The endovascular recanalization of the iliocaval system has replaced venous surgical reconstructions as the primary treatment option in severe post-thrombotic syndrome (PTS). We herein present a 51-year-old female with previous deep venous thrombosis, complicated with PTS with a large and complex circumferential calf ulcer measuring 25 cm of length in the left lower extremity. Venogram revealed a complete and extensive occlusion in the left iliofemoral system. A surgical bypass from the left common femoral vein to the right common iliac vein was performed. Patient recovered well and after 12 months postoperation her large wound is healing favorably with a clean and well granulated bed. Iliofemoral venous bypass is a feasible treatment for non-healing ulcer of lower extremity.
Female ; Femoral Vein ; Humans ; Iliac Vein ; Lower Extremity ; Middle Aged ; Ulcer ; Venous Thrombosis ; Wounds and Injuries

STUDY DESIGN: Case report. OBJECTIVES: To report a rare case in which a tack was used to control bleeding due to a torn iliac vein during revisional anterior spine surgery. SUMMARY OF LITERATURE REVIEW: During anterior lumbar surgery, bleeding following a vascular injury is possible to control and reparable in most cases. During revisional anterior lumbar surgery, however, there are irreparable cases of bleeding as well. In some cases, it can threaten the patient's life. MATERIALS AND METHODS: A 56-year-old man suffered from potentially fatal bleeding following iliac vein rupture during revisional anterior lumbar surgery. Primary vascular closure was impossible due to severe adhesion. We attempted to stop the venous bleeding with a tack, as an alternative treatment. The potentially fatal bleeding was controlled and the patient's vital signs stabilized after hemostasis by the tack. RESULTS: Hemostasis using the tack saved the patient's life without any rebleeding. CONCLUSIONS: During revisional anterior lumbar surgery, bleeding following an iliac vein rupture can be controlled by a tack in cases that are irreparable due to severe adhesion.
Hemorrhage ; Hemostasis ; Humans ; Iliac Vein* ; Middle Aged ; Rupture* ; Spine ; Vascular System Injuries ; Vital Signs

May-Thurner syndrome, also known as iliac vein compression syndrome, is an anatomically variable condition that is characterized by left common iliac vein compression by the right common iliac artery and the lumbar vertebra. This chronic and pulsatile venous compression by the right common iliac artery can cause local intimal injury, inflammation, scarring, and fibrosis, leading to venous outflow obstruction and increased intraluminal pressure. This can cause several complications, such as venous insufficiency, venous claudication, deep vein thrombosis, and very rarely extraperitoneal hematoma due to spontaneous iliac vein rupture. In particular, in middle aged women, hormonal imbalance coupled with these mechanical and inflammatory factors can cause further weakening of the venous wall integrity and develop spontaneous and potentially lethal venous rupture. This paper reports an extremely rare case of a 58-year-old woman with May-Thurner syndrome with acute and extensive deep vein thrombosis of the left lower extremity and a spontaneous extraperitoneal hematoma caused by utero-ovarian vein rupture.
Abdominal Cavity ; Cicatrix ; Female ; Fibrosis ; Hematoma* ; Humans ; Iliac Artery ; Iliac Vein ; Inflammation ; Lower Extremity ; May-Thurner Syndrome* ; Middle Aged ; Rupture* ; Spine ; Vascular System Injuries ; Veins* ; Venous Insufficiency ; Venous Thrombosis*

A 36-year-old male presented with progressive exertional dyspnea over months. Physical examination showed jugular venous distension, lung crecipitations, femoral bruit and pitting pedal edema. Echocardiogram showed a dilated right ventricle with severe pulmonary hypertension and a non collapsing inferior vena cava (IVC). On right heart catheterization, IVC oxygen saturation was noted at 92% suggesting arterial mixing; a computed tomography of the abdomen showed a fistula between the right common iliac artery to the right common iliac vein at L4 level and a massive IVC; this was linked to trauma from a disectomy done 16 years ago at L4–L5 level. Endovascular sealing with a 16 × 60 mm bifurcated stent graft (S & G Biotech, Seoul, Korea) was performed which led to complete resolution of the patient’s dyspnea. Iatrogenic vascular injury during lumbar disc surgery, although rare, can lead to high output cardiac failure developing over months to years.
Abdomen ; Adult ; Arteriovenous Fistula* ; Blood Vessel Prosthesis ; Cardiac Catheterization ; Cardiac Catheters ; Dyspnea ; Edema ; Fistula ; Heart Failure* ; Heart Ventricles ; Heart* ; Humans ; Hypertension, Pulmonary ; Iliac Artery ; Iliac Vein ; Intervertebral Disc Displacement* ; Lung ; Male ; Oxygen ; Physical Examination ; Seoul ; Vascular System Injuries ; Vena Cava, Inferior

BACKGROUNDSeveral studies, including those done in China, report that paravertebral vascular injury during posterior spinal surgery can greatly harm patients, though it is a relatively rare complication. However, few studies have examined their course and anatomic relationship to the spine. The aim of this study was to measure the course of the major paravertebral vessels and their positional relationships to the vertebral bodies in Chinese subjects using computed tomography.

METHODSWe studied a total of fifty subjects who underwent thoracolumbar computed tomography from T1-S1 at our institution. We measured the theoretical distance, actual distance, theoretical angle, and actual angle of the paravertebral vessels at each thoracolumbar intervertebral disc.

RESULTSThe paravertebral artery actual angle at T4-L4 ranged from -11.41 to 79.75° and the actual distance from 16.98 to 52.53 mm. The actual angle of the inferior vena cava at L1-L5 intervertebral disc ranged from -40.75 to 34.50° and the actual distance from -36.63 to 61.69 mm. There was no significant difference in the actual angle of the paravertebral vein or in the actual distance in the thoracic segments according to gender (P > 0.05). However, the actual distance in the lumbar segments were significantly different according to gender (P < 0.05).

