Left Iliac Vein Research Articles

Large inferior vena cava thrombosis in a 25-year-old female patient: A case report.

The incidence of venous thromboembolism is increasing, and it is more common in older than in younger patients. Inferior vena cava (IVC) thrombosis is a rare subtype of deep vein thrombosis, and it is associated with a high incidence of arterial and venous thrombosis in patients with systemic lupus erythematosus (SLE). We present the case of a 25-year-old female patient with a large IVC thrombosis caused by SLE that was intractable to thrombolytic therapy. A 25-year-old previously healthy female patient presented to the emergency department with a 5-day history of fever. Her computed tomography revealed a large thrombus with an approximate length 25 cm extending from the suprarenal IVC to the right common iliac vein and the left external and internal iliac veins. We decided to perform intravenous thrombolysis (alteplase 65 mg) because of the massive thrombus burden followed by an infusion of intravenous heparin. However, the size of the thrombus did not showed reduction 3 days after treatment. For the next step, the catheter-directed thrombolysis (CDT) was performed; however, no changes were observed. She was diagnosed with SLE, and the large IVC thrombus gradually improved after primary treatment for SLE, including immunosuppressive drugs combined with anticoagulant. We found a large IVC thrombus secondary to SLE in a young female patient. In this case, systemic thrombolysis or CDT did not improve the thrombus. The thrombus only improved after immunosuppressive treatment for SLE. Our case highlights the importance of treatment for etiologic disease in an intractable thrombosis developed by provoked cause.

Long-term follow-up for the treatment of symptomatic pelvic venous insufficiency secondary to combined iliac vein stenosis and ovarian vein reflux treated with iliac vein stenting alone

BackgroundWe previously reported that in women with symptomatic pelvic venous insufficiency secondary to combined iliac vein stenosis (IVS) and ovarian vein reflux (OVR), treated with iliac vein stenting alone that 78% reported complete symptom resolution up to 6 months. The purpose of this investigation was to determine the long-term effectiveness of this treatment strategy, the poststent reintervention rate and the incidence of poststent ovarian vein embolization (OVE) for residual symptoms. MethodsA retrospective review of prospectively collected data at the Center for Vascular Medicine was performed. We investigated women with pelvic pain or dyspareunia secondary to combined IVS and OVR who were treated with stenting alone. Patients whose primary complaint was dysmenorrhea and/or leg symptoms were excluded from the analysis. Assessments and interventions consisted of an evaluation for other causes of pelvic venous disorder by a gynecologist, documentation of preintervention and 3-, 6-, 12-, 24-, and 36-month visual analog scale pain scores; transabdominal duplex ultrasound examination; stent type, diameter, and length; vein territory covered; and reintervention rates. All patients underwent diagnostic venography of their pelvic, left ovarian veins, and pelvic reservoirs, and intravascular ultrasound examination of their iliac veins. ResultsFrom February 2018 to January 2023, 141 women with a pelvic venous disorder secondary to IVS and OVR were identified. The average age was 44.7 ± 10.5 years with 3.18 ± 1.82 pregnancies. The average follow-up time for the entire cohort was 12.0 ± 12.1 months (median, 10.65 months). Types of stents were Venovo 48 (34%), Wallstent 14 (10%), and Abre 79 (56%). The most common diameter and stent lengths used were 14 and 16 mm and 140 and 150 mm, respectively. The most common vein territories covered were the inferior vena cava to the left external iliac vein in 83% and inferior vena cava to right external iliac vein in 13%. Pelvic and dyspareunia VAS scores before the intervention and at 3, 6, 12, 24, and 36 months after the intervention were as follows: 6.4 ± 73 (n = 141), 2.6 ± 3.3 (n = 98), 1.71 ± 2.83 (n = 77), 2.04 ± 3.5 (n = 76), 2.4 ± 3.7 (n = 30), and 1.15 ± 3 (n = 13) (P ≤ .001). Of the entire cohort no patients required OVE and pelvic reservoir embolization. Pelvic reservoirs were present in 113 of 141 patients (83%). Stent reinterventions were required in 19 of 141 patients (13%). ConclusionsThe majority of women with pelvic pain secondary to combined IVS and OVR achieved near complete symptom resolution with iliac vein stenting alone, despite the presence of a pelvic reservoir in 83% of patients. Although most women complained of some minimal residual pelvic pain or dyspareunia, the majority were satisfied with their outcomes and did not require further intervention. In this patient population, iliac vein stenting should be considered the primary treatment modality. OVE should be reserved for patients with persistent or recurrent pelvic pain unresolved with stenting.

