Venous disorders
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
The deep veins of the lower limb (Figure57.1a) include three pairs of venae commitantes, which accompany the three crural arteries (anterior and posterior tibial and peroneal arteries). These six veins intercommunicate and come together in the popliteal fossa to form the popliteal vein, which also receives the soleal and gastrocnemius veins. The popliteal vein passes up through the adductor hiatus to enter the subsartorial canal as the femoral vein, which receives the deep (profunda) femoral vein (or veins) in the femoral triangle before passing behind the inguinal ligament to become the external iliac vein. The internal iliac vein combines with the external iliac vein in the pelvis to form the common iliac vein. The left common iliac vein passes behind the right common iliac artery to join the right common iliac vein on the right side of the abdominal aorta to form the inferior vena cava, which goes on to the right atrium.
Management of pelvic congestion syndrome and perineal varicosities
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
Unlike the lower extremity, the veins of the pelvis have few valves to restrict the direction of venous outflow. In a cadaver study of 200 gonadal veins, single bicuspid valves were noted in 62% of left-sided veins and 48% of right-sided veins. The ovarian vein valve is located just prior to its termination point.9 However, there are no valves within the uterine veins. The internal iliac veins also share this paucity of valves. LePage and colleagues studied 79 internal iliac venous systems in 42 cadavers. The common iliac vein was formed by the confluence of the external iliac vein with single internal iliac veins in 73% and dual internal iliac veins in 27%. Valves were identified in only 10.1% of the main trunks of the internal iliac veins and in only 9.1% of the secondary branches.10 In the absence of valves, the rich anastomotic networks allow blood to flow in alternative directions during periods of relative venous overload, such as that which may occur during pregnancy or in the setting of venous reflux.
Vascular Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
What is the role of venous stents in patients with iliofemoral DVTs?Venous stenting appears to be an effective adjunct to early thrombus removal, particularly associated May–Thurner syndrome; although stents placed for external compression have less favourable outcomes.2May−Thurner syndrome is a condition in which compression of the common venous outflow tract of the left lower extremity may cause discomfort, swelling, pain or blood clots (deep-venous thrombosis) in the iliofemoral veins. It is due to left common iliac vein compression by the overlying right common iliac artery. This leads to stasis of blood, which predisposes to the formation of blood clots.
Abdominal aortic and iliac aneurysm presented as lower limb deep vein thrombosis: case report
Published in Acta Chirurgica Belgica, 2020
Vedran Pazur, Inga Dakovic Bacalja, Ivan Cvjetko, Ana Borovecki
A 63-year old patient presented to our emergency room with right lower limb swelling and pain. There was no history of trauma or recent travel. The patient denied any prior symptoms of lower extremity claudication or vein disease. He had a history of dyslipidemia, hypertension, cerebrovascular disease, and a heart failure. His vital signs were stable. Blood pressure was 135/80 mmHg, pulse was 83/min and the RBC (red blood cell count) were normal. During the initial examination, the patient presented with a swollen right leg (both thigh and the calf) and a palpable pulsatile abdominal mass without abdominal or chest pain. A duplex ultrasound examination confirmed a DVT of the right common iliac vein. In addition, computed tomography angiography (CTA) scan of the thorax and abdomen showed an AAA 60 × 70 mm and a 22-mm aneurysm of the right common iliac artery compressing the inferior caval vein (ICV) and the right common iliac vein. The thrombosis of the ICV and the right common iliac vein resulted in the right lower extremity edema only. The circumference of the right and left thigh measured 86 and 73 cm, respectively. The right and left calf measures were 55 and 45 cm, respectively (Figure 1).
Behçet’s disease; A rare refractory patient with vena cava superior syndrome treated with infliximab: a case report and review of the literature
Published in Acta Clinica Belgica, 2019
Oguz Abdullah Uyaroglu, Abdulsamet Erden, Levent Kilic, Bora Peynircioğlu, Omer Karadag, Umut Kalyoncu
In our case, the patient had thrombus in inferior vena cava and iliac veins and he was currently using warfarin when he was admitted to us. We detected bilateral internal iliac artery aneurysms and thrombus in vena cava inferior that extends to common iliac veins and external iliac veins, simultaneously. In this time, we decided to implant bilateral stent-graft to the iliac aneurysms. Patient was anticoagulated with warfarin and a shunt was implanted between left brachiocephalic vein and right atrium. We continued therapy with warfarin. After the IFX therapy, we have not detected any thrombus or occlusion again. However, we do not know whether this is due to anticoagulation or infliximab therapy. It is believed that venous disease in BD results from endothelial inflammation [24]. Therefore, to control systemic inflammation is very important. Seyahi et al. reports their approach is to not anticoagulate BD patients with venous thrombosis, instead treating these patients with immunosuppressive agents alone. Therewithal treatment of thrombosis in BD differs between clinics [1].
An expert spotlight on inferior vena cava filters
Published in Expert Review of Hematology, 2021
Anil Pillai, Manoj Kathuria, Maria del Pilar Bayona Molano, Patrick Sutphin, Sanjeeva P Kalva
Failure of regression of the left supracardinal vein results in duplicated IVC. The left common iliac vein continues as the left-sided IVC draining into the left renal vein which joins the right IVC and continues as the single normal suprarenal IVC. The incidence of duplicated IVC ranges from 0.2% to 3% [57]. Alternatively, the left IVC may join the hemiazygous vein. Most of the times the ipsilateral common Iliac vein drains into the ipsilateral IVC. If a duplication stays unrecognized, the incidence of recurrent pulmonary emboli is higher [56]. Multiple approaches for the insertion of an IVC filter have been described including the use of a suprarenal IVC filter, bilateral infrarenal IVC filters, and bilateral common Iliac vein filters [58,59].