MAY-THURNER SYNDROME: THE IMPORTANCE OF IVUS IN THE DIAGNOSTIC AND THERAPEUTIC ALGORITHM
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.48750/acv.412 |
Resumo: | Introduction : May Thurner Syndrome (MTS) is a clinical condition as a result of an anatomical compression of the left common iliac vein by the fifth lumbar vertebra posteriorly, and by the right common iliac artery anteriorly associated with symptomatology. Affirming the diagnosis can be difficult and intravascular ultrasonography (IVUS) can help in the definitive decision. Clinical Case: A 43 years old man with a past history of a deep venous thrombosis of the left lower limb presented at our clinical appointment with a 5 months history of left limb edema and inability to stand up for long periods of time, disabling him from working.A venous-CT scan was obtained to diagnose the condition but was inconclusive. It was proposed to the patient to carry out a phlebography and an IVUS to eliminate the doubt and increase the diagnosis acuity, which was accepted.A phlebography and IVUS confirmed a significant compression of the left common iliac vein (image 1).The patient was treated by endovenous placement of an Abre 16/80 medtronic stent followed by dilatation with a 16/40 balloon Boston scientific. The phlebography and IVUS control showed complete resolution of the compression. (Image 2) Discussion/Conclusion: The diagnosis of MTS can be difficult and implies a high degree of clinical suspicion.The TC scan alone may not be diagnostic. The phlebography, and especially the more recent IVUS technology increases the accuracy of the diagnosis.Emergence of endovascular surgery revolutionized the treatment of obstructive venous disease, and became the gold standard of treatment. However, the implantation of stents in a young population implies additional cautions due to the lack of knowledge about their behavior over the long term.In this clinical case, the IVUS allowed us to reach the diagnosis and to increase the therapeutic accuracy of the ilio- cava stenting. We recommend the routine use of IVUS in the management of MTS. |
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MAY-THURNER SYNDROME: THE IMPORTANCE OF IVUS IN THE DIAGNOSTIC AND THERAPEUTIC ALGORITHMSÍNDROME MAY-THURNER: IMPORTÂNCIA DO IVUS NO ALGORITMO DIAGNÓSTICO E TERAPÊUTICOCockett SyndromeMay Thurner syndromeIliac vein stentigCompression syndromeStentingIVUSSíndrome CockettSíndrome May thurnerSíndrome compressão da veia ilíacaStentingIVUSIntroduction : May Thurner Syndrome (MTS) is a clinical condition as a result of an anatomical compression of the left common iliac vein by the fifth lumbar vertebra posteriorly, and by the right common iliac artery anteriorly associated with symptomatology. Affirming the diagnosis can be difficult and intravascular ultrasonography (IVUS) can help in the definitive decision. Clinical Case: A 43 years old man with a past history of a deep venous thrombosis of the left lower limb presented at our clinical appointment with a 5 months history of left limb edema and inability to stand up for long periods of time, disabling him from working.A venous-CT scan was obtained to diagnose the condition but was inconclusive. It was proposed to the patient to carry out a phlebography and an IVUS to eliminate the doubt and increase the diagnosis acuity, which was accepted.A phlebography and IVUS confirmed a significant compression of the left common iliac vein (image 1).The patient was treated by endovenous placement of an Abre 16/80 medtronic stent followed by dilatation with a 16/40 balloon Boston scientific. The phlebography and IVUS control showed complete resolution of the compression. (Image 2) Discussion/Conclusion: The diagnosis of MTS can be difficult and implies a high degree of clinical suspicion.The TC scan alone may not be diagnostic. The phlebography, and especially the more recent IVUS technology increases the accuracy of the diagnosis.Emergence