OBJECTIVE: To compare the efficacy of mechanical thrombectomy with transcatheter thrombolysis in the treatment of acute iliac femoral venous thrombosis. METHODS: The clinical data of 170 patients with acute iliac venous thrombosis treated in Ningbo No.2 Hospital from September 2015 to September 2017 were retrospectively reviewed. Among them, 94 cases were treated with AngioJet mechanical thrombolysis or additional thrombolysis for residual thrombus (PMT group) and 76 cases were treated with catheter-directed thrombolysis(CDT group). After thrombolytic treatment if there was stenosis of iliac vein, the transluminal angioplasty was also performed. The clearance of thrombus and safety were evaluated and compared between two groups. RESULTS: In PMT group there were 86 cases (91.5%) with grade Ⅲ, 5 cases (5.3%) with grade Ⅱ, 3 cases (3.2%) with grade Ⅰ clearance of thrombus; while in CDT group, there were 63 cases (82.9%) with grade Ⅲ, 7 cases (9.2%) with grade Ⅱ and 6 cases (7.9%) with grade Ⅰ clearance of thrombus (>0.05). The differences of diameter of two lower extremities 15 cm above knee after treatment in PMT and CDT groups were (2.3±0.9) cm and (2.5±1.1) cm, respectively (>0.05). The time of thrombolysis in group PMT was significantly shorter than that in group CDT[(2.6±1.2) d vs. (5.3±1.5) d, <0.05]. The dosage of urokinase in PMT group was significantly lower than that in CDT group[(15.0±5.0)×10 U vs. (26.5±7.5)×10 U, <0.05]. Hemoglobin decrease was observed in both groups, which was more significant in PMT group (<0.01). During the following period, there was no significant difference in the incidence of recurrence and post-thrombosis syndrome in two groups (all >0.05). CONCLUSIONS Both PMT and CDT have good thrombus clearance effect in the treatment of acute iliac femoral venous thrombosis, however, PMT has the advantages of short thrombolytic time and less urokinase.
Catheterization, Peripheral ; Fibrinolytic Agents ; therapeutic use ; Humans ; Iliac Vein ; pathology ; surgery ; Retrospective Studies ; Thrombectomy ; Thrombolytic Therapy ; Treatment Outcome ; Venous Thrombosis ; surgery ; therapy

BACKGROUNDIliac vein compression syndrome (IVCS) is an important cause of deep vein thrombosis, but the incidence of IVCS is still unclear. The purpose of this prospective study was to determine the incidence of IVCS in an asymptomatic patient population and to evaluate the risk factors in patients with and without IVCS.

METHODSFrom October 2011 to November 2012, a total of 500 patients (228 women and 272 men; mean age of 55.4 ± 14.7 years) with no vascular-related symptoms were enrolled in this study. Computed tomography was performed to evaluate all patients. The degree of venous compression was calculated as the diameter of the common iliac vein at the site of maximal compression divided by the mean diameter of the uncompressed proximal and caudal left common iliac vein (LCIV). We compared the stenosis rate of the common iliac vein in women and men according to age and followed up patients to evaluate outcomes.

RESULTSThe mean compression degree of the LCIV was 16% (4%, 36%); 37.8% of patients had a compression degree ≥25% and 9.8% had a compression degree ≥50%. There was a significant difference between men and women in the LCIV compression degree (9% [3%, 30%] vs. 24% [8%, 42%]; U = 4.66, P< 0.01). In addition, the LCIV compression degree among younger women (≤40 years) was significantly different compared with that in older women (>40 years) (42% [31%, 50%] vs. 19% [5%, 39%]; U = 5.14, P< 0.001). Follow-up was completed in 367 patients with a mean follow-up of 39.5 months (range, 6-56 months). The incidence of IVCS in the follow-up period was 1.6%. Stenosis rate and the diameter of the site of maximal compression correlated with the incidence of IVCS. Multivariable Cox regression analysis showed that the stenosis rate was an independent risk factor of IVCS (Wald χ2 = 8.84, hazard ratio = 1.13, P< 0.001).

CONCLUSIONSThe incidence of IVCS was low and correlated with the stenosis rate of iliac vein. Preventative therapy may be warranted for common iliac vein compression in patients at an increased risk of venous thromboembolism, especially patients with a higher iliac vein compression degree.

