Left Common Iliac Vein Research Articles

Bilateral Multiple Renal Vessels Associated with Pyelo‐ureteral Position Anomalies. Case Report

During the routine dissection of a 67‐year‐old male within our university's Department of Anatomy, we identified multiple renal vascular and ductal anomalies.The left kidney was irrigated by three arteries, two with a hilar penetration and one inferior polar artery. All three of these arteries originated from the aorta – two on the anterior side, at the L1 and L3 levels respectively, and the inferior one on the posterior face of the aorta, at the same level as the median sacral artery (L5). All three arteries had accompanying veins. The upper‐most artery was accompanied by the main renal vein, the middle artery – by one of the renal vein's tributaries, and the inferior one by two veins, which joined and opened into the left common iliac vein.The right kidney had two renal arteries, both of aortic origin – the superior one at the L1 level, 0.5cm below the superior mesenteric artery, and the inferior one on the anterior side of the aorta, at the L5 level and at the point where the aorta split into the two common iliac arteries. The superior artery entered the kidney through the sinus and was accompanied by the right renal artery. The inferior artery entered the kidney through the inferior pole, accompanied by a renal vein that drained into the left common iliac vein together with the left inferior polar renal vein.In both kidneys, the renal pelvis was anterior of the vessels, with the ureters having a descending path on the anterior side of the kidneys.Familiarity with such variations in renal vascular and ductal elements is critical for surgical interventions such as for total or partial nephrectomies, aortic aneurysms or renal artery reconstruction for stenosis.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Endovascular management of iliac vein compression syndrome: a prospective case series of 61 patients

Context Iliac vein compression syndrome (IVCS) or May–Thurner syndrome is an anatomically variable condition of venous outflow obstruction caused by extrinsic compression. The pathology of this condition is secondary to a partial obstruction of the common iliac vein by an overlying common iliac artery with subsequent entrapment of the left common iliac vein. Clinical presentations include, but not limited to, pain, swelling, venous stasis ulcers, and skin discoloration. With extensive deep venous thrombosis, postphlebitic syndrome, with all its sequelae, may also develop. Endovascular interventions of this syndrome have become first-line therapy. Aims To estimate the prevalence of IVCS in patients with unilateral left lower limb venous disease [chronic venous disease (CVD)], assess the sensitivity and specificity of modified computed tomography venography in the diagnosis of IVCS, and evaluate the feasibility and effectiveness of the endovascular treatment. Settings and design This was a prospective case series study. The study was performed at three tertiary referral centers in Kingdom of Saudi Arabia (Security Forces Hospital Program, Al-Noor Specialist Hospital, Makkah, Almoosa Specialist Hospital, Al-Ahsaa) and three hospitals in Egypt (Benha University Hospitals, Nile Insurance Hospital, and Kuwaiti Specialized Hospital, Benha). Patients and methods Between March 2015 and February 2018, we evaluated 369 patients with unilateral left lower limb symptomatic CVD in the outpatient clinic of vascular surgery in the study hospitals. Sixty-one symptomatic patients with IVCS who received endovascular treatment were included in our study. Statistical analysis used The initial data entry used Microsoft excel (2010 version) for logical proofreading and analysis. We expressed continuous data as mean±SD and compared continuous variables using two-sided Student’s t tests. We estimated stent patency using Kaplan–Meier method. We considered P value less than 0.05 to be statistically significant. Statistical analysis was performed by using IBM Statistical Package for the Social Sciences software (version 22 for Windows program package). Results The 1-year patency rates in the nonthrombotic and thrombotic IVCS groups were 95.7 and 80%, respectively (P=0.146). The overall primary patency rate at 1 year after treatment was 93%. Complete pain relief was achieved in 76.7% of patients. The overall edema relief rate was 78.1%. Of the 12 limbs with active ulceration before treatment, 10 (83.3%) healed completely. Conclusion IVCS is not an uncommonly encountered condition, especially among patients with unilateral left lower extremity CVD. Computed tomography venography with three-dimensional reconstruction images was more sensitive and specific as a diagnostic approach for IVCS and provided useful information for the endovascular treatment planning. Moreover, endovascular therapy is feasible and effective for treating left-sided IVCS with high technical success rate and with an acceptable complication profile. So, we concluded that endovascular treatment should be considered as the first line of therapy for patients experiencing IVCS.

Defining the utility of anteroposterior venography in the diagnosis of venous iliofemoral obstruction

BackgroundIntravascular ultrasound (IVUS) is the current standard for the diagnosis of obstruction in the iliac and femoral veins. However, multiple venographic findings including collaterals, pancaking, and contrast thinning have been suggested to improve the sensitivity of venography. The objective of our study was to further elucidate where and how anteroposterior venography may successfully guide the diagnosis of venous obstruction. MethodsA retrospective review of patients with chronic venous insufficiency who received iliofemoral stenting by a single practitioner at a tertiary medical center between January 2014 and August 2016 was performed. Patients who had records of anteroposterior venography and IVUS were included. Patients who underwent reoperation, did not have complete records of venography and IVUS, or had preoperative acute deep vein thrombosis were excluded. All patients with a greater than 50% luminal area reduction by IVUS underwent balloon angioplasty and stent placement. The locations of stenosis, collaterals, pancaking, and contrast thinning with venography, the locations of stenosis with IVUS, and the location of each stent placed were recorded. ResultsThere were 107 patients who underwent venous stenting guided by venography and IVUS in this study. Six patients who underwent reoperation, 1 patient who had an acute preoperative deep vein thrombosis, and 14 patients who had incomplete records were excluded. Thus, 86 patients with 77 left lower extremity and 68 right lower extremity studies were available for analysis. The sensitivity by stenosis on venography was 4% in the left common iliac vein (CIV), 44% in the left external iliac vein (EIV), and 44% in the common femoral vein (CFV). The sensitivity by stenosis on venography in the right CIV, EIV, and CFV was 21%, 46%, and 40%, respectively. Combined, pancaking and collaterals had a sensitivity of 97% in the left CIV. IVUS resulted in a change in plan in 2%, 32%, and 48% of patients in the left CIV, EIV, and CFV, and in 26%, 35%, and 48% of patients in the right CIV, EIV, and CFV, respectively. ConclusionsAnteroposterior venography can indirectly diagnose obstruction of the left CIV through the identification of collaterals and pancaking. The combination of low sensitivity and a high rate of change of plan owing to IVUS precludes complete reliance on anteroposterior venography for the diagnosis of lesions in the left EIV and CFV and the right CIV, EIV, and CFV. IVUS must be used to comprehensively identify all venous iliofemoral lesions.

03:27 PM Abstract No. 96 Prevalence of May-Thurner variants in patients with symptomatic May-Thurner syndrome

May-Thurner syndrome (MTS) is typically characterized by the compression of the left common iliac vein (LCIV) between the right common iliac artery (RCIA) and the fifth vertebra. Various types of May-Thurner variants (MTV) have been sporadically documented in case reports. This study aimed to identify the prevalence of MTV among the subset of symptomatic MTS. Single-center data of 173 consecutive patients presented with symptomatic MTS were reviewed from October 2004 to April 2018. MTS was diagnosed by computed tomographic venography. MTV was defined as (i) compression of the LCIV by other structures than the RCIA or (ii) compression of other pelvic veins than the LCIV. MTV was categorized as (i) LCIV compression group if the LCIV is compressed by other structures than the RCIA and (ii) non-LCIV compression group if the LCIV is not involved. Ten MTV were identified (5.8%), including 5 LCIV compression (category 1) and 5 non-LCIV compression (category 2). Patients’ median age was 76 years (range, 51-94 years), male/female: 1/1, median follow-up was 388 days (range, 12-4694 days). All patients presented with deep vein thrombosis of the corresponding limbs. In category 1, the LCIVs were compressed by the left common iliac artery (LCIA) (n=2), huge myoma (n=1), LCIA aneurysm (n=1) and RCIA aneurysm (n=1). In category 2, the right common iliac veins (RCIVs) were compressed by RCIA (n=4) and L5 osteophyte (n=1). Inferior vena cava filters were inserted in 4 patients. Endovascular management with balloon angioplasty and stent insertion were performed in 6 patients, 3 of each category. One patient underwent endovascular aneurysm repair for RCIA aneurysm. The rest 3 patients received conservative treatment due to advanced age and comorbidities. Follow-up images were available for 6 patients and all of them had patent venous outflow. This study brings attention to the relatively high variant of symptomatic MTS population. Vigilance of different anatomical MTV is essential for correct diagnosis and treatment. Endovascular management is safe and effective and should tailor the lesion anatomy.