of endovascular surgery revolutionized the treatment of obstructive venous disease, and became the gold standard of treatment. However, the implantation of stents in a young population implies additional cautions due to the lack of knowledge about their behavior over the long term.In this clinical case, the IVUS allowed us to reach the diagnosis and to increase the therapeutic accuracy of the ilio- cava stenting. We recommend the routine use of IVUS in the management of MTS.Introdução: A síndrome de May Thurner (SMT) é uma condição clínica resultante da compressão anatómica da veia ilíaca comum esquerda pela quinta vértebra lombar posteriormente e pela artéria ilíaca comum direita anteriormente associada a sintomatologia. Afirmar o seu diagnóstico pode ser difícil e a ultrassonografia intravascular (IVUS) pode ajudar na decisão definitiva. Caso Clínico: Homem de 43 anos com história de trombose venosa profunda do membro inferior esquerdo recorre à consulta com história de edema do membro inferior esquerdo com agravamento desde há cinco meses associado a incapacidade de ficar em pé por longos períodos , facto que o impedia de realizar a sua atividade laboral.Realizou flebo-TC no enatnto este foi inconclusivo. Foi proposto ao paciente a realização de flebografia e IVUS para eliminar as dúvidas e aumentar a acuidade diagnóstica. A flebografia e o IVUS confirmaram a compressão significativa da veia ilíaca comum esquerda pela artéria ilíaca comum direita (imagem 1).O paciente foi tratado através da implantação endovascular de um stent Abre 16/80 da Medtronic, seguido da dilatação com um balão 16/40 da Boston Scientific. A flebografia e o IVUS de controle mostraram a resolução completa da compressão. (Imagem 2) Discussão/Conclusão: O diagnóstico do SMT pode ser difícil e implica alto grau de suspeita clínica. O veno-TC pode não ser diagnóstico e ser necessário flebografia e IVUS.A cirurgia endovascular revolucionou o tratamento da doença venosa obstrutiva, tornando-se o gold standart terapêutico. No entanto, o implante de stents numa população jovem implica cuidados acrescidos devido ao desconhecimento de seu comportamento a longo prazo. Neste caso, o IVUS permitiu aumentar o grau de certeza diagnóstica e aumentar a qualidade do controle terapêutico do stenting ílio-cava.Nós recomendamos o uso do IVUS de forma rotineira na abordagem do SMT.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2021-12-24T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.412oai:ojs.acvjournal.com:article/412Angiologia e Cirurgia Vascular; Vol. 17 No. 3 (2021): September; 278-282Angiologia e Cirurgia Vascular; Vol. 17 N.º 3 (2021): Setembro; 278-2822183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://acvjournal.com/index.php/acv/article/view/412https://doi.org/10.48750/acv.412http://acvjournal.com/index.php/acv/article/view/412/265Copyright (c) 2021 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessMachado, MartaMachado, MiguelMachado, ArlindoMachado, Rui2022-05-23T15:10:13Zoai:ojs.acvjournal.com:article/412Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T14:57:45.082906Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
MAY-THURNER SYNDROME: THE IMPORTANCE OF IVUS IN THE DIAGNOSTIC AND THERAPEUTIC ALGORITHM SÍNDROME MAY-THURNER: IMPORTÂNCIA DO IVUS NO ALGORITMO DIAGNÓSTICO E TERAPÊUTICO |
title |
MAY-THURNER SYNDROME: THE IMPORTANCE OF IVUS IN THE DIAGNOSTIC AND THERAPEUTIC ALGORITHM |
spellingShingle |
MAY-THURNER SYNDROME: THE IMPORTANCE OF IVUS IN THE DIAGNOSTIC AND THERAPEUTIC ALGORITHM Machado, Marta Cockett Syndrome May Thurner syndrome Iliac vein stentig Compression syndrome Stenting IVUS Síndrome Cockett Síndrome May thurner Síndrome compressão da veia ilíaca Stenting IVUS |
title_short |
MAY-THURNER SYNDROME: THE IMPORTANCE OF IVUS IN THE DIAGNOSTIC AND THERAPEUTIC ALGORITHM |
title_full |
MAY-THURNER SYNDROME: THE IMPORTANCE OF IVUS IN THE DIAGNOSTIC AND THERAPEUTIC ALGORITHM |
