SINDROME DE MAY-THURNER ASSOCIADO A UM SINDROME DE NUTCRACKER: CASO CLINICO E REVISÃO DA LITERATURA
Autor(a) principal: | |
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Data de Publicação: | 2017 |
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.34 |
Resumo: | Introduction: The May Thurner syndrome (MTS), results from compression of left common iliac vein (LCIV) between the fifth lumbar vertebra, posteriorly, and the right common iliac artery (RCIA), anteriorly. This phenomenon can cause venous stasis in the pelvis and in the left lower limb. The Nutcracker syndrome (NCS) result from compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta, called Anterior NCS, or more rarely by compression of the LRV between the aorta and the lumbar vertebra, when the vein passes behind the aorta, called posterior NCS. The association of the two anomalies can occur when a circunaortic renal vein exists. This phenomenon can cause stasis in the kidney and in the pelvis. The MTS and NCS are rare clinical entities and the association of the two pathologies is extremely rare. Clinical Case: A 29-year-old female, complaints of bilateral leg pain, predominantly on the left side, left malleolar edema which increases in the end of the day, and dyspaneuria. These complaints interfere severely with the quality of life of the patient. The physical examination reveals collateral varices in the posterior aspect of the left tight, a right side vulvar varicose vein and mild left malleolar edema. A phlebography of the ilio-cava system and the ovarian vein reveal a compression of LCIV by the RCIA with an extensive collateral pathway communicating the left and the right vein iliac system, the origin of a right side vulvar varicose vein in the right internal iliac vein and the compression of a posterior LRV by the aorta. A transluminal angioplasty with sequential dilatation with a 12, 14 and 16 mm balloon was done and an Optimed stent 16/100 mm was implanted in the LCIV.At 3 months of follow up, the patient called and informed that she was pregnant, so she stopped the rivaroxabane and maintained the elastics stockings. The pregnancy and the child birth had no intercurrences. An abdomino-pelvic control CT at 12 months follow-up was done, showing the stent in a good position and patent, and posteriorly she was submitted to stab avulsion of varicose veins in the left thigh. At 18 months follow-up, the patient was clinically asymptomatic. Discussion/Conclusion: Insufficient knowledge about the natural history of NCS and MTS results from the uncertainty in the diagnostic criteria and treatment selection, particularly in the rare association of both. This association can be responsible for the amplification of the symptomatology of the venous obstruction. In our case, we have seen the resolution of the complaints by treating only one of the obstructive lesion (MTS) and we haven’t seen any effect of the pregnancy in the structure and patency of the ilio-caval stent. |
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SINDROME DE MAY-THURNER ASSOCIADO A UM SINDROME DE NUTCRACKER: CASO CLINICO E REVISÃO DA LITERATURAMAY-THURNER SYNDROME ASSOCIATED WITH NUTCRACKER SYNDROME: CLINICAL CASE AND LITERATURE REVIEWMay-Thurner SyndromeNutcracker SyndromeSíndrome de NutcrackerSíndrome de May-ThurnerIntroduction: The May Thurner syndrome (MTS), results from compression of left common iliac vein (LCIV) between the fifth lumbar vertebra, posteriorly, and the right common iliac artery (RCIA), anteriorly. This phenomenon can cause venous stasis in the pelvis and in the left lower limb. The Nutcracker syndrome (NCS) result from compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta, called Anterior NCS, or more rarely by compression of the LRV between the aorta and the lumbar vertebra, when the vein passes behind the aorta, called posterior NCS. The association of the two anomalies can occur when a circunaortic renal vein exists. This phenomenon can cause stasis in the kidney and in the pelvis. The MTS and NCS are rare clinical entities and the association of the two pathologies is extremely rare. Clinical Case: A 29-year-old female, complaints of bilateral leg pain, predominantly on the left side, left malleolar edema which increases in the end of the day, and dyspaneuria. These complaints interfere severely with the quality of life of the patient. The physical examination reveals collateral varices in the posterior aspect of the left tight, a right side vulvar varicose vein and mild left malleolar edema. A phlebography of the ilio-cava system and the ovarian vein reveal a compression of LCIV by the RCIA with an extensive collateral pathway communicating the left and the right vein iliac system, the origin of a right side vulvar varicose vein in the right internal iliac vein and the compression of a posterior LRV by the aorta. A transluminal angioplasty with sequential dilatation with a 12, 14 and 16 mm balloon was done and an Optimed stent 16/100 mm was implanted in the LCIV.At 3 months of follow up, the patient called and informed that she was pregnant, so she stopped the rivaroxabane and maintained the elastics stockings. The