The Long-Term Prognosis of Endovascular Thrombectomy in Patients with Acute Left Iliofemoral Vein Thrombosis Combined with Left Iliac Vein Compression

This study investigated the long-term outcomes of different thrombus removal methods in patients with acute left iliofemoral vein thrombosis (IFDVT) accompanied by left iliac vein compression (LIVC). This was a single-center cohort study. 240 patients with acute left-sided IFDVT complicated by LIVC were categorized based on their treatment approach into two groups: those receiving anticoagulation alone (No-PCDT group) and those undergoing anticoagulation combined with pharmacomechanical catheter-directed thrombolysis (PCDT group). The PCDT group was further divided into three subgroups: anticoagulation combined with percutaneous mechanical thrombectomy (PMT group), anticoagulation combined with catheter-directed thrombolysis (CDT group), and anticoagulation combined with both percutaneous mechanical thrombectomy and catheter-directed thrombolysis (PMT+CDT group). The incidence of post-thrombotic syndrome (PTS) was assessed using Villalta scores and Venous Clinical Severity Scores (VCSS). Patients were followed up for 24 months to compare long-term outcomes. The No-PCDT group consisted of 123 individuals, while the PCDT group comprised 117, with 36 in the CDT subgroup, 41 in the PMT subgroup, and 40 in the PMT+CDT subgroup. The follow-up period ranged from 3 to 24 months. The PCDT group was associated with a reduced incidence of PTS and a lower risk of high VCSS (Villalta scale ≥5 or presence of ulcer: 22% PCDT vs. 39% No-PCDT; OR, 0.446; 95% CI, 0.253-0.787; P=0.005; and VCSS≥4: 22% PCDT vs. 34% No-PCDT; OR, 0.551; 95% CI, 0.311-0.978; P=0.042). Among the three subgroups of PCDT cohort, compared to the CDT group, the PMT group showed a decreased incidence of PTS and a lower risk of high VCSS (Villalta scale ≥5 or ulcer: 12% PMT vs. 39% CDT; OR, 0.218; 95% CI, 0.069-0.690; P=0.010; and VCSS≥4: 12% PMT vs. 36% CDT; OR, 0.246; 95% CI, 0.077-0.781; P=0.017). The PMT+CDT group also demonstrated a reduced incidence of PTS (18% PMT+CDT vs. 39% CDT; OR, 0.333; 95% CI, 0.116-0.958; P=0.041) compared to the CDT group, but did not show a significant reduction in the risk of high VCSS (20% PMT+CDT vs. 36% CDT; P=0.121). Compared to the PMT group, the PMT+CDT group did not significantly reduce the incidence of PTS (12% PMT vs. 18% PMT+CDT; P=0.504) or the rate of high VCSS (12% PMT vs. 20% PMT+CDT; P=0.343). In patients with acute left IFDVT complicated by LIVC, PMT may serve as a more efficacious method for thrombus removal compared to CDT and combined PMT+CDT in reducing both the incidence of PTS and the risk of high VCSS.

Sciatica secondary to deep venous thrombosis of the persistent sciatic vein: the first case in the literature. Illustrative case.

