment results for male stress urinary incontinence (SUI).AimTo determine the predictive factors, the incidence, severity and timing of the onset of complications after Argus sling implantation for males with post-operative SUI.Material and methodsA total of 41 patients who underwent Argus sling implantation due to post-operative SUI were included. Median follow-up was 12 months. All complications were captured and graded according to severity and classified by timing of onset. Logistic regression analysis was performed to identify predictors of the most common side effects.ResultsOverall 22 (54%) of 41 males have experienced 31 complications. Three (7%) patients have experienced only intra-operative, 16 (39%) patients only post-operative and 3 (7%) patients both intra-operative and post-operative complications. The most common intra-operative complications were bladder perforation (12%) and external iliac vein injury (5%), while post-operative complications were acute urinary retention (29%), infection (10%) and perineal pain (7%). Previous radiotherapy has significantly increased the risk of intra-operative complications, while a non-significant tendency was observed for younger age, previous androgen deprivation therapy and grade 3 SUI. In terms of severity, most post-operative complications were classified as grade 3 according to the modified Clavien-Dindo system.ConclusionsArgus sling implantation provides a tolerable complication rate, where acute urinary retention was the most common side effect. Previous radiotherapy significantly increases the risk of serious intra-operative complications.

Urological and surgical complications of renal transplant recipients as a single-center experience

Background: Kidney transplantation is considered the most effective therapy for end-stage renal disease (ESRD). Postoperative complications continue to occur in nearly 12–20% of patients. These complications can be sub-divided into three categories: vascular, urologic, and nephrogenic. Objective: To determine the surgical and urological complications of renal transplant in Basra Training Center. Patients and Methods: A prospective descriptive study was done on 71 patients who underwent renal transplant surgery between October 2015 and August 2018. After taking their informed consent, preoperative antibiotics were given, and the procedure was done under general anesthesia. In all the transplantations, the renal vein of the donor was anastomosed to the external iliac vein of the recipient with an end-to-side. While the renal artery anastomosed to the internal iliac artery of the recipient with an endto-end for the first 50 cases, in the other 21 cases, renal artery anastomosed to the external iliac artery of the recipient with an end-to-side anastomosis. Ureters were anastomosed by the Lich–Gregoire procedure. Results: Overall, urological and surgical complications were encountered in 12 of the renal transplants recipients from the total number (71, 17%). This study included a total of 71 patients (59 male and 12 female, 83% and 17%, respectively). The complications that occurred during the follow-ups of the patients were as follows: one patient developed urinary leak (1.4%), five patients developed lymphocele (7%), four patients complained of acute pyelo nephritis (6%), one patients (1.4%) complained of wound infection, and one complained of renal stone (1.4%). Conclusions: In conclusion, urological complications such as lymphocele (7%) and acute graft pyelonephritis (AGPN) (6%) remain the most common type of surgical complications following kidney transplantation (in this study). Our urological and surgical complication rate was relatively low compared to others noted in the literature. Keywords: Kidney transplantation, ESRD, urinary leak, lymphocele

Inconsistent Use of Terminology and Different Treatment Outcomes of Venous Adventitial Cystic Disease: A Proposal for Reporting Standards.

Adventitial cystic disease (ACD) is a very rare condition characterized by the accumulation of a cyst filled with gelatinous substance in the adventitia of a vessel adjacent to the joint area. The cyst usually compresses the vessel lumen, causing claudication or leg swelling. The disease usually affects the popliteal artery. However, several cases of venous ACDs particularly in the common femoral or external iliac vein have been reported. The definition, diagnosis, and optimal treatment of ACD remain controversial because of its rarity and the inconsistent use of terminology. The heterogeneity of the reported cases is more prominent in venous ACD. Herein, the accurate terminology of cysts correlated to the joint (synovial cyst, ganglion cyst, and adventitial cyst) and the pathogenesis, anatomy, and optimal therapy of venous ACD are discussed in detail to establish reporting standards for future studies.

