Editor's Update

VASCULAR DISEASE MANAGEMENT

Editor’s Update*

November 2014, Vol. 11, No. 11

 

CLINICAL REVIEW

Diagnosis and Treatment of May-Thurner Syndrome

Robert M. Schainfeld, MD

From Massachusetts General Hospital, Boston.

 

Abstract

In 1908, McMurrich described the presence of strictures in the common iliac vein that were believed to be responsible for the increased incidence of left leg DVTs. This syndrome would eventually become known as iliac vein compression syndrome (IVCS) or May-Thurner, Cockett’s syndrome or non-occlusive iliac vein lesion (NIVL). Left iliac vein compression from the contralateral right common iliac artery, against the posterior fifth lumbar vertebral body is estimated to comprise 49%-62% of cases of left lower extremity disease. Although there is some degree of iliac vein compression present as a normal anatomic variant in otherwise healthy patients (>50% compression) in up to 25% of patients, those who experience DVT frequently have anatomically abnormal veins with spur formation, and are at high risk of developing recurrent DVT and PTS. Herein we describe the presentation, diagnosis, and management techniques for May-Thurner syndrome.

 

CASE REPORT

Serial CT Imaging of Rapid Progression and Spontaneous Regression of Multiple Arterial Abnormalities in a Patient with Vascular Ehlers-Danlos Syndrome

Danielle Chan, MD1; Thomas Casciani, MD2; Sabah Butty, MD2

From 1Indiana University School of Medicine, and 2Interventional Radiology Section, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana.

 

Abstract

This case illustrates the rapid progression of multiple arterial abnormalities in a patient with vascular Ehlers-Danlos syndrome (EDS), through serial imaging with computed tomography (CT) over a 2-week time period. A right renal artery aneurysm required emergent intervention, whereas other renal and hepatic artery aneurysms were conservatively managed. A CT scan 16 months later showed regression of hepatic artery aneurysms and mild interval enlargement of a left renal artery aneurysm. This case emphasizes the variable outcomes and unpredictable nature of arterial complications in vascular EDS. To our knowledge, it is also first to demonstrate spontaneous regression of arterial aneurysms.

 

EDITORIAL COMMENTARY: Point-Counterpoint

Vascular Closure Devices: Necessary or Not?

Oliver G. Abela, MD1; Jimmy Diep, MD2; Chowdhury H. Ahsan, MD3; Ehrin J. Armstrong, MD, MSc4

From 1University of Cincinnati College of Medicine, Cincinnati, Ohio; 2University of Nevada School of Medicine, Las Vegas, Nevada; 3Nevada Heart and Vascular Center, Las Vegas, Nevada; 4University of Colorado School of Medicine and Denver VA Medical Center Denver, Colorado.

 

* Articles are subject to change at the editor’s discretion. 

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Editor's Update

VASCULAR DISEASE MANAGEMENT

Editor’s Update*

November 2014, Vol. 11, No. 11

 

CLINICAL REVIEW

Diagnosis and Treatment of May-Thurner Syndrome

Robert M. Schainfeld, MD

From Massachusetts General Hospital, Boston.

 

Abstract

In 1908, McMurrich described the presence of strictures in the common iliac vein that were believed to be responsible for the increased incidence of left leg DVTs. This syndrome would eventually become known as iliac vein compression syndrome (IVCS) or May-Thurner, Cockett’s syndrome or non-occlusive iliac vein lesion (NIVL). Left iliac vein compression from the contralateral right common iliac artery, against the posterior fifth lumbar vertebral body is estimated to comprise 49%-62% of cases of left lower extremity disease. Although there is some degree of iliac vein compression present as a normal anatomic variant in otherwise healthy patients (>50% compression) in up to 25% of patients, those who experience DVT frequently have anatomically abnormal veins with spur formation, and are at high risk of developing recurrent DVT and PTS. Herein we describe the presentation, diagnosis, and management techniques for May-Thurner syndrome.

 

CASE REPORT

Serial CT Imaging of Rapid Progression and Spontaneous Regression of Multiple Arterial Abnormalities in a Patient with Vascular Ehlers-Danlos Syndrome

Danielle Chan, MD1; Thomas Casciani, MD2; Sabah Butty, MD2

From 1Indiana University School of Medicine, and 2Interventional Radiology Section, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana.

 

Abstract

This case illustrates the rapid progression of multiple arterial abnormalities in a patient with vascular Ehlers-Danlos syndrome (EDS), through serial imaging with computed tomography (CT) over a 2-week time period. A right renal artery aneurysm required emergent intervention, whereas other renal and hepatic artery aneurysms were conservatively managed. A CT scan 16 months later showed regression of hepatic artery aneurysms and mild interval enlargement of a left renal artery aneurysm. This case emphasizes the variable outcomes and unpredictable nature of arterial complications in vascular EDS. To our knowledge, it is also first to demonstrate spontaneous regression of arterial aneurysms.

 

EDITORIAL COMMENTARY: Point-Counterpoint

Vascular Closure Devices: Necessary or Not?

Oliver G. Abela, MD1; Jimmy Diep, MD2; Chowdhury H. Ahsan, MD3; Ehrin J. Armstrong, MD, MSc4

From 1University of Cincinnati College of Medicine, Cincinnati, Ohio; 2University of Nevada School of Medicine, Las Vegas, Nevada; 3Nevada Heart and Vascular Center, Las Vegas, Nevada; 4University of Colorado School of Medicine and Denver VA Medical Center Denver, Colorado.

 

* Articles are subject to change at the editor’s discretion. 

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