Sciatica usually results from lumbar nerve compression due to factors like disc herniations or lumbar canal stenosis. Despite its common causes, sciatic pain in a 52-year-old man following a coronavirus disease 2019 infection highlighted the importance of considering less common factors. Initially, minor disc protrusions were suspected as the cause of the symptoms, leading to the offer of surgery at another facility. The patient sought a second opinion, and our evaluation revealed a unique finding. Pelvic magnetic resonance imaging uncovered varicose structures displacing the left sciatic nerve. Subsequent pelvic computed tomography angiography identified a remarkable finding-the lack of opacification in a left persistent sciatic vein ascending toward a left internal iliac vein, originating from a common internal iliac venous trunk-confirming a suspicion for deep venous thrombosis. These findings represented not 1, but 2, extremely rare and distinct variants in the venous anatomy. The authors promptly initiated anticoagulant therapy and tailored pain management strategies, observing progressive thrombosis resolution on follow-up imaging. This report highlights the need for comprehensive diagnostics when symptoms and imaging differ. Misdiagnosis could lead to unnecessary surgeries and potential risks for the patient. https://thejns.org/doi/10.3171/CASE23652.

Leiomyosarcoma of vascular origin: lessons learned from misdiagnosis

BackgroundLeiomyosarcoma (LMS) of vascular origin is a rare entity of soft tissue sarcomas. Although they arise mostly from retroperitoneal major vascular structures, some encountered cases may arise from the smaller vascular structures of the thigh as the femoral vein. Due to their origin from the vascular structures, they represent a diagnostic challenge as they may be misdiagnosed as deep vein thrombosis (DVT).Case presentationWe present a case of a 45-year-old woman with left femoral and iliac vein LMS that was previously described in the vascular ultrasound (US) report as extensive DVT involving the femoral and external iliac veins. The patient did not improve after receiving the prescribed anticoagulants. Seven months later, the patient underwent computerized tomography (CT) with contrast, revealing a soft tissue mass in the anatomical site of the left common femoral and external iliac veins. The patient underwent both US-guided tru-cut biopsy and incisional biopsy from the iliac lymph nodes which revealed leiomyosarcoma.Materials and methodsThe patient underwent both vascular ultrasound and magnetic resonance imaging of the pelvis and the left thigh at the time of the first presentation. Seven months later, she underwent contrast-enhanced CT of the abdomen and pelvis.OutcomeThe patient was referred to the oncology department to receive the appropriate chemotherapy protocol as the tumor was inoperable.ConclusionsAlthough leiomyosarcoma of vascular origin is a rare entity of neoplasms, it is usually underestimated. A high index of suspicion would help the clinician to suspect such a neoplasm and save time for early diagnosis and management. Special caution should be taken for patients with venous thrombosis not improving on anticoagulants. When there is suspicion, other modalities such as computerized tomography and magnetic resonance imaging help confirm the diagnosis.

Haemodynamic study of left nonthrombotic iliac vein lesions: a preliminary report

Nonthrombotic iliac vein lesions (NIVLs) are significant causes of chronic venous insufficiency (CVI) in the left lower limb and symptom recurrence following left lower limb varicose vein treatment. The goal of this study was to explore the haemodynamic and morphological characteristics of iliac veins in patients with NIVLs. Pressure at the caudal end of the stenotic left common iliac vein (LCIV) segment, local blood flow velocity, and time-averaged wall shear stress in the stenotic segment exhibited positive correlations with the clinical CVI classification (R = 0.92, p < 0.001; R = 0.94, p < 0.001; R = 0.87, p < 0.001), while the relative retention time showed a negative correlation (R = -0.94, p < 0.001). The pressure difference (∆P) between the two ends of the stenotic segment and the velocity difference (∆V) between the stenotic segment and the caudal end were positively correlated with the clinical classification (R = 0.92, p < 0.001; R = 0.9, p < 0.001). The cross-sectional area stenosis rate and length of the stenotic LCIV segment were positively correlated with the clinical classification (R = 0.93, p < 0.001; R = 0.63, p < 0.001). The results suggest that haemodynamic assessment of the iliac vein could effectively portray blood flow disturbances in stenotic segments of the LCIV, potentially reflecting the degree of iliac vein stenosis. Haemodynamic indicators are correlated with the severity of clinical CVI symptoms.