CONCLUSIONSThe major paravertebral vessels' course is closer to the mid-sagittal plane as they move posterior along the vertebrae, and the actual distance of the paravertebral artery and azygos vein increase, while the actual distance of the inferior vena cava decreases. The course of the lumbar paravertebral vessels varies, especially at L4/L5, and may be more prone to intraoperative injury in female subjects.

Adolescent ; Adult ; Arteries ; injuries ; Azygos Vein ; diagnostic imaging ; injuries ; Female ; Humans ; Iliac Vein ; diagnostic imaging ; injuries ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Young Adult

STUDY DESIGN: Modern biomaterials and instrumentation have popularised surgery of the thoraco-lumbar spine through an anterior route. The advantage of anterior surgery is that it allows for a direct decompression of the compromised spinal canal. However, the potential for devastating long-term sequelae as a result of complications is high. PURPOSE: The aim of this study was to give a general overview and identify the incidence of vascular complications. OVERVIEW OF LITERATURE: There is limited literature describing the overall incidence and complications of anterior spinal surgery. METHODS: A retrospective review of a prospective database of 1,262 consecutive patients with anterior surgery over a twelve-year period. RESULTS: In our study, 1.58% (n=20) of patients suffered complications. Injury to a major vessel was encountered in 14 (1.11%) cases, of which nine involved an injury to the common iliac vein. In six cases, the original procedure was abandoned due to a life-threatening vascular injury (n=3) and unfavourable anatomy (n=3). CONCLUSIONS: The incidence of vascular and other complications in our study was relatively low. Nevertheless, the potential for devastating long-term sequelae as a result of complications remains high. A thorough knowledge and awareness of normal and abnormal anatomy should be gained before attempting such a procedure, and a vascular surgical assistance especially should be readily accessible. We believe use of access surgeons is mandatory in cases with difficult or aberrant anatomy.
Biocompatible Materials ; Decompression ; Humans ; Iliac Vein ; Incidence* ; Prospective Studies ; Retrospective Studies ; Spinal Canal ; Spine* ; Vascular System Injuries

Injury of common iliac vein related to lumbar discectomy is a rare complication. We report a patient who sustained injury of common iliac vein during lumbar discectomy for extraforaminal lumbar herniated disc. In this case, she had hypovolemic shock due to massive bleeding, and underwent emergent interventional treatment and open laparatomy. Although the vascular injuries were successfully repaired, it could be a fatal complication. We report the clinical features and early management, emphasizing the need for rapid diagnosis, immediate intervention and treatment for favorable outcome.
Diskectomy ; Glycosaminoglycans ; Hemorrhage ; Humans ; Iliac Vein ; Intervertebral Disc Displacement ; Shock ; Vascular System Injuries

We report a rare case of vascular injury secondary to a damaged Hot Shearstrade mark tip cover. Two 1 mm holes in the tip cover resulted in perforations in the obturator and external iliac veins during pelvic node dissection. Bleeding was controlled with bipolar coagulation and a 5 mm metal clip in the obturator and iliac vein, respectively. The rest of the procedure was completed uneventfully. Frequent integrity assessment of this accessory is necessary. Its function is important in order to carry out safe dissection in proximity to delicate structures. When injuries arise from areas not directly involved in the dissection, immediate inspection of the instruments should be mandatory.
Humans ; Iliac Vein/*injuries ; Male ; Middle Aged ; Prostatectomy/*adverse effects/instrumentation/methods ; Prostatic Neoplasms/surgery ; Robotics/instrumentation

There have been a few reports on deep vein thrombosis (DVT) associated with compression of the left common iliac vein by the right common iliac artery, referred to as May-Thurner syndrome (MTS). However, there have been no reports on DVT associated with MTS in amyotrophic lateral sclerosis (ALS) patients exhibiting similar clinical features to paraplegic spinal cord injury patients. We hereby report a case of DVT associated with MTS in an ALS patient, who was treated successfully.
Amyotrophic Lateral Sclerosis ; Humans ; Iliac Artery ; Iliac Vein ; May-Thurner Syndrome ; Spinal Cord Injuries ; Venous Thrombosis

The vascular injuries that occur with lumbar discectomy are serious and often fatal complications. The incidence of such injuries is very low, but they are probably underestimated due to the various clinical manifestations such as retroperitoneal hemorrhage, hematoma and iliac artery-IVC vein fistula. A delayed diagnosis, and especially in case of iliac-IVC fistula, results in high output heart failure and cardiopulmonary insufficiency. We report here on 2 cases of iliac arteriovenous fistula that occurred after lumbar discectomy. An 18-year-old man and a 37-year-old man were admitted to our department with the symptoms of high output heart failure 3 and 24 days, respectively, after lumbar discectomy was performed. Both of them presented with clinical manifestations of pulmonary edema, tachycardia, hydrothorax and high output heart failure. One man died after an iliac artery stent graft and one man was salvaged after left common iliac vein ligation, aorto-common iliac artery bypass and left common iliac vein-IVC bypass surgery. Prompt diagnosis and aggressive treatment can hep to salvage the patients from these fatal complications. A high index of suspicion for this malady, based on the clinical signs, is mandatory.
Adolescent ; Adult ; Arteriovenous Fistula ; Blood Vessel Prosthesis ; Delayed Diagnosis ; Diagnosis ; Diskectomy* ; Fistula* ; Heart Failure ; Hematoma ; Hemorrhage ; Humans ; Hydrothorax ; Iliac Artery ; Iliac Vein ; Incidence ; Ligation ; Pulmonary Edema ; Tachycardia ; Vascular System Injuries ; Veins