Re-evaluation of iliac compression syndrome using magnetic resonance imaging in patients with acute deep venous thromboses Douglas G.W. Fraser, MRCP,

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Presentation transcript:

Re-evaluation of iliac compression syndrome using magnetic resonance imaging in patients with acute deep venous thromboses Douglas G.W. Fraser, MRCP, Alan R. Moody, FRCS, Anne Martel, PhD, Paul S. Morgan, PhD Journal of Vascular Surgery Volume 40, Issue 4, Pages 604-611 (October 2004) DOI: 10.1016/j.jvs.2004.07.039 Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 1 Compression of the left common iliac vein by the right common iliac artery (RCIA/LCIV compression) visualized with magnetic resonance venography, arteriography, and direct thrombus imaging in 2 study patients. a, Surface rendered pelvic venogram shows a defect at the origin of the left common iliac vein (arrow). b, Superimposed surface-rendered venogram (blue) and arteriogram (red) show the defect in the LCIV is due to the presence of the right common iliac artery, which crosses and compresses the vein onto the vertebral column at this point (arrow). c, In a second patient, a maximum-intensity projection direct thrombus image of the pelvis shows thrombus filling the left common iliac vein (arrow), left internal iliac vein (double arrow), left external iliac vein (unfilled arrow), and left common femoral vein (unfilled arrow). The black and white arrow shows a cranially directed branch of the internal iliac vein. The dotted lines are the points at which cross-sectional images d and e were constructed. d, Thrombus filling the lumen of the left common iliac vein shows that the vein is flattened (white arrowheads) due to compression by the overriding right common iliac artery (unfilled arrowheads). e, Cross-sectional image showing thrombus filling a more distal portion of the left common iliac vein (arrow) that is not compressed. Journal of Vascular Surgery 2004 40, 604-611DOI: (10.1016/j.jvs.2004.07.039) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 2 Summary of results showing the number of patients with and without compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) according to the extent and pattern of thrombosis. Type 1 was compression of the origin of the LCIV by the RCIA. Type 2 was compression of the origin of the LCIV by the RCIA together with compression of the midpoint of the LCIV by the left common iliac artery. contiguous fempop, Contiguous thrombus from the calf to the femoral veins; noncontig fempop, femoropopliteal and calf thrombus that are not contiguous; contiguous ileofem, contiguous thrombus from the calf to the iliac veins; noncontiguous ileofemoral, iliac/ileofemoral thrombus and distal thrombosis that are not contiguous. Journal of Vascular Surgery 2004 40, 604-611DOI: (10.1016/j.jvs.2004.07.039) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 3 Propagation of thrombus distally from the left common iliac vein in 2 study patients. a, Venogram at presentation shows thrombus filling of the left external iliac vein and retrograde filling of the left internal iliac vein (unfilled arrow). There is no filling of the left common iliac vein (LCIV) with a sharp cut-off due to isolated LCIV thrombus (arrow). b, Repeat venography 2 days later shows that thrombus has extended distally from the LCIV to fill both the left external iliac and common femoral veins (arrows). c, Magnetic resonance pelvic venogram at presentation in a second patient shows a filling defect in the LCIV extending into the inferior vena cava due to thrombus (arrows). Calf thrombus was also present (not shown). d, Repeat magnetic resonance venogram 5 days later shows a filling defect extending from the inferior vena cava distally to the common femoral vein due to distal extension of thrombus into the left external iliac and common femoral veins (arrows). Journal of Vascular Surgery 2004 40, 604-611DOI: (10.1016/j.jvs.2004.07.039) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions