The Experts below are selected from a list of 324 Experts worldwide ranked by ideXlab platform
Seshadri Raju - One of the best experts on this subject based on the ideXlab platform.
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anomalous features of Iliac Vein stenosis that affect diagnosis and treatment
Journal of vascular surgery. Venous and lymphatic disorders, 2014Co-Authors: Seshadri Raju, Micah DavisAbstract:Background Endovenous management of venous lesions is largely derived from arterial experience. However, venous lesions, particularly Iliac Vein stenoses, differ from their arterial counterparts in some crucial respects. Awareness of these differences is necessary for proper diagnosis and treatment. This report expands on three such anomalous features that we have noted previously in anecdotal form: (1) a unique form of a long and diffuse stenosis (Rokitansky stenosis) that may escape diagnosis with conventional techniques; (2) the invariable failure of plain old balloon angioplasty (POBA) to relieve Iliac Vein stenosis (both focal and diffuse); and (3) the stent compression by venous strictures, whether focal or diffuse, extrinsic to the stent. Although these features are somewhat interrelated from the concentric fibrous structure of Iliac Vein stenosis, they represent different phases in the overall management of Iliac Vein lesions. Methods The analyses are derived from electronic medical records of 2534 Iliac Vein stent procedures performed from 1996 to 2013. Smaller subsets were used to record more detailed intravascular ultrasound planimetry data than were available in the generic database. Results The incidence of Rokitansky stenosis without focal lesions was 1.5%. After POBA, stenotic area increased from a median of 60 mm2 to 62 mm2, a miniscule improvement. Lumen area increased to a nearly “normal” 172 mm2 after stent placement. In 103 limbs with residual or recurrent symptoms, in-stent restenosis (ISR) was present in all limbs; additional stent compression was evident in 25% of the limbs, adding to the overall severity of the stenosis. ISR responded well to high-pressure balloon dilation, with total clearance in 62% of treated limbs and substantial improvement in others. In contrast, stent compression was resistant, remaining unchanged in 68% after balloon dilation. Conclusions Rokitansky stenosis is easily missed with conventional diagnostic techniques and may not be recognizable even with intravascular ultrasound, unless routine planimetry is used. POBA as a primary treatment invariably fails to correct focal or diffuse Iliac Vein stenosis, and stenting is always required. Stent compression is a unique feature of Iliac Vein stenosis, whether it is focal or diffuse. It often occurs in association with ISR, when overall stenosis can be underestimated if stent compression is not taken into account. Stent compression responds poorly to balloon dilation, whereas the associated ISR shows complete clearance in the majority of treated limbs.
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Best management options for chronic Iliac Vein stenosis and occlusion
Journal of vascular surgery, 2013Co-Authors: Seshadri RajuAbstract:Background Iliac Vein stenting technology is rapidly emerging as a minimally invasive alternative to traditional open venovenous bypass procedures for Iliac Vein stenoses and chronic total occlusions. Methods Peer-reviewed publications meeting eligibility criteria were retrieved and reviewed from public domain databases. Results Reviewed reports encompass ∼1500 patients. Evidence quality was judged moderate, with a grade 1B recommendation (benefits outweigh risks) for patients with disabling symptoms in whom conservative therapy had failed. A grade 2B recommendation was assigned for patients with less severe symptoms. Iliac Vein stenting is safe, with negligible morbidity ( Conclusions Iliac Vein stenting is emerging as a safe and effective alternative to traditional open surgery to correct Iliac Vein obstruction.
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Iliac Vein stenting in postmenopausal leg swelling
Journal of Vascular Surgery, 2011Co-Authors: Seshadri Raju, Matthew Oglesbee, Peter NeglenAbstract:Background Leg swelling in menopausal women is well known. Prevailing concept in primary care is that it is polycentric and a treatable cause may not be found. Patients are placed on empiric diuretics often without benefit. Our clinical experience indicates that Iliac venous Vein obstruction is the core cause; a variety of secondary factors common in postmenopausal women precipitate symptoms. Patients and Methods A total of 163 limbs in 150 postmenopausal women (≥55 years of age) with leg swelling unresponsive to conservative therapy underwent intravascular ultrasound-guided Iliac Vein stenting over an 11-year period. Preoperative investigations included duplex, airplethysmography, venous pressure tests, contrast studies, and lymphangiography. The postmenopausal group constituted 9% of all limbs (n = 1760) stented for chronic venous disease (CVD) during the same period and 18% of those stented for swelling (n = 922). Median age was 67 (range, 55-92) and left-to-right ratio 2:1. Results Iliac Vein obstruction was "primary" (nonthrombotic) in 65% and postthrombotic in 35% of limbs; 35% of limbs had obstruction only and 65% combined obstruction/reflux. Lymphatic dysfunction was present in 21% of the limbs. Mean intravascular ultrasound area stenosis was 68% ± 22 SD. Mean follow-up was 22 months (±26 SD) (range, 1-113 months). Secondary stent patency (6 years) was 100% in primary and 91% in postthrombotic limbs; overall 98%. Swelling improved significantly ( P P P Conclusions Patients with postmenopausal leg swelling often have obstructive venous pathology even though suggestive venous history and other signs are often absent. Morbidity arises from painful swelling that affects mobility, quality of life, and ability of self-care at later stages of life. Outpatient percutaneous Iliac Vein stenting affords substantial symptom relief and improvement in quality-of-life measures. Recognition of the clinical complex as a distinct entity of venous origin may lead to greater awareness and effective treatment.
Raymond Limet - One of the best experts on this subject based on the ideXlab platform.