Adult ; Aged ; Constriction, Pathologic ; pathology ; physiopathology ; Female ; Hemodynamics ; physiology ; Humans ; Iliac Vein ; pathology ; physiopathology ; Male ; Middle Aged ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; Sex Factors ; Tomography, X-Ray Computed ; Venous Thrombosis ; pathology ; physiopathology

OBJECTIVE: This study was conducted to evaluate stent compression in iliac vein compression syndrome (IVCS) and to identify its association with stent patency. MATERIALS AND METHODS: Between May 2005 and June 2014, after stent placement for the treatment of IVCS with acute ilio-femoral deep vein thrombosis, follow-up CT venography was performed in 48 patients (35 women, 13 men; age range 23-87 years; median age 56 years). Using follow-up CT venography, the degree of the stent compression was calculated and used to divide patients into two groups. Possible factors associated with stent compression and patency were evaluated. The cumulative degree of stent compression and patency rate were analyzed. RESULTS: All of the stents used were laser-cut nitinol stents. The proportion of limbs showing significant stent compression was 33%. Fifty-six percent of limbs in the significant stent compression group developed stent occlusion. On the other hand, only 9% of limbs in the insignificant stent compression group developed stent occlusion. Significant stent compression was inversely correlated with stent patency (p < 0.001). The median patency period evaluated with Kaplan-Meier analysis was 20.0 months for patients with significant stent compression. Other factors including gender, age, and type of stent were not correlated with stent patency. Significant stent compression occurred most frequently (87.5%) at the upper end of the stent (ilio-caval junction). CONCLUSION: Significant compression of nitinol stents placed in IVCS highly affects stent patency. Therefore, in order to prevent stent compression in IVCS, nitinol stents with higher radial resistive force may be required.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Iliac Vein/pathology/*radiography ; Kaplan-Meier Estimate ; Male ; May-Thurner Syndrome/*diagnosis/radiography/*therapy ; Middle Aged ; Phlebography ; Retrospective Studies ; Stents/adverse effects ; Tomography, X-Ray Computed ; Treatment Outcome ; Vascular Patency/*physiology ; Venous Thrombosis/radiography/*therapy ; Young Adult

Since the introduction of pancreas transplantation more than 40 years ago, surgical techniques and immunosuppressive regiments have improved and both have contributed to increase the number and success rate of this procedure. However, graft survival corresponds to early diagnosis of organ-related complications. Thus, knowledge of the transplantation procedure and postoperative image anatomy are basic requirements for radiologists. In this article, we demonstrate the imaging spectrum of pancreas transplantation with enteric exocrine drainage.
Adult ; Anastomosis, Surgical/methods ; Diagnostic Imaging/methods ; Drainage/methods ; Female ; Graft Rejection/pathology ; Graft Survival ; Humans ; Iliac Artery/radiography/surgery ; Immunosuppressive Agents ; Kidney Transplantation ; Male ; *Medical Illustration ; Mesenteric Artery, Superior/radiography/surgery ; Middle Aged ; Pancreas/*blood supply/radiography ; Pancreas Transplantation/adverse effects/*methods ; Pancreatitis, Graft/etiology ; Portal Vein/radiography/surgery ; Postoperative Complications/radiography ; Postoperative Hemorrhage/etiology ; Survival Rate

BACKGROUNDCatheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) of the lower extremity has good effect, but whether iliac vein stent placement after thrombolytic therapy is still controversial. The goal of this study was to evaluate the efficacy of stent placement in the iliac vein following CDT in lower extremity DVT.

METHODSThis was a single-center, prospective, randomized controlled clinical trial. After receiving CDT, the major branch of the distal iliac vein was completely patent in 155 patients with lower extremity DVT, and 74 of these patients with iliac vein residual stenosis of >50% were randomly divided into a control group (n = 29) and a test group (n = 45). In the test group, stents were implanted in the iliac vein, whereas no stents were implanted in the control group. We evaluated the clinical indicators, including patency of the deep vein, C in CEAP classification, Venous Clinical Severity Score (VCSS), and Chronic Venous Insufficiency Questionnaire (CIVIQ) Score.

RESULTSAll patients had postoperative follow-up visits for a period of 6-24 months. Venography or color ultrasound was conducted in subjects. There was a significant difference between the patency rate at the last follow-up visit (87.5% vs. 29.6%) and the 1-year patency rate (86.0% vs. 54.8%) between the test and control groups. The change in the C in CEAP classification pre- and post-procedure was significantly different between the test and control groups (1.61 ± 0.21 vs. 0.69 ± 0.23). In addition, at the last follow-up visit, VCSS and CIVIQ Score were both significantly different between the test and control groups (7.57 ± 0.27 vs. 0.69 ± 0.23; 22.67 ± 3.01 vs. 39.34 ± 6.66, respectively).