Repair with Gonadal Vein Patch in the Unexpected Left Renal Vein Injury During Donor Nephrectomy

Objective: The objective of this presentation is to share our experiences with an unusual repair of a defective graft renal vein using an own gonadal vein, which occurred iatrogenically during a laparoscopic donor nephrectomy. Case Report: A 35-year-old man with situs inversus totalis was referred to our clinic for a living-related renal transplant with a diagnosis of end-stage renal disease. The donor was 66-year-old mother of the patient. Laparoscopic left donor nephrectomy was planned for his mother . At the end of laparascopic disection renal vein tear occurred during the renal extraction. Without any intervention renal extraction was performed to maintain the patency of renal allograft and to stabilize the donor. Partial hemorrhage from renal vein was brought under control. Donor nephrectomy was completed with a defective remaining segment of renal vein. We decided to repair with gonadal vein patch ın the unexpected renal vein injury. Patch from tearing part of renal vein with short gonadal vein repairment was performed. After repairment of graft renal vein, anastomosis to external iliac vein was performed. The trans-plant procedure was completed successfully. The kidney functioned immediately. Doppler ultrasound revealed that perfusion of the kidney was normal. The postoperative creatinine levels of recipient were in the normal ranges. Daily urine output was normal. Conclusion: Repairment of a defective graft renal vein by using own gonadal vein seems to be a simple, safe, and reliable method. This technique provides an alternative approach for the reconstruction of vessels in living-donor kidney transplants.

An image analysis of the major angles along the pathway of iliac veins involved in endovenous interventions

ObjectiveThe specific anatomic characteristics of the iliac veins are often important reasons for stent failure. However, to the best of our knowledge, the inherent angles and configurations of the iliac veins have not been thoroughly studied. MethodsFifty patients without venous diseases who had undergone computed tomography urography for diagnosis of urolithiasis were included in this study. The pathways of the iliac veins were mapped out, and the major angles were measured. The factors associated with steep angles were also evaluated. ResultsThere were two relatively constant angles on the right side and three on the left side along the common femoral vein, external iliac vein, and common iliac vein. All these were measured with the patients in the supine position. The angles at the inguinal region (γ) and internal-external iliac vein confluence (β) were at similar sites for both sides. There was a third angle in front of the fifth vertebra for the left side (α). The γ angle was 125.03 ± 11.68 degrees for the right side and 122.26 ± 9.64 degrees for the left side. The β angle was 136.91 ± 14.24 degrees for the right side and 125.61 ± 20.76 degrees for the left side. According to the β angle of the left side, the iliac veins could be categorized into three types. For type I, the angle was >150 degrees (14% [7/50]). For type II, it was 120 to 150 degrees (50% [25/50]). For type III, it was ≤120 degrees (36% [18/50]). The angles between the anterior border of the fifth vertebra and pelvic inlet plane (0.866; 95% confidence interval, 0.777-0.966) and age (1.087; 95% confidence interval, 1.004-1.177) were related to type III configurations on multilogistic regression analysis. ConclusionsThere were several relatively constant angles along the pathway of the iliac veins. The pathway of the left side was more complex than that of the right side. This difference in the angles might be related to the patients' age and bone structures. These angles should be considered in planning iliac vein stenting as well as in designing stents specifically for the iliac veins.

Robotically Assisted Laterally Extended Endopelvic Resection (LEER) of an Isolated Ovarian Cancer Recurrence

A 64-year-old woman with recurrent ovarian cancer isolated to the left pelvic sidewall underwent robotic resection of a tumor adherent to the external iliac vein and encasing the ureter and internal iliac vessels. A narrated video-clip of the case is included.

Association of spectral Doppler cardiac activity in the lower limb veins and echocardiographic findings in patients with tricuspid regurgitation.

ObjectiveTo determine the association between spectral Doppler cardiac activity in the lower limb veins and echocardiographic findings in patients with tricuspid regurgitation.Material and methodsA cross-sectional analysis was performed in the Gilani Ultrasound Center over a period of 13 months. The total study sample comprised 400 subjects. All individuals referred for abdominal ultrasound having cardiac activities in external iliac vein, popliteal and posterior tibial vein, individuals having normal venous Doppler ultrasound, both genders and all ages, were included, and unwilling and non-cooperative patients were excluded from the study.ResultsOut of 400 individuals, 200 showed cardiac activity in the lower limb veins on Doppler vascular ultrasound, while 200 did not show cardiac activity. On echocardiography, 204 individuals were diagnosed with tricuspid regurgitation, and 196 individuals had a competent tricuspid valve. According to the independent sample t-test the mean difference in the posterior tibial vein was 25.54 (95% CI: 24.09; 26.98), while the mean difference in the iliac vein was 2.34 (95% CI: 0.64; 4.03) among normal and tricuspid regurgitation.ConclusionA correlation was found between the cardiac activities in the lower limb veins and tricuspid regurgitation.

Radiation induced vasculitis of iliac veins: presentation of a case and therapeutic dilemmas

A case of radiation-induced venous stenosis (phlebitis) after pelvic irradiation in a patient with prostate cancer is reported. Progressive swelling of both lower limbs developed due to bilateral external iliac vein stenosis. Conservative treatment with new oral anticoagulants and elastic stockings was conducted with clinical improvement of symptoms. Serial duplex scanning with trimestral frequency reveals no other progression of stenosis and the patient is well 2 years after diagnosis. Lack of data in the current literature makes management of this disease problematic.

Pediatric living donor liver transplantation with non-anatomical portal vein reconstruction in idiopathic extrahepatic portal vein thrombosis

A 13-year-old boy had a history of recurrent hematemesis and melena since the age of 2 years. Owing to recurrent bleeding, he had undergone several endoscopic ligation procedures and had received regular blood transfusions over the last 7 years. Doppler ultrasonography showed extrahepatic portal vein thrombosis, while the hepatic vein was not visualized. Abdominal computed tomography confirmed cavernous transformation in the liver hilum. Liver biopsy revealed fibrosis. A diagnosis of extrahepatic portal vein obstruction (EHPVO) with portal hypertension was established. Living donor liver transplantation (LDLT) was performed owing to recurrent gastrointestinal bleeding and liver fibrosis. The liver graft was obtained from the patient's father, utilizing segments 2, 3, and 4 (graft-to-recipient weight ratio: 0.84%). Portal vein reconstruction using native internal jugular vein and external iliac vein was achieved with non-anatomical anastomosis due to the lack of availability of sizable superior mesenteric vein. The postoperative course was uneventful. We successfully performed LDLT with unusual portal vein reconstruction in a patient with EHPVO. Multiple interposition grafts were used to obtain adequate inflow from the splenorenal shunt. LDLT remains the last resort in such cases as other surgical procedures (such as Meso-Rex bypass) are not feasible.

Surgical Procedures of Portal Vein Reconstruction for Recipients With Portal Vein Thrombosis in Adult-to-Adult Living Donor Liver Transplantation

BackgroundPortal vein (PV) reconstruction is an important surgical skill for living donor liver transplantation (LDLT), especially for patients with portal vein thrombosis (PVT). However, this technique remains a critical problem in LDLT because of technical demands and requirements for appropriate venous graft harvesting. This study aimed to evaluate the surgical procedure used for PV reconstruction and outcomes in LDLT recipients with PVT. MethodsBetween March 2002 and December 2018, 128 adult LDLTs were performed. Fourteen recipients (10.8%) had PVT at the time of LDLT, classified as grade I in 2, grade II in 5, grade III in 6, and grade IV in 1, according to the Yerdel classification. We retrospectively analyzed the surgical procedure and postoperative complications associated with PV reconstruction of recipients with PVT. ResultsSurgical treatments for 14 recipients with PVT were as follows: thrombectomies in 2 recipients, replacement of interpositional venous grafts using the internal jugular vein (IJV) in 3 recipients and the external iliac vein (EIV) in 6 recipients, mesoportal jump grafts using the IJV in 1 recipient and the IJV + EIV in 1 recipient, and renoportal anastomosis using the EIV in 1 recipient. Among interpositional venous grafts, 5 venous grafts (IJV: 2, EIV: 3) passed the dorsal side of the pancreas without using the jump graft. Postoperative complications associated with PV anastomosis occurred in 1 of 14 (7.1%) recipients, who developed anastomosis bleeding caused by coagulation disorders at 27 days after LDLT, without any strictures of PV anastomoses. The overall survival rate at 5 years posttransplant was not statistically different between recipients with and without PVT (50.0% vs 65.0%, P = .163). ConclusionOur techniques of PV reconstruction, using the appropriate venous grafts and route, are feasible, resulting in a prognosis comparable to that of recipients without PVT.