pregnancy and the child birth had no intercurrences. An abdomino-pelvic control CT at 12 months follow-up was done, showing the stent in a good position and patent, and posteriorly she was submitted to stab avulsion of varicose veins in the left thigh. At 18 months follow-up, the patient was clinically asymptomatic. Discussion/Conclusion: Insufficient knowledge about the natural history of NCS and MTS results from the uncertainty in the diagnostic criteria and treatment selection, particularly in the rare association of both. This association can be responsible for the amplification of the symptomatology of the venous obstruction. In our case, we have seen the resolution of the complaints by treating only one of the obstructive lesion (MTS) and we haven’t seen any effect of the pregnancy in the structure and patency of the ilio-caval stent. Introdução: A Síndrome de May Thurner (SMT) resulta da compressão da veia ilíaca comum esquerda (VICE), entre a quinta vértebra lombar, posteriormente, e a artéria ilíaca comum direita (AICD), anteriormente. Este fenómeno pode causar estase venosa na pélvis e no membro inferior esquerdo. A Síndrome de Nutcracker (SNC) resulta da compressão da veia renal esquerda (VRE), entre a artéria mesentérica superior e a aorta, chamada SNC anterior, ou mais raramente pela compressão da VRE, entre a aorta e as vértebras lombares, quando a veia passa posteriormente à aorta, chamada SNC posterior. A associação das duas anomalias pode ocorrer quando existem veias renais circun-aórticas, chamado de SNC misto. Este fenómeno pode causar estase no rim e na pélvis. O SMTe o SNC são entidades clínicas raras e a associação das duas patologias é ainda mais rara. Caso clínico: Uma mulher de 29 anos recorre à consulta com dor nas pernas, predominantemente à esquerda, edema maleolar esquerda, com agravamento vespertino e dispaneuria. Estas queixas interferiam severamente com a sua qualidade de vida. O exame físico revelou varizes colaterais na face posterior esquerda, variz vulvar direita e edema maleolar esquerdo discreto. Realizou flebografia do sistema ilio-cava e da veia ovária, observando-se compressão da VICE pela AICD com extensa colateralidade, comunicando o sistema venoso ilíaco esquerdo e direito, origem da veia vulvar direita em ramo da artéria ilíaca interna direita e compressão da veia renal esquerda posterior pela aorta. Uma angioplastia transluminal percutânea com dilatação sequencial com balões de diâmetro 12, 14 e 16 mm foi efectuada, com posterior colocação de um stent optimed 16/100 mm na VICE. Aos 3 meses de follow-up, a doente informou que estava grávida, tendo suspendido a hipocoagulação com rivaroxabane, mantendo o uso de meia elástica. A gravidez e o pós-parto ocorreram sem intercorrências. Aos 12 meses de follow-up, foi realizado um TC que mostrou o stent em boa posição e patente e, posteriormente, foi submetida a fleboextração de varizes da coxa esquerda. Aos 18 meses de follow-up, a doente está clinicamente assimtomática. Discussão/Conclusão: Um insuficiente conhecimento da história natural da SNC e da SMT resulta de uma indefinição sobre os critérios de diagnóstico e indicação terapêutica, particularmente na rara associação destas duas síndromes. Esta pode ser responsável pela amplificação dos sintomas da obstrução venosa e estado subsequente. No nosso caso clínico, observámos a resolução das queixas da doente, apenas com o tratamento da obstrução da VICE e não observámos nenhum efeito na estrutura e patência do stent iliocava.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2017-07-17T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.34oai:ojs.acvjournal.com:article/34Angiologia e Cirurgia Vascular; Vol. 13 No. 2 (2017): JuneAngiologia e Cirurgia Vascular; Vol. 13 N.º 2 (2017): Junho2183-00961646-706Xreponame: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/34https://doi.org/10.48750/acv.34http://acvjournal.com/index.php/acv/article/view/34/26Copyright (c) 2017 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessMachado, MiguelMachado, RuiMendes, DanielAlmeida, Rui2022-05-23T15:09:58Zoai:ojs.acvjournal.com:article/34Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T14:57:27.215869Repositório 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 |
SINDROME DE MAY-THURNER ASSOCIADO A UM SINDROME DE NUTCRACKER: CASO CLINICO E REVISÃO DA LITERATURA MAY-THURNER SYNDROME ASSOCIATED WITH NUTCRACKER SYNDROME: CLINICAL CASE AND LITERATURE REVIEW |
title |
SINDROME DE MAY-THURNER ASSOCIADO A UM SINDROME DE NUTCRACKER: CASO CLINICO E REVISÃO DA LITERATURA |
spellingShingle |
SINDROME DE MAY-THURNER ASSOCIADO A UM SINDROME DE NUTCRACKER: CASO CLINICO E REVISÃO DA LITERATURA Machado, Miguel May-Thurner Syndrome Nutcracker Syndrome Síndrome de Nutcracker Síndrome de May-Thurner |
title_short |
SINDROME DE MAY-THURNER ASSOCIADO A UM SINDROME DE NUTCRACKER: CASO CLINICO E REVISÃO DA LITERATURA |
title_full |
SINDROME DE MAY-THURNER ASSOCIADO A UM SINDROME DE NUTCRACKER: CASO CLINICO E REVISÃO DA LITERATURA |
title_fullStr |
SINDROME DE MAY-THURNER ASSOCIADO A UM SINDROME DE NUTCRACKER: CASO CLINICO E REVISÃO DA LITERATURA |
title_full_unstemmed |