title_fullStr |
MAY-THURNER SYNDROME: THE IMPORTANCE OF IVUS IN THE DIAGNOSTIC AND THERAPEUTIC ALGORITHM |
title_full_unstemmed |
MAY-THURNER SYNDROME: THE IMPORTANCE OF IVUS IN THE DIAGNOSTIC AND THERAPEUTIC ALGORITHM |
title_sort |
MAY-THURNER SYNDROME: THE IMPORTANCE OF IVUS IN THE DIAGNOSTIC AND THERAPEUTIC ALGORITHM |
author |
Machado, Marta |
author_facet |
Machado, Marta Machado, Miguel Machado, Arlindo Machado, Rui |
author_role |
author |
author2 |
Machado, Miguel Machado, Arlindo Machado, Rui |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Machado, Marta Machado, Miguel Machado, Arlindo Machado, Rui |
dc.subject.por.fl_str_mv |
Cockett Syndrome May Thurner syndrome Iliac vein stentig Compression syndrome Stenting IVUS Síndrome Cockett Síndrome May thurner Síndrome compressão da veia ilíaca Stenting IVUS |
topic |
Cockett Syndrome May Thurner syndrome Iliac vein stentig Compression syndrome Stenting IVUS Síndrome Cockett Síndrome May thurner Síndrome compressão da veia ilíaca Stenting IVUS |
description |
Introduction : May Thurner Syndrome (MTS) is a clinical condition as a result of an anatomical compression of the left common iliac vein by the fifth lumbar vertebra posteriorly, and by the right common iliac artery anteriorly associated with symptomatology. Affirming the diagnosis can be difficult and intravascular ultrasonography (IVUS) can help in the definitive decision. Clinical Case: A 43 years old man with a past history of a deep venous thrombosis of the left lower limb presented at our clinical appointment with a 5 months history of left limb edema and inability to stand up for long periods of time, disabling him from working.A venous-CT scan was obtained to diagnose the condition but was inconclusive. It was proposed to the patient to carry out a phlebography and an IVUS to eliminate the doubt and increase the diagnosis acuity, which was accepted.A phlebography and IVUS confirmed a significant compression of the left common iliac vein (image 1).The patient was treated by endovenous placement of an Abre 16/80 medtronic stent followed by dilatation with a 16/40 balloon Boston scientific. The phlebography and IVUS control showed complete resolution of the compression. (Image 2) Discussion/Conclusion: The diagnosis of MTS can be difficult and implies a high degree of clinical suspicion.The TC scan alone may not be diagnostic. The phlebography, and especially the more recent IVUS technology increases the accuracy of the diagnosis.Emergence of endovascular surgery revolutionized the treatment of obstructive venous disease, and became the gold standard of treatment. However, the implantation of stents in a young population implies additional cautions due to the lack of knowledge about their behavior over the long term.In this clinical case, the IVUS allowed us to reach the diagnosis and to increase the therapeutic accuracy of the ilio- cava stenting. We recommend the routine use of IVUS in the management of MTS. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-12-24T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.48750/acv.412 oai:ojs.acvjournal.com:article/412 |
url |
https://doi.org/10.48750/acv.412 |
identifier_str_mv |
oai:ojs.acvjournal.com:article/412 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://acvjournal.com/index.php/acv/article/view/412 https://doi.org/10.48750/acv.412 http://acvjournal.com/index.php/acv/article/view/412/265 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2021 Angiologia e Cirurgia Vascular info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2021 Angiologia e Cirurgia Vascular |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
dc.source.none.fl_str_mv |
Angiologia e Cirurgia Vascular; Vol. 17 No. 3 (2021): September; 278-282 Angiologia e Cirurgia Vascular; Vol. 17 N.º 3 (2021): Setembro; 278-282 2183-0096 1646-706X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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