Abstract No. 592 Two steps forward, one step back: development of contralateral DVT following left common iliac vein stenting

Treatment of iliac vein narrowing/thrombosis necessitates stent deployment which typically extends into the inferior vena cava (IVC). The purpose of this study is to determine whether stent placement into the left iliac vein leads to future contralateral deep vein thrombosis (DVT). A retrospective analysis of 93 consecutive patients that underwent left common iliac vein stent placement between July 2008 and August 2017 was performed. In addition to demographic data the following was collected: proximal and distal stent landing zones, quantification of stent extension into the IVC, etiology of vein stenosis/thrombosis, presence of an IVC filter, incidence of ipsilateral and contralateral DVT, anticoagulation status, risk factors for DVT after stent placement, and reintervention rates. Pre procedural and post-procedure clinic visits were performed on all patients that had a stent deployed. A multiple logistic regression model was used for analysis. 93 patients (67 female, 26 male) underwent stent placement for left common iliac vein stenosis/thrombosis with an average follow-up of 826 days. Contralateral DVT developed in 9/93 (9.68%) with 8/9 developing after 30 days and 1/9 less than 30 days. Clinical symptoms necessitated reintervention on the ipsilateral side in 30/93 (32.29%) patients with 19/30 after 30 days and 11/30 within 30 days. Stent extension into the inferior vena cava was 24.3 ± 13.6 mm. Stent extension into the IVC in patients that developed contralateral DVT was 26.7 ± 18.0 mm. Mean stent diameter placed into the left common iliac vein was 14 mm for all patients. The upper landing zone/ extent of stent extension into the IVC did not carry an association with contralateral DVT formation (p=0.17) or rate of ipsilateral reintervention (p=0.07). Presence of an IVC filter (p=0.22) and stent diameter (p=0.13) did not correlate with contralateral DVT development. Contralateral DVT formation was a frequent finding in this study population but did not reach statistical significance. Further studies are warranted to elucidate potential etiologies for contralateral DVT formation in this patient population.

A SIGNIFICANT PORTION OF PATIENT WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION WERE DIAGNOSED WITH MAY-THURNER SYNDROME USING SCREENING VENOGRAPHY

May-Thurner syndrome (MTS) is a rare condition in which patients develop left iliofemoral deep venous thrombosis (DVT) due to an anatomical variant in which the right common iliac artery overlies and compresses the left common iliac vein. Currently, there is no evidence in the medical literature to

May-Thurner syndrome - Are we aware enough?

Iliac vein compression syndrome (May-Thurner syndrome- MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

Spine Stabilization Is a Risk Factor for the Development of Pelvic Iliac Vein Lesions

Open lumbar spine stabilization surgery often requires mobilization of the left and right common iliac veins (CIVs) and the placement of plates and screws that can impinge on iliac veins. We reviewed our venography experience during the past 3 years to determine whether there is an association between spine stabilization surgery and the development of iliac vein lesions and symptomatic iliac vein outflow obstruction. A retrospective chart review was performed to identify patients who underwent venography with or without venous stenting and who had a history of previous lumbar spine stabilization. From January 2014 to April 2018, venography were performed in 1713 limbs in 1245 patients at the Center for Vascular Medicine. Of the 1245 patients, 17 patients had a history of lumbar spine stabilization procedures (4 anterior-posterior and 13 posterior). Nine had single-level and eight had two- or three-level fusions. All 17 patients demonstrated pelvic lesions, which included the following: one left CIV aneurysm, five left CIV stenoses, three bilateral CIV stenoses, two left CIV and inferior vena cava occlusions, and two external iliac vein stenoses. The aneurysm patient was treated with anticoagulation. Eight patients underwent stenting, and one patient refused stenting because of relocation to another country. One inferior vena cava-CIV occlusion could not be crossed. Fear of dislodging a thrombus and the proximity to a protruding posteriorly placed screw prevented stenting in two patients. Four patients had a venoplasty alone because of undersizing of a stenosis or missed lesions with intravascular ultrasound after review by a blinded reviewer. Lesions in anterior-posterior patients were extremely stenotic, required predilation, and resulted in a residual stenosis requiring venoplasty at a second setting in one patient. Lumbar spine stabilization surgery may be a risk factor for development of symptomatic venous outflow obstruction lesions. During venography and stenting in patients with anterior-posterior approaches, significant scarring may be encountered, resulting in a residual stenosis after stent placement. Predilation venoplasty, before stent deployment, is recommended to prevent stent migration. Furthermore, a history of spine stabilization surgery in patients presenting with pelvic or lower extremity pain or swelling should prompt consideration of a pelvic venous duplex ultrasound examination to assess for the presence of an iliac venous outflow lesion.

Clot Mayhem: A Case of May-Thurner Syndrome

May-Thurner syndrome (MTS), also known as the iliac vein compression syndrome, is an anatomic anomaly in which the compression of the left common iliac vein by an overlying right common iliac artery leads to blood stasis, which predisposes to deep venous thrombosis (DVT) in the iliofemoral venous system. We present a case of a female with a history of DVT and currently on warfarin with a therapeutic international normalized ratio (INR), admitted with left leg swelling, redness, and intractable pain. Venous Doppler scan confirmed a massive DVT from the level of the left common femoral vein to the popliteal vein. The clot recurred after an unsuccessful trial of argatroban, in-line pharmacokinetic thrombolysis with local catheter-based alteplase infusion, and interventional radiology (IR)-guided mechanical thrombectomy. Subsequently, the patient was diagnosed as MTS with overlying left common iliac vein compression, as evident on venous Doppler ultrasound. She was managed successfully by venous stent placement and ongoing systemic anticoagulation with fondaparinux.

Right varicocele secondary to left-sided inferior vena cava with a retro-aortic left renal vein and azygos continuation.

Varicocele represents the main cause of male infertility. Right-sided varicocele is rare and can be due to renal malignancy or a venous abnormality. The most common anomaly of the inferior vena cava (IVC) is interruption of IVC with azygos continuation, which is recognized as an uncommon congenital anomaly. The prevalence of the interruption of IVC is less than 0.3% in the healthy population. We describe the case of a 26-year-old man who had right varicocele because of a right-sided IVC with a retro-aortic left renal vein and azygos continuation. The right and left IVCs received the right and left common iliac veins, respectively, and the left renal vein crossed posteriorly to the aorta and joined the right IVC. The right IVC continued cephalad as the azygos vein within the retrocrural space. Isolated right-sided varicoceles are uncommon, but practitioners should be aware of such a condition. In case of a venous anomaly, clinicians should aware of the association with other important clinical presentations.

The summary of experience of abdominal vascular injury related to posterior lumbar surgery.

To study the clinical and pathophysiologic characteristics and summarize the experience of treatment of abdominal vascular injury related to lumbar surgery. We analyzed patients who suffered abdominal vascular injury during lumbar surgery in our hospital retrospectively and reviewed related literature in the PUBMED database from 2002 to 2017. Combined with the existing treatment options and outcomes, we investigated further and summarized our findings. With the data from our hospital, four cases of injuries were included, i.e., left common iliac artery and vein (CIA and CIV), left internal iliac artery, and inferior vena cava. Almost all of the patients (one exception) manifesting unstable haemodynamics were primarily treated by traditional vessel suture. After treatment, two patients died eventually, while the others recovered well at follow-up. With the reported data, 77 patients with the most frequently type of laceration (58.4%) were included. For vascular laceration, unstable haemodynamics was diagnosed in most of the patients (88.9%); CIA and CIV accounted for the all the most common patients (78.7%). Extracted from these data, traditional surgical method was selected to repair laceration prevalently (86.7%), while arteriovenous fistula and pseudoaneurysm were treated with an interventional procedure. Negative outcomes included two deaths, two suffered lower limb deep vein thrombosis, and two suffered graft infection. Different treatment choices should be conducted depending on different injury characteristics and patients' condition. Moreover, early recognition and prompt treatment are critical components to successful rescue. When a vascular injury is suspected, ultrasonography and positive abdominal exploration are recommended together with unified leadership in the rescue team.

May–Thurner Syndrome

May–Thurner syndrome (MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. We would like to substantiate that MTS is often underdiagnosed, and it should always be suspected in left iliofemoral vein thrombosis in young individuals.

Slc:Hartley guinea pigs frequently possess duplication of the caudal vena cava.

The formation of the caudal vena cava is a complex process involving development, regression, and anastomosis. In mammals, the normal caudal vena cava runs to the right side of the abdominal aorta, while duplication of the caudal vena cava has been identified as a congenital abnormality in both companion animals and humans. The present study demonstrates that Slc:Hartley guinea pigs frequently possess asymptomatic duplicated caudal vena cava. The prevalence was 30% and 24% for males and females, respectively, with no sex-related differences. In accordance with Saad et al. (2012)’s criteria, duplicated caudal vena cava were classified into two distinct variations. The dominant variation was a complete duplication without iliac anastomosis where the left caudal vena cava continued from the left common iliac vein and joined the left renal vein; the left renal vein ran to the right to join the right caudal vena cava. The alternative variation was an incomplete duplication where the left caudal vena cava joined the right infrarenal caudal vena cava at a more cranial point than in normal cases; the renal segment was unchanged. Iliac anastomosis was not found in any cases. Duplicated caudal vena cava neither affected the body weight nor the kidney weight. In conclusion, Slc:Hartley guinea pigs frequently possess asymptomatic duplicated caudal vena cava in the absence of iliac anastomosis and appear to be a novel and useful animal model for duplicated caudal vena cava in animals and humans.

Multiple left accessory renal vessels

Anatomical variations of the abdominal aorta are common. Using standard techniques, abdominal and renal vessels were dissected and measured. Six accessory renal vessels were identified on the left. One accessory artery from the posterolateral abdominal aorta entered the hilum superior to the main renal artery and a corresponding accessory vein emptied into the main renal vein. Two accessory arteries from the left common iliac artery entered the kidney’s inferomedial and inferolateral pole. The corresponding accessory veins emptied into the left common iliac vein, and a lumber vein posterior to the abdominal aorta, respectively. The number of accessory renal vessels in this specimen is unusual, and the branching pattern is extremely rare. Knowledge of these variations is important for surgical procedures such as transplantation, vascular reconstruction, and abdominal aortic aneurism reconstruction. Additionally, the presence of accessory renal vessels has been associated with renal pathology such as hypertension and hydronephrosis.