SINDROME DE MAY-THURNER ASSOCIADO A UM SINDROME DE NUTCRACKER: CASO CLINICO E REVISÃO DA LITERATURA |
title_sort |
SINDROME DE MAY-THURNER ASSOCIADO A UM SINDROME DE NUTCRACKER: CASO CLINICO E REVISÃO DA LITERATURA |
author |
Machado, Miguel |
author_facet |
Machado, Miguel Machado, Rui Mendes, Daniel Almeida, Rui |
author_role |
author |
author2 |
Machado, Rui Mendes, Daniel Almeida, Rui |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Machado, Miguel Machado, Rui Mendes, Daniel Almeida, Rui |
dc.subject.por.fl_str_mv |
May-Thurner Syndrome Nutcracker Syndrome Síndrome de Nutcracker Síndrome de May-Thurner |
topic |
May-Thurner Syndrome Nutcracker Syndrome Síndrome de Nutcracker Síndrome de May-Thurner |
description |
Introduction: The May Thurner syndrome (MTS), results from compression of left common iliac vein (LCIV) between the fifth lumbar vertebra, posteriorly, and the right common iliac artery (RCIA), anteriorly. This phenomenon can cause venous stasis in the pelvis and in the left lower limb. The Nutcracker syndrome (NCS) result from compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta, called Anterior NCS, or more rarely by compression of the LRV between the aorta and the lumbar vertebra, when the vein passes behind the aorta, called posterior NCS. The association of the two anomalies can occur when a circunaortic renal vein exists. This phenomenon can cause stasis in the kidney and in the pelvis. The MTS and NCS are rare clinical entities and the association of the two pathologies is extremely rare. Clinical Case: A 29-year-old female, complaints of bilateral leg pain, predominantly on the left side, left malleolar edema which increases in the end of the day, and dyspaneuria. These complaints interfere severely with the quality of life of the patient. The physical examination reveals collateral varices in the posterior aspect of the left tight, a right side vulvar varicose vein and mild left malleolar edema. A phlebography of the ilio-cava system and the ovarian vein reveal a compression of LCIV by the RCIA with an extensive collateral pathway communicating the left and the right vein iliac system, the origin of a right side vulvar varicose vein in the right internal iliac vein and the compression of a posterior LRV by the aorta. A transluminal angioplasty with sequential dilatation with a 12, 14 and 16 mm balloon was done and an Optimed stent 16/100 mm was implanted in the LCIV.At 3 months of follow up, the patient called and informed that she was pregnant, so she stopped the rivaroxabane and maintained the elastics stockings. The pregnancy and the child birth had no intercurrences. An abdomino-pelvic control CT at 12 months follow-up was done, showing the stent in a good position and patent, and posteriorly she was submitted to stab avulsion of varicose veins in the left thigh. At 18 months follow-up, the patient was clinically asymptomatic. Discussion/Conclusion: Insufficient knowledge about the natural history of NCS and MTS results from the uncertainty in the diagnostic criteria and treatment selection, particularly in the rare association of both. This association can be responsible for the amplification of the symptomatology of the venous obstruction. In our case, we have seen the resolution of the complaints by treating only one of the obstructive lesion (MTS) and we haven’t seen any effect of the pregnancy in the structure and patency of the ilio-caval stent. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-07-17T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
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publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.48750/acv.34 oai:ojs.acvjournal.com:article/34 |
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https://doi.org/10.48750/acv.34 |
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oai:ojs.acvjournal.com:article/34 |
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eng |
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eng |
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http://acvjournal.com/index.php/acv/article/view/34 https://doi.org/10.48750/acv.34 http://acvjournal.com/index.php/acv/article/view/34/26 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2017 Angiologia e Cirurgia Vascular info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2017 Angiologia e Cirurgia Vascular |
eu_rights_str_mv |
openAccess |
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application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
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Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
dc.source.none.fl_str_mv |
Angiologia e Cirurgia Vascular; Vol. 13 No. 2 (2017): June Angiologia e Cirurgia Vascular; Vol. 13 N.º 2 (2017): Junho 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 |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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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) |
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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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