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Spontaneous rupture of the Iliac Vein
Journal of vascular surgery, 1993Co-Authors: H. Van Damme, Gary Hartstein, Raymond LimetAbstract:Abstract A spontaneous rupture of the left Iliac Vein is described. A 2 cm tear on the anterior surface of the left Iliac Vein was discovered at emergency laparotomy on a patient who was suspected of having a huge intraabdominal hemorrhage. Prodromal symptoms, cause, and treatment are discussed. The nine previously reported cases are reviewed. This case represents the seventh successful repair of an idiopathic rupture of an Iliac Vein. (J VASC SURG 1993;17:757-8.)
Levent Oguzkurt - One of the best experts on this subject based on the ideXlab platform.
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Ultrasonographic diagnosis of Iliac Vein compression (May-Thurner) syndrome.
Diagnostic and interventional radiology (Ankara Turkey), 2007Co-Authors: Levent Oguzkurt, Fahri Tercan, Ugur Ozkan, Zafer KocAbstract:Iliac Vein compression syndrome (IVCS), also known as May-Thurner syndrome, is the result of compression of the left common Iliac Vein between the right common Iliac artery and overlying vertebrae. The most common clinical presentation is left lower extremity deep Vein thrombosis. Rarely, a patient with IVCS can present with obstruction of venous outflow, without deep Vein thrombosis. Iliac Vein compression, with or without thrombosis, should be treated if symptomatic. We present a patient with IVCS that was initially diagnosed with transabdominal ultrasonography (US), and then confirmed with computed tomography and venography with pressure measurements. We believe this is the first report of an IVCS patient diagnosed with US.
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Computed tomography findings in 10 cases of Iliac Vein compression (May-Thurner) syndrome.
European Journal of Radiology, 2005Co-Authors: Levent Oguzkurt, Fahri Tercan, M. Ali Pourbagher, Osman Kizilkilic, Rıza Türköz, Fatih BoyvatAbstract:Objective: To present the computed tomography (CT) findings for the Iliac Veins of 10 patients who had left-sided lower extremity deep Vein thrombosis due to Iliac Vein compression syndrome. Materials and methods: The CT findings for 10 cases of left-sided acute or chronic deep Vein thrombosis caused by Iliac Vein compression syndrome were retrospectively evaluated. The patients were five women and five men (mean age ± S.D., 49.9 ± 15.6 years). In each patient with Iliac Vein compression syndrome, the diagnosis of the compression was established by venography performed during endovascular treatment. Diameter of the left common Iliac Vein was also measured in 14 control subjects without any lower extremity venous disease for comparison. Results: In all 10 cases, CT images in the transverse plane demonstrated the left common Iliac Vein being compressed by the overlying right common Iliac artery. The mean diameter at the origin of the left common Iliac Vein (3.5 mm) in patients group was much smaller than the mean diameter of the same Vein (11.5 mm) in the control group (p < 0.01). The mean percent stenosis of the left common Iliac Vein due to compression by the artery was 68%. Conclusion: Pelvic CT images in the transverse plane are useful for detecting Iliac Vein compression by the overlying right common Iliac artery in patients with left-sided deep Vein thrombosis. Radiologists should be aware of this imaging finding of Iliac Vein compression by the artery where the inferior vena cava bifurcates into the common Iliac Veins. © 2004 Elsevier Ireland Ltd. All rights reserved.
Sun Cheol Park - One of the best experts on this subject based on the ideXlab platform.
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ruptured aneurysm of the external Iliac Vein
Journal of vascular surgery. Venous and lymphatic disorders, 2016Co-Authors: Jang Sang Park, Sun Cheol ParkAbstract:Primary Iliac venous aneurysm is an extremely rare vascular abnormality that is associated with the likelihood of rupture, embolism, and thrombosis. In this report, we describe the case of a ruptured aneurysm of the external Iliac Vein in a 63-year-old woman who was admitted to the emergency department and diagnosed by computed tomography. Computed tomography indicated a 4 × 5-cm ruptured aneurysm in the right external Iliac Vein that was surrounded by hematoma in the right side of the pelvis. The aneurysm was successfully treated by tangential aneurysmectomy and lateral venorrhaphy.
Fatih Boyvat - One of the best experts on this subject based on the ideXlab platform.
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Computed tomography findings in 10 cases of Iliac Vein compression (May-Thurner) syndrome.
European Journal of Radiology, 2005Co-Authors: Levent Oguzkurt, Fahri Tercan, M. Ali Pourbagher, Osman Kizilkilic, Rıza Türköz, Fatih BoyvatAbstract:Objective: To present the computed tomography (CT) findings for the Iliac Veins of 10 patients who had left-sided lower extremity deep Vein thrombosis due to Iliac Vein compression syndrome. Materials and methods: The CT findings for 10 cases of left-sided acute or chronic deep Vein thrombosis caused by Iliac Vein compression syndrome were retrospectively evaluated. The patients were five women and five men (mean age ± S.D., 49.9 ± 15.6 years). In each patient with Iliac Vein compression syndrome, the diagnosis of the compression was established by venography performed during endovascular treatment. Diameter of the left common Iliac Vein was also measured in 14 control subjects without any lower extremity venous disease for comparison. Results: In all 10 cases, CT images in the transverse plane demonstrated the left common Iliac Vein being compressed by the overlying right common Iliac artery. The mean diameter at the origin of the left common Iliac Vein (3.5 mm) in patients group was much smaller than the mean diameter of the same Vein (11.5 mm) in the control group (p < 0.01). The mean percent stenosis of the left common Iliac Vein due to compression by the artery was 68%. Conclusion: Pelvic CT images in the transverse plane are useful for detecting Iliac Vein compression by the overlying right common Iliac artery in patients with left-sided deep Vein thrombosis. Radiologists should be aware of this imaging finding of Iliac Vein compression by the artery where the inferior vena cava bifurcates into the common Iliac Veins. © 2004 Elsevier Ireland Ltd. All rights reserved.