May‐Thurner syndrome and thrombosis: A systematic review of antithrombotic use after endovascular stent placement

BackgroundMay‐Thurner Syndrome (MTS) is caused by compression of the left common iliac vein between the right common iliac artery and the pelvis. It likely predisposes an individual to lower extremity deep vein thrombosis (DVT) as well as symptoms of unilateral lower extremity swelling and discomfort in the absence of a known history of thrombosis. In the case of MTS‐associated acute thrombosis, there is low‐quality evidence to suggest that endovascular intervention including thrombolysis and endovascular stent placement reduces the risk of recurrent thrombosis. However, the optimal type and duration of antithrombotic therapy after stent placement for left iliofemoral vein stenosis is not known. MethodsA systematic literature search including studies that evaluated the outcome of endovascular stent occlusion and systemic anticoagulant use in patients with MTS associated DVT was performed. The primary outcome of interest was 12‐month risk of endovascular stent occlusion or recurrent DVT. ResultsA total of five studies encompassing 61 patients were included in our study. All studies were retrospective without a comparator group. A variety of anticoagulants and durations were prescribed. Of the 55 patients evaluable, the 12‐month rate of endovascular stent occlusion or recurrent DVT ranged from 0% to 40%. The 12‐month stent patency rate ranged from 60% to 100%. ConclusionsThe published evidence regarding antithrombotic treatment for patients with MTS who have undergone stent placement for a DVT is limited. Further high‐quality, prospective studies are needed in this setting to inform clinical decision making.

May-Thurner Syndrome – Diagnostic and therapeutic dilemmas (RCD code: I-1D.2)

May‐Thurner Syndrome is a rare vascular disease in which the right common iliac artery compresses the left common iliac vein. It occurs 5 times more often in women than in men, usually in their 20s and 40s. Patients suffer from deep vein thrombosis, post‐thrombotic syndrome, and pulmonary embolism. They usually present with swelling of the left leg, chronic leg pain, skin colour changes, tingling and/or numbness of the affected limb, varicosities, phlebitis, and venous stasis ulcers. Available diagnostic tests include venous duplex ultrasound, computed tomography, magnetic resonance imaging, venography, and intravascular ultrasound. Endovascular therapy, including angioplasty, stenting, and catheter‐directed thrombolysis is the current mainstay of treatment. Long‐term anticoagulation and elastic compression stockings are used to prevent recurrent blood clot formation and decrease the risk of post‐thrombotic syndrome. Thrombophilia screening is essential, as it would aid in the decision‐making process regarding continuation of anticoagulant therapy. We present the case of a 38‐year‐old woman in her fourth pregnancy, presenting with persistent left leg oedema and recurrent deep vein thrombosis, eventually diagnosed with May‐Thurner Syndrome. JRCD 2018; 4 (1): 22-25.

Systemic Laparoscopic Para-Aortic Lymphadenectomy to the Left Renal Vein.

Background:No large-scale clinical study has been done to show the standard surgical boundary and efficacy of laparoscopic para-aortic lymphadenectomy (LPAL).Objectives:Therfore, this study aimed to evaluate the feasibility, efficacy, and standard surgical boundary of LPAL performed up to the left renal vein level in gynecological malignancies.Methods:Medical records of 333 patients were retrospectively reviewed. All cases had gynecologic malignancies and had an operation including LPAL by a single surgical team between November 2003 and May 2018.Results:Three hundred twenty-six patients underwent LPAL as part of their staging, restaging, or debulking surgery. Seven patients with isolated para-aortic lymph node recurrence underwent a repeat LPAL. The median age and body mass index were 54 years (range, 28–81 years) and 26.0 kg/m2 (range, 20.3–37.2 kg/m2), respectively. The median operating time was 60 minutes (range, 24–135 minutes), and the median number of harvested para-aortic lymph nodes was 12 (range, 6–49). There were 11 cases of complications: 5 of major vessel injuries (3 inferior vena cava, 1 aorta, and 1 common iliac vein), 2 lymphocysts, 2 cases of chylous ascites, a cisterna chyli rupture, and 1 case of ureteric injury. There were 2 conversions to laparotomy: 1 left common iliac vein laceration that needed to be repaired and removal of an enlarged para-aortic lymph node completely.Conclusion:It is feasible and efficient to perform LPAL to the left renal vein level for women with gynecologic malignancies by well-trained gynecologic oncology surgeons according to our suggested standard surgical boundary.