CONCLUSIONThe stenting of iliac vein obstruction following CDT in lower extremity DVT may increase the patency of the deep vein, and thus provides better efficacy and quality of life.

Adolescent ; Adult ; Aged ; Catheterization, Peripheral ; methods ; Female ; Humans ; Iliac Vein ; Lower Extremity ; pathology ; Male ; Middle Aged ; Stents ; Thrombolytic Therapy ; methods ; Venous Thrombosis ; therapy ; Young Adult

A 58-year-old female patient, diagnosed with adenocarcinoma of the lung, underwent percutaneous vertebroplasty at the L4 vertebral body due to painful spinal metastases. Because of deep venous thrombosis of the left femoral and iliac veins, an inferior vena cava filter had been placed before vertebroplasty. Bone cement migrated into the venous bloodstream and then was being trapped within the previously placed filter. This case illustrates that caval filter could capture the bone cement and prevent it from migrating to the pulmonary circulation.
Adenocarcinoma/secondary ; Bone Cements/*adverse effects ; Embolism/*etiology ; Female ; Humans ; Iliac Vein ; Lumbar Vertebrae/surgery ; Lung Neoplasms/pathology ; Middle Aged ; Pulmonary Embolism/prevention & control ; Spinal Neoplasms/secondary ; *Vena Cava Filters ; *Vena Cava, Inferior ; Venous Thrombosis/radiography ; Vertebroplasty/*adverse effects/methods

BACKGROUNDIliac vein compression syndrome (IVCS), the symptomatic compression of the left common iliac vein between the right common iliac artery and the vertebrae, is not an uncommon condition. The aim of this research was to retrospectively evaluate long-term outcome and the significance of endovascular treatment in patients with left IVCS.

METHODSBetween January 1997 and September 2008, 296 patients received interventional therapy in the left common iliac vein. In the second stage, 170 cases underwent saphenous vein high ligation and stripping. Two hundred and thirty-one cases were followed up over a period of 6 to 120 months (average 46 months) and evaluated for symptom improvement with color ultrasound and ascending venography.

RESULTSThe stenotic or occlusive segments of the left iliac vein were successfully dilated in 285 cases, of whom 272 received stent implantation therapy. Most of the patients achieved satisfactory results on discharge. During the follow-up period, varicose veins were alleviated in 98.7% of the patients, and leg swelling disappeared or was obviously relieved in 84% of cases. About 85% of leg ulcers completely healed. The total patency rate was 91.7% as evaluated with color ultrasound and 91.5% with ascending venography.

CONCLUSIONSEndovascular treatment of IVCS provides effective symptomatic improvement and good long-term patency in most patients.

Adolescent ; Adult ; Angioplasty, Balloon ; Female ; Humans ; Iliac Vein ; pathology ; Male ; Middle Aged ; Peripheral Vascular Diseases ; pathology ; therapy ; Phlebography ; Stents ; Young Adult

BACKGROUND AND OBJECTIVEPelvic lymph node metastasis is an important prognostic factor of cervical cancer. The prognosis of cervical cancer patients with common iliac lymph node metastasis is poor, but few systematic studies have been reported . This study was to investigate the characteristics, risk, treatment and prognosis of stage IB-IIB cervical carcinoma patients with common iliac lymph node metastasis.

METHODSA total of 960 patients with cervical cancer receiving radical hysterectomy and bilateral pelvic lymphadenectomy were selected from the hospitalized patients in the Cancer Center of Sun Yat-sen University between January 1995 and December 2005, and analyzed retrospectively.

RESULTSOf the 960 patients, 288 (30.0%) had pelvic lymph node metastasis, and 45 (4.7%) had positive common iliac lymph node. The 5-year overall survival rate (OS) of patients with common iliac lymph node metastasis was 46.1%, and 67.5% in patients with other pelvic lymph node metastasis (P < 0.05). Univariate analysis showed that clinical stage, serum level of squamous cell carcinoma antigen (SCC-Ag) > 4 microg/L before treatment, depth of cervical invasion > or =2/3 and positive parametrial margin were associated with common iliac lymph node metastasis (P < 0.05). Patients with > or =3 pelvic lymph node metastasis (excluding common iliac lymph node) or recurrence had poor prognosis (P < 0.05). Factors predictive of common iliac lymph node metastasis on Logistic forward regression were SCC-Ag > 4 microg/L (P = 0.026, OR = 2.303) before treatment and positive parametrial margin (P = 0.045, OR = 2.634).

