Identificação pela ultrassonografia vascular da compressão da veia ilíaca comum esquerda em mulheres assintomáticas: ortostatismo pode influenciar o diagnóstico?
Left common iliac vein compression identified by vascular ultrasonography in asymptomatic women: does standing position influence diagnosis?
Ana Luiza Dias Valiente Engelhorn; Lucas de Brito Lima; Maria Julia Saggiorato Werka; Anna Victoria Valiente Engelhorn; Dirceu Augusto Rüdiger Bombardelli; Lucas Daniel Oliveira da Silva; Giovanna Silva Barbosa; Carlos Alberto Engelhorn
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Abstract
Background: Vascular ultrasonography is the imaging exam of choice for initial screening for left common iliac vein compression, which is an asymptomatic finding that can be detected in up to 25% of some patient samples. Objective: To determine, using vascular ultrasonography, whether findings of left common iliac vein compression in asymptomatic women are different when assessed in the prone and standing positions. Methods: This is a cross-sectional observational study of 50 adult female volunteers with no symptoms of pelvic venous compression. The parameters assessed with vascular ultrasonography in the prone and standing positions were diameters and maximum velocities of the left common iliac vein at the point at which it crosses behind the right common iliac artery and before this point, in addition to left common iliac vein velocity indices at the crossing. Results: Eight cases of significant compression of the left common iliac vein were identified when assessed in prone position (16%) and just two cases (4%) were identified in the standing position. Left common iliac vein diameters were statistically larger (p = 0.002) at the point where it crosses behind the right common iliac artery in the standing position and velocities and velocity indices were statistically higher (p < 0.001) in the prone position. No significant compression of the left common iliac vein was identified in the standing position when velocity indices were normal in the prone position. Conclusions: There was no difference in detection of significant compression of the left common iliac vein when assessed in the standing position in comparison with assessment in the prone position. However, the study showed that anatomic compression of the left common iliac vein may be reduced in the standing position.
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References
1 Melo CCS, Barros MVL, Armando J, et al. Tratamento endovascular na síndrome de May-Thurner: relato de caso e revisão da literatura. Rev Bras Ecocardiogr Imagem Cardiovasc. 2012;25(2):122-5.
2 Lamba R, Tanner DT, Sekhon S, McGahan JP, Corwin MT, Lall CG. Multidetector CT of vascular compression syndromes in the abdomen and pelvis. Radiographics. 2014;34(1):93-115.
3 Heniford BT, Senler SO, Olsofka JM, Carrillo EH, Bergamini TM. May-Thurner syndrome: management by endovascular surgical techniques. Ann Vasc Surg. 1998;12(5):482-6.
4 Rollo JC, Farley SM, Oskowitz AZ, Woo K, DeRubertis BG. Contemporary outcomes after venography-guided treatment of patients with May-Thurner syndrome. J Vasc Surg Venous Lymphat Disord. 2017;5(5):667-76.
5 DeStephano C, Werner C, Holly EF, Lessne ML. Diagnosis and management of iliac vein thrombosis in pregnancy resulting from May-Thurner Syndrome. J Perinatol. 2014;34(7):566-8.
6 Pavon CC, Peloche JLS, Olea EDA, Servia AC. Rotura espontánea de la vena ilíaca. Emergencias. 2003;15:376-80.
7 May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957;8(5):419-27.
8 Kalva S, Reddick M, Anderson M, Sutphin P, Chamarthy M. Evolving concepts in the diagnosis and management of May-Thurner Syndrome. J Clin Interv Radiol. 2017;1(01):23-30.
9 Galang LD, Tulsidas H. May-Thurner Syndrome: An important differential diagnosis for DVT. J Vasc Med Surg. 2016;4:2.
10 Ahmed OJ, Patel M, Ward TJ, Wang DS, Shah R, Hofmann LV. Endovascular stent placement for May-Thurner Syndrome in the absence of acute deep vein thrombosis. J Vasc Interv Radiol. 2016;27(2):167-73.
11 Cavalcante LP, Souza JES, Pereira RM, et al. Síndrome de compressão da veia ilíaca: revisão de literatura. J Vasc Bras. 2015;14(1):78-83.
12 Mousa AY, AbuRahma AF. May-Thurner Syndrome: Update and review. Ann Vasc Surg. 2013;27(7):984-95.
13 Labropoulos N, Borge M, Pierce K, Pappas PJ. Criteria for defining significant central vein stenosis with duplex ultrasound. J Vasc Surg. 2007;46(1):101-7.
14 Metzger PB, Rossi FH, Kambara AM, et al. Criteria for detecting significant chronic iliac venous obstructions with duplex ultrasound. J Vasc Surg Venous Lymphat Disord. 2016;4(1):18-27.
15 Negus D, Fletcher EWL, Cockett FB, Thomas ML. Compression and band formation at the mouth of the left common iliac vein. Br J Surg. 1960;55(5):369-74.
16 Du Pont B, Verbist J, Van den Eynde W, Peeters P. Right-sided Cockett’s syndrome. Acta Chir Belg. 2016;116(2):114-8.
17 Kaltenmeier CT, Erben Y, Indes J, et al. Systematic review of May-Thurner syndrome with emphasis on gender differences. J Vasc Surg Venous Lymphat Disord. 2018;6(3):399-407.e4.
18 Neglén P, Thrasher TL, Raju S. Venous outflow obstruction: an underestimated contributor to chronic venous disease. J Vasc Surg. 2003;38(5):879-85.
19 Labropoulos N, Volteas N, Leon M, et al. The role of venous outflow obstruction in patients with chronic venous dysfunction. Arch Surg. 1997;132(1):46-51.
20 Birn J, Vedantham S. May–Thurner syndrome and other obstructive iliac vein lesions: Meaning, myth, and mystery. Vasc Med. 2015;20(1):74-83.
21 Murphy EH, Davis CM, Journeycake JM, DeMuth RP, Arko FR. Symptomatic ileofemoral DVT after onset of oral contraceptive use in women with previously undiagnosed May-Thurner Syndrome. J Vasc Surg. 2009;49(3):697-703.
22 Esposito A, Charisis N, Kantarovsky A, Labropoulos N. A Comprehensive Review of the Pathophysiology and Clinical Importance of Iliac Vein Obstruction Clinical Importance of Iliac Vein Obstruction. Eur J Vasc Endovasc Surg. 2020;60(1):118-25.
Submitted date:
09/27/2020
Accepted date:
02/01/2021
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