Tailoring Management of May-Thurner Syndrome : Case Comparison

Background: May-Thurner syndrome (MTS) is a post-thrombosis syndrome (PTS) of the lower extremity. This disorder results from compression and/or irritation from adjacent crossing the right common iliac artery to the left iliac venous. In this report, we present two management comparisons of patients with left lower DVT with consideration of MTS. Case Illustration: The first patient is a 49-year-old male soldier presented with chronic unilateral left leg edema and a mild clinical presentation for 9 months. Previous Doppler ultrasonography (DUS) revealed a thrombus in the left venous femoralis. Anticoagulant was given for six months. DUS and CT venography following anticoagulant treatment revealed a thrombus in the left venous femoralis. Venography revealed entire blockage of the left common femoral and left iliac veins, with adequate collateral flow. PTV was attempted twice and failed both times. The patient was following a conservative therapy (walking exercise and stocking compression) that yielded positive outcomes. The second patient is a 53-year-old male soldier has had unilateral left leg edema for three years, which has increased during the previous three months with ulceration and active bleeding. Previous Doppler ultrasonography revealed a thrombus in the left iliac externa. Anticoagulants and compression stockings were given for eight months, but the symptoms persisted. CT and venography revealed a complete blockage from the left popliteal vein to the iliac vein. Femoral crossover bypass surgery yielded favorable results. Conclusion: Clinically moderate MTS demonstrated fair results with conservative treatment, whereas clinically severe MTS showed superior results with bypass surgery. Keyword: Anticoagulant, May-Thurner Syndrome, Palma Procedure.

Deep vein thrombosis secondary to an ovarian tumor – approach in low resource settings: A case report

We present a case of a 37-year-old woman who exhibited symptomatic acute deep vein thrombosis (DVT) due to extrinsic compression from a giant ovarian cyst, detected during clinical examination. Doppler ultrasound confirmed a thrombus in the left iliac vein. Although surgery was initially planned to insert a vena cava filter, the absence of this resource during her 14-day hospital stay led to the decision to proceed without it. The surgery was carried out without complications, and she was discharged on the second postoperative day. A 3-month follow-up indicated favorable recovery.

Frank Cockett and the story of the ancient anatomical wax model of the left iliac vein compression

In 1988, Professor Donini organized an international phlebo-lymphology meeting at the University of Ferrara in Italy. At that time, I was a young surgical resident with the task of picking up Professor Frank Cockett at the railway station. I recognized him immediately, introduced myself and, together, we crossed the station square to my car. I asked him where he wanted to be taken, and he asked me to go to the anatomical museum of the University. We arrived just before the closure time, and Mister Cockett was intrigued and enthusiastic about an anatomical wax specimen.

Absence of a Deep Vein and the Significance of Drainage from the Superficial Venous System

We submit a case of a 57-year-old man who presented to the Vascular Clinic seeking treatment for worsening varicosities in the left lower extremity. Specifically, these veins were located in the left lateral thigh. He had lost a considerable amount of weight and the varicosities had become more visible and painful. Duplex imaging was performed and revealed non-visualization of the left external iliac and common femoral veins. These findings were confirmed by both computed tomography (CT) imaging and lower extremity venography with fluoroscopy. It was deemed that the great saphenous vein was providing drainage from the limb and, therefore, should not be ablated. Duplex ultrasound was crucial in identifying the abnormal anatomy and planning the subsequent care of the patient. We are reporting this case because of its rarity and to provide awareness.

A Case of Non-Seminomatous Germ Cell Tumor Complicated by Tumor Thrombus in an Active Duty Soldier.