Deep vein thrombosis due to May-Thurner syndrome: a case report

BackgroundMay-Thurner syndrome (MTS) or Cockett’s syndrome is a rare clinical syndrome, which refers to the compression of the left common iliac vein (LCIV) by right common iliac artery and vertebral body. Complications of MTS include deep vein thrombus formation and even life-threatening pulmonary embolism.Case presentationHere, we report the case of a 60-year-old female patient with a complaint of swelling in the left lower limb and pain for 5 days. Computed tomography angiography indicated MTS, and thrombus formation of left external iliac vein and femoral vein. The patient was diagnosed with deep venous thrombosis (DVT) and MTS. The patient underwent ascending venography from the lower extremity to inferior vena cava (IVC) and then to the pulmonary artery with IVC filter implantation, left iliac vein balloon plasty, and stent placement. The patient visited the hospital for the removal of IVC filter, 28 days after the operation. After the interventional therapy, the patient had no in-stent restenosis and had remission during the 2-year follow-up.ConclusionsThis case presents a successful management of MTS in presence of DVT. Although clinicians are rarely aware, the presence of unilateral lower limb swelling and thrombosis may be the manifestations of MTS.

The two-segment caliber method of diagnosing iliac vein stenosis on routine computed tomography with contrast enhancement

BackgroundIliac vein stenosis is a frequent pathologic process in advanced chronic venous disease. Intravascular ultrasound (IVUS) has emerged as the “gold standard” to diagnose iliac vein stenosis and to guide stent treatment. A pre-IVUS test is often obtained. Routine venography is deficient in several respects to fill this role; absence of an internal scale is a critical deficiency. Computed tomography venography (CTV) may be superior; its measurement capabilities can be used to precisely identify stenotic iliac vein caliber. Furthermore, the calibers of common iliac vein (CIV) and external iliac vein (EIV) can be individually assessed, yielding two data points instead of single-point assessment used in venography and current CTV protocols. We compared the diagnostic accuracy of the two-segment caliber method of CTV (arm vein injection of contrast material) with IVUS. MethodsIn patients who underwent computed tomography assessment of iliac vein segments before IVUS examination during a 5-year period, 91 limbs were analyzed. This is a single-center, retrospective analysis of prospectively collected data. CTV images of CIV and EIV segments were compared individually and in combination with IVUS planimetry images. A caliber diameter of <16 mm for CIV and <14 mm for EIV was considered stenotic with either imaging technique. Bland-Altman plots and receiver operating characteristic curves were used. ResultsOn IVUS evaluation, 84% of CIVs and 78% of EIVs were stenotic and 16% and 22% were of normal caliber. These provided IVUS positive and negative controls for CTV comparison. On CTV, at least one of the two segments (CIV or EIV) was stenotic in 90% of the limbs, about 10% to 15% higher than single-segment involvement. Mean CTV caliber difference from IVUS was +2.5% for CIV and +7.3% for EIV. On Bland-Altman plot, single-segment diagnostic sensitivity of CTV was 83% and 73% for CIV and EIV, respectively, compared with IVUS. The sensitivity increased to 97% with a positive predictive value and accuracy of 93% and 91%, respectively, when a stenotic caliber in at least one of the two segments was considered diagnostic of iliac vein stenosis. Receiver operating characteristic analysis confirmed increased accuracy of the two-segment method over single-segment assessment with an area under the curve of 0.89 (P < .001). ConclusionsCaliber diameter of <16 mm for CIV or <14 mm for EIV on routine CTV imaging appears to correlate with IVUS caliber stenosis with good diagnostic metrics of low false positives and false negatives.