CONCLUSIONSCervical cancer patients with common iliac lymph node metastasis had poorer prognosis compared with patients with other pelvic lymph node metastasis. SCC-Ag >4 microg/L before treatment and positive parametrial margin were the independent predictive factors for common iliac lymph node metastasis of cervical carcinoma. Pelvic lymph node metastasis (excluding common iliac lymph node) > or = 3 or recurrence was prognostic factors for patients with common iliac lymph node metastasis.

Adenocarcinoma ; blood ; pathology ; surgery ; Adult ; Antigens, Neoplasm ; blood ; Carcinoma, Squamous Cell ; blood ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; methods ; Iliac Artery ; Iliac Vein ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Pelvis ; Retrospective Studies ; Risk Factors ; Serpins ; blood ; Survival Rate ; Uterine Cervical Neoplasms ; blood ; pathology ; surgery

OBJECTIVETo investigate the role of revascularization procedures with autologous greater saphenous vein in surgical management of iliac-femoral artery pseudoaneurysm in parenteral drug abusers.

METHODSTwenty-one patients with iliac-femoral artery pseudoaneurysm caused by parenteral drug abuse from 2004 to 2007 were enrolled. Among them, 15 patients were male and 6 were female; their average age was 31.3 years. The size of pseudoaneurysms ranged from 3.0 cm to 7.5 cm. Common femoral artery and distal external iliac artery were often involved. We performed arterial reconstruction on these patients with autologous greater saphenous vein as a graft after excising iliac-femoral artery pseudoaneurysm through a single curved inguinal incision. All patients were followed up, and the complications were recorded.

RESULTSThe surgical procedures were finished without intraoperative mortality or perioperative complications. All patients were free of claudication symptoms after the surgery except one case with preoperative popliteal artery stenosis. One case of infection and wound tissue fistula was found later. One case had inguinal incisional hematoma and another complained of numbness in thigh skin.

CONCLUSIONSThe use of autologous greater saphenous venous grafts for arterial reconstruction after pseudoaneurysm excision in drug abusers is safe and effective. This technique offers more advantages than arterial ligation alone without revascularization. An optimal greater saphenous venous graft is a prerequisite for revascularization.

Adult ; Aneurysm, False ; etiology ; surgery ; Female ; Femoral Artery ; pathology ; surgery ; Humans ; Iliac Artery ; pathology ; surgery ; Male ; Middle Aged ; Neovascularization, Physiologic ; Saphenous Vein ; surgery ; Substance Abuse, Intravenous ; complications ; Vascular Surgical Procedures ; methods ; Young Adult

OBJECTIVESTo confirm the occurrence time of iliac-femoral post-thrombotic syndrome (IFPTS) with the experimental analysis of fibrinolytic activation and vessel wall remodeling after iliofemoral vein thrombosis (IFVT). To explore the optimal timing of surgery for IFPTS with comparative study of surgical effect after early and late treatment.

METHODSIFVT was performed on 20 SD rats. The plasminogen activation [tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA)] and vascular remodeling (positive rates of internal elastic membrane, vascular perimeter and vessel wall stiffness index) were detected by immunohistochemistry and Weigert Van Gieson staining respectively. Fifty-one IFPTS patients with Palma-Dale treatment from January 1990 to December 2005 were divided into early surgical group (1 to 2 months after IFVT) and later surgical group (> 2 months after IFVT), including 20 patients and 31 patients respectively. Treatment effects were evaluated by venous clinical severity score (VCSS).

RESULTSThe positive rate of internal elastic membrane decreased significantly at the 4th, 8th and 12th week (P < 0.01), while the vessel wall stiffness index increased at the same time (P < 0.01). The vascular perimeter elevated obviously at 12th week (P < 0.05). Symptoms of early treatment group improved significantly after surgery (3.4 ± 0.9 vs. 5.2 ± 1.2, P < 0.05). Whereas the late treatment group had no significant changes of symptoms (6.8 ± 1.7 vs. 7.6 ± 3.0, P > 0.05).

CONCLUSIONSThe present findings suggest that IFPTS occurs around first month after IFVT. Acceptable surgery timing for IFPTS exists at 1 to 2 months post-IFVT.

Adult ; Aged ; Animals ; Disease Models, Animal ; Female ; Femoral Vein ; Humans ; Iliac Vein ; Male ; Middle Aged ; Postthrombotic Syndrome ; metabolism ; pathology ; surgery ; Rats ; Rats, Sprague-Dawley ; Retrospective Studies ; Tissue Plasminogen Activator ; metabolism ; Treatment Outcome ; Urokinase-Type Plasminogen Activator ; metabolism