Testicular malignancies commonly affect adolescent and young adult males. Although they tend to respond well to cisplatin-based chemotherapy with excellent overall survival, complications such as inferior vena cava tumor thrombus are rare and can be associated with high morbidity and mortality. We present a case of tumor thrombus in a 21-year-old active duty male with a newly diagnosed stage IIIB non-seminomatous germ cell tumor presenting with extensive left lower extremity swelling. Ultrasound with Doppler was notable for significant thrombus of the left common femoral, femoral, and popliteal vein. Computed tomography imaging revealed extensive thrombus of the inferior vena cava, left iliac veins, and left gonadal vein with sparing of the left renal vein. Endovascular thrombectomy was performed with pathologic analysis confirming the presence of malignant cells consistent with tumor thrombus. The patient continued subsequent non-seminomatous germ cell tumor treatment without complications.

Application of 4D flow MRI for exploring factors affecting haemodynamics of iliac veins in asymptomatic population.

Haemodynamics plays an important role in the development of vascular disease. There is currently a lack of studies evaluating the characteristics and affecting factors of the iliac vein haemodynamics in clinical practice. The goal of this study was to use 4D flow MRI to explore the haemodynamic characteristics of iliac veins and its affecting factors in an asymptomatic population. Thirty consecutive volunteers without venous-related symptoms or signs underwent four-dimensional postprocessing of their MRI images. Relevant parameters, the demographic data, common iliac vein-inferior vena cava angle, iliac vein area, tortuosity, iliac vein mean flow, mean velocity was computed and analysed. T tests and Spearman's tests were used for analysing. A P value of 0.05 or less was considered significant. Height and iliac vein area were positively correlated with flow, while degree of stenosis, and common iliac-inferior vena cava angle were negatively correlated with that. Degree of stenosis was positively correlated with velocity, but the common iliac-inferior vena cava angle and iliac vein tortuosity were negatively correlated with that. The mean flow and velocity of iliac veins in females were lower than males. The mean flow and velocity of the left iliac veins were lower than those of the right. The height, gender, tortuosity, degree of stenosis, common iliac vein-inferior vena cava angle of the iliac vein are important factors that affect flow and velocity of the iliac veins. There were differences in haemodynamic parameters of the bilateral iliac veins.

Kidney Transplant Loss Due to May-Thurner Syndrome: Case Report and Review of the Literature

May-Thurner syndrome (MTS) is an extrinsic venous compression by the arterial system against bony structures in the iliocaval territory. The most common variant of MTS is due to compression of the left iliac vein between the overlying right common iliac artery and the fifth lumbar vertebrae. The prevalence of MTS is unknown; therefore, there are only a few publications about MTS in kidney transplant recipients. Risk factors that may progress from usually asymptomatic to symptomatic MTS are female sex, scoliosis, dehydration, coagulation disorders, and radiation. Clinical presentations include acute extremity pain and swelling, venous claudication, and chronic signs of venous insufficiency. We describe a 63-year-old man who underwent kidney transplantation (left iliac fossa). Four days after transplantation, a graftectomy was done due to graft rupture caused by renal vein thrombosis. After imaging studies, a diagnosis of MTS was established. The patient had no typical symptoms of MTS. However, an incidence of right lower limb thrombosis was observed, and due to vertebral discopathy, the patient underwent surgery with implantation of a vertebral implant. After a successful second transplantation on the right side, incidents of thrombosis were observed: superficial thrombosis of the upper limbs and massive deep vein thrombosis of the right lower limb. Thrombophilia was recognized, the graft function is stable, and anticoagulation therapy is being continued. Asymptomatic MTS in the case of coincidence of other risk factors, such as coagulation disorders, history of vertebral operation, and additional pressure of the graft, can result in graft failure.