Hilar Arteriovenous Pattern in a Case of Horseshoe Kidney

AbstractHorseshoe kidney is a poor congenital formation that results in the union of the lower poles of the kidneys through the fibrous isthmus that crosses the median line, with a prevalence of 0.25% (1 in 400 births), a higher rate in males (2:1 or 3:1), and an important variation in the arrangement of arteries and veins in the hilum. The present study aims to describe the arteriovenous pattern in the renal hilum in a case of horseshoe kidney. A conventional retroperitoneal dissection was performed in a 64-year-old female corpse of brown skin color, legally belonging to the Anatomy Laboratory of Unicastelo, Fernandópolis, state of São Paulo, Brazil, with causa mortis associated with uterine cancer. The dissection revealed a horseshoe kidney, with the right kidney measuring 5.69 cm, the left kidney measuring 11.65 cm, and the isthmus measuring 6.40 cm, and with the presence of a single right superior polar segmental artery (originated in the posterior aspect of the renal artery), of a double left superior polar segmental artery (originated in the renal artery, with one for each renal aspect), of one renal isthmus artery (originated in the posterior aspect of the abdominal aorta), and of one renal isthmus vein (left common iliac vein). Horseshoe kidney is a congenital abnormality whose arteries may originate from branches of the renal artery, of the inferior mesenteric artery, or of the iliac artery. Its veins drain into the renal vein, into the inferior vena cava, or into the iliac vein. It may be associated with hydronephrosis and nephroblastoma. However, no reports in the literature are found regarding the correlation with uterine cancer, highlighting the relevance of the hilar vascular pattern of the reported case.

Occult Left Common Iliac Vein Compression Increases Postoperative Venous Thromboembolism Risk Following Total Hip Arthroplasty

BackgroundLeft common iliac vein (LCIV) compression by the right or left common iliac artery (RCIA, LCIA) is known to cause venous thromboembolism (VTE), but the extent to which occult LCIV compression synergizes with lower extremity orthopedic surgery is unknown. We hypothesize that occult LCIV compression is associated with increased VTE risk following total hip or knee arthroplasty (THA, TKA). MethodsThis case-control study involves all patients at our institution who underwent primary or revision THA or TKA from 2009 to 2017 who had computed tomography or magnetic resonance imaging of the abdomen or pelvis available preoperatively. VTE cases (pulmonary embolism or left-sided deep vein thrombosis) within 30 days of surgery were matched to a control by age, gender, body mass index, Charlson Comorbidity Index, surgical site, and hypercoagulable risk factors. LCIV compression by the right common iliac artery and/or the left common iliac artery was measured in a blinded fashion and was considered present at 50% diameter reduction. ResultsOne hundred twelve patients (22 cases, 90 controls) were included for analysis. Nineteen (86.4%) cases and 46 (51.1%) controls demonstrated LCIV compression. The overall sample odds ratio of postoperative VTE in the presence of LCIV compression was 5.97 (95% confidence interval 1.59-33.67, P = .003). In patients who underwent THA (n = 75), LCIV compression was highly predictive of VTE (odds ratio ∞, 95% confidence interval 2.83-∞, P < .001). Compression in the TKA patients did not significantly predict VTE. ConclusionCompression of the LCIV significantly increases odds of developing postoperative VTE following THA. This effect may suggest a new method of stratifying VTE risk in the orthopedic population to reduce VTE-associated morbidity and mortality.

Osteophytic Iliac Venous Compression: Technical Considerations for a Bony May-Thurner Syndrome Variant

AbstractMay-Thurner syndrome (MTS) results in compression of the left common iliac vein between the spine and right common iliac artery leading to symptomatic venous outflow obstruction. The authors depict a classic case of MTS followed by four variant cases in which the primary culprit lesions causing compression were degenerative vertebral osteophytes. The osteophytic variant of MTS poses distinct diagnostic and therapeutic challenges.