In vivo evaluation of safety and performance of a tapered nitinol venous stent with inclined proximal end in an ovine iliac venous model

A tapered stent with inclined proximal end is designed for fitting the iliac anatomically. The aim of the present study was to evaluate the safety and performance of the new stent in ovine left iliac veins. The experiment was performed in 30 adult sheep, and one nitinol-based VENA-BT® iliac venous stent (KYD stent) was implanted into each animal’s left common iliac vein. Follow-up in all sheep consisted of angiographic, macroscopic, and microscopic examinations at Day 0 (< 24 h), Day 30, Day 90, Day 180 and Day 360 post-stenting (six animals per each time-point). 30 healthy ~ 50 kg sheep were included in this study and randomly divided into five groups according to the follow-up timepoint. All stents were implanted successfully into the left ovine common iliac vein. No significant migration occurred at follow-up. There is no statistically significant difference between the groups (p > 0.05), indicating no serious lumen loss occurred during the follow-up period. Common iliac venous pressure was further measured and the results further indicated the lumen patency at follow-up. Histological examinations indicated that no vessel injury and wall rupture, stent damage, and luminal thrombus occurred. There was moderate inflammatory cell infiltration around the stent in Day-0 and Day-30 groups with the average inflammation score of 2.278 and 2.167, respectively. The inflammatory reaction was significantly reduced in Day-90, Day-180 and Day-360 groups and the average inflammation scores were 0.9444 (p < 0.001, Day-90 vs Day-0), 1.167 (p < 0.001, Day-180 vs Day-0) and 0.667 (p < 0.001, Day-90 vs Day-0), respectively. The microscopic examinations found that the stents were well covered by endothelial cells in all follow-up time points. The results suggested that the KYD stent is feasible and safe in animal model. Future clinical studies may be required to further evaluate its safety and efficacy.

Epidural venous plexus enlargement secondary to left iliac vein occlusion: case report

We present a 34-year-old male case, with a history of primary thrombophilia under treatment with rivaroxaban, deep vein thrombosis of the left leg and extremities plus pulmonary thromboembolism 10 years ago. He reported digestive symptoms and chronic low back pain with left leg edema. Phlebography diagnoses occlusion of the left iliac vein with dilated veins of more than 3 cm on the left peri-vertebral side. Angioplasty plus stent placement is performed, the collateral venous network and the patient's symptoms disappear.

A rare etiology of frequent ventricular ectopy: Embolic complication of a venous iliac stent to the right ventricle.

Peripheral venous stent migration is an exceedingly rare complication of endovascular stenting. In this clinical vignette, we present a case of a 74-year-old male with a history of endo-venous laser ablation therapy of the right greater saphenous vein complicated with an occlusion requiring a left iliac vein stent. The patient presented to the clinic months after the procedure with complaints of palpitations. Multimodality imaging revealed a stent that had become dislodged and was now located in the right ventricle, trapped within the tricuspid valve apparatus.

Considerations for Iliac Vein Repair in the Setting of Urologic Procedures

Introduction: Iliac vein injuries are associated with high morbidity and mortality, with a feared complication of hemorrhage. We discuss management and the thought process behind mitigating such emergencies. Case Presentation: An 81-year-old Caucasian male was seen intraoperatively by Vascular Surgery for hemorrhage from an injured left external iliac vein (LEIV) in the setting of left radical nephrectomy and ureterectomy. Conclusion: Despite initial temporizing efforts by Urology, Vascular Surgical intervention proved necessary in hemostasis, venous reconstruction and thus, establishing continuity of lower extremity venous drainage.

Comparison between canine and porcine models of chronic deep venous thrombosis

ObjectiveTo first induce chronic deep venous thrombosis in the left iliac veins of canines and porcines and then compare these two models to validate endovascular treatment devices.MethodsThrombin and fibrinogen were used to produce a solid thrombus in the left iliac veins of a stenosis model. The researchers used venous angiography and histological staining to investigate the progression of thrombosis.ResultsA left iliac vein thrombus was successfully formed in all experimental animals, including six Labrador dogs and three Bama miniature pigs, and there was minimal surgical bleeding. All dogs survived until 90 days, and three pigs died on Days 29, 33, and 58.ConclusionThe researchers first established the models and then observed the progression of chronic deep venous thrombosis of the iliac vein in large animals for up to 90 days. Dogs are better suited for chronic deep venous thrombosis models due to their uncomplicated anatomy, excellent obedience, and proneness to physical activity compared with pigs.

May-Thurner Syndrome

May-Thurner is a condition characterized by extrinsic venous compression by the arterial system against bone structures in the ileocecal region. MTS is also referred to as an iliocaval venous compression syndrome, iliac vein compression syndrome, Cockett's syndrome, and venous spur. The most common variant of MTS is due to compression of the left iliac vein between the overlying right common iliac artery and the fifth lumbar vertebrae, approach to diagnosis and treatment depends upon whether venous thrombosis is present.

THU153 Deep Vein Thrombosis As The Presenting Symptom In An Adolescent With New-Onset Type 2 Diabetes

Abstract Disclosure: F.I. Cooper: None. S. Gurnurkar: None. M. Carakushansky: None. Introduction The prothrombin G20210A mutation occurs in a small portion of the population, but usually does not become apparent unless the individual exhibits another risk factor for clotting (such as diabetes in adulthood). In this case report, we discuss a 15-year-old male with extensive deep vein thrombosis (DVT) in the setting of hyperglycemia and a newly-discovered prothrombin G20210A mutation. Case Presentation A previously healthy, obese 15-year-old male presented to the emergency department with two days of left hip pain radiating down to the left calf, and one day of left calf swelling. The patient denied prolonged immobility, recent infections, or recent vaccinations. There was strong maternal family history of diabetes but no history of thrombosis. D-dimer was 2013 ng/mL (0-500 ng/mL). A Computed Tomography of the abdomen and pelvis with contrast revealed thrombi in the inferior vena cava, left common iliac, left external iliac, left internal iliac and left common femoral veins. Initial labs were remarkable for unexpected significant hyperglycemia-- random serum glucose 317 mg/dl (&amp;lt;140 mg/dl).He was started on unfractionated heparin infusion as well as Lantus and Humalog insulins. An echocardiogram did not reveal pulmonary embolism or right heart strain. Hemoglobin A1C was 11.8% (3.4-5.6%) and C-peptide was detectable at 1.2 ng/mL (1.1-4.4 ng/mL), suggesting type 2 diabetes (in addition to negative anti-GAD 65 and islet cell antibody titers, in this child with a BMI of 34 kg/m2). The patient underwent image-guided thrombolysis and thrombectomy from the popliteal vein to the left iliac vessels and received continuous infusion of heparin and tissue plasminogen activator (TPA). As the clot improved over the subsequent days, he underwent image-guided angioplasty and removal of the popliteal sheath. He was then transitioned to enoxaparin and discharged on day 10 of hospitalization. His blood sugars responded well to insulin therapy (85-308 mg/dl). The patient received a staged thrombophilia workup. A heterozygous mutation was found in factor II (prothrombin G20210A) gene which is associated with a 2-4 fold increased risk of venous thromboembolism. The patient was discharged on enoxaparin, as well as Lantus and Humalog. He is followed by the Hematology and Endocrinology departments. Conclusion In this case, we presented the first written occurrence of DVT in a pediatric patient with type 2 diabetes. Our patient’s hyperglycemia caused by his new onset type 2 diabetes may have led to onset of an extensive DVT thrombosis at an usually young age, since he had an underlying prothrombin G20210A mutation. Our case also illustrates the need for a multidisciplinary approach (involving endocrinology, hematology, pediatric intensive care, and interventional radiology) for successful outcomes in these patients. Presentation: Thursday, June 15, 2023