Left iliac vein compressed obliquely & anteriorly by right iliac artery
Right iliac artery compresses vein against spine
Occurs near iliac venous confluence into IVC
Produces endoluminal fibrous venous scar
Well seen by intravascular US (IVUS)
Termed venous "spur" by surgeons & pathologists
Phlegmasia alba dolens: Massive venous thrombosis-associated lower extremity swelling without cyanosis
Phlegmasia cerulea dolens: Massive venous thrombosis-associated lower extremity swelling with limb-threatening cyanosis of lower extremity
Proximal/distal thrombus: Society for Vascular Surgery (SVS) recommends use of precise anatomic terminology (e.g., iliofemoral, femoropopliteal, calf) instead of describing thrombus as proximal/distal
Report with/without extension into IVC
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
Society Guidelines
PROCEDURE
Procedure-Specific Goals
Patient Position/Location
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Problems
Complications
Expected Outcomes
Selected References
Kutsenko O et al: Iliac vein stenosis: is the data strong enough for stenting in the young pelvic venous disorders (PeVD) population? Tech Vasc Interv Radiol. 24(1):100733, 2021
Robertson B et al: Technical success and short-term results from mechanical thrombectomy for lower extremity iliofemoral deep vein thrombosis using a computer aided mechanical aspiration thrombectomy device. J Vasc Surg Venous Lymphat Disord. ePub, 2021
Shah NG et al: Management of inferior vena cava thrombosis with the FlowTriever and ClotTriever systems. J Vasc Surg Venous Lymphat Disord. 9(3):615-20, 2021
Stevens SM et al: Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 160(6):e545-608, 2021
Vedantham S et al: Clinical outcomes of a pharmacomechanical catheter-directed venous thrombolysis strategy that included rheolytic thrombectomy in a multicenter randomized trial. J Vasc Interv Radiol. 32(9):1296-1309.e7, 2021
Benarroch-Gampel J et al: Technical success and short-term outcomes after treatment of lower extremity deep vein thrombosis with the ClotTriever system: a preliminary experience. J Vasc Surg Venous Lymphat Disord. 8(2):174-81, 2020
Kahn SR et al: Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 8(1):8-23.e18, 2020
Masuda E et al: The 2020 appropriate use criteria for chronic lower extremity venous disease of the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, and the Society of Interventional Radiology. J Vasc Surg Venous Lymphat Disord. 8(4):505-525.e4, 2020
Expert Panel on Interventional Radiology: ACR Appropriateness Criteria® radiologic management of venous thromboembolism-inferior vena cava filters. J Am Coll Radiol. 16(5S):S214-26, 2019
Magnuson EA et al: Cost-effectiveness of pharmacomechanical catheter-directed thrombolysis versus standard anticoagulation in patients with proximal deep vein thrombosis: results from the ATTRACT trial. Circ Cardiovasc Qual Outcomes. 12(10):e005659, 2019
Chick JFB et al: Endovascular iliocaval reconstruction for chronic iliocaval thrombosis: the data, where we are, and how it is done. Tech Vasc Interv Radiol. 21(2):92-104, 2018
Shamimi-Noori SM et al: Venous stents: current status and future directions. Tech Vasc Interv Radiol. 21(2):113-6, 2018
Tritschler T et al: Venous thromboembolism: advances in diagnosis and treatment. JAMA. 320(15):1583-94, 2018
Mousa AY et al: Catheter-directed thrombolysis versus full anticoagulation alone in treating proximal iliofemoral deep venous thrombosis. Vascular. 25(1):111-2, 2017
Kearon C et al: Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 149(2):315-52, 2016
Birn J et al: May-Thurner syndrome and other obstructive iliac vein lesions: meaning, myth, and mystery. Vasc Med. 20(1):74-83, 2015
Comerota AJ: Catheter-directed thrombolysis for iliofemoral deep vein thrombosis: helpful or hurtful? Expert Rev Hematol. 8(2):131-3, 2015
Du GC et al: Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis. Vasa. 44(3):195-202, 2015
Kahn SR et al: Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet. 383(9920):880-8, 2014
Enden T et al: Health-related quality of life after catheter-directed thrombolysis for deep vein thrombosis: secondary outcomes of the randomised, non-blinded, parallel-group CaVenT study. BMJ Open. 3(8):e002984, 2013
Vedantham S et al: Rationale and design of the ATTRACT study: a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis. Am Heart J. 165(4):523-530.e3, 2013
Enden T et al: Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet. 379(9810):31-8, 2012
Kearon C et al: Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 141(2 Suppl):e419S-94S, 2012
Meissner MH et al: Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 55(5):1449-62, 2012
Broholm R et al: Acute iliofemoral venous thrombosis in patients with atresia of the inferior vena cava can be treated successfully with catheter-directed thrombolysis. J Vasc Interv Radiol. 22(6):801-5, 2011
Chinsakchai K et al: Trends in management of phlegmasia cerulea dolens. Vasc Endovascular Surg. 45(1):5-14, 2011
Jaff MR et al: Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 123(16):1788-830, 2011
Karthikesalingam A et al: A systematic review of percutaneous mechanical thrombectomy in the treatment of deep venous thrombosis. Eur J Vasc Endovasc Surg. 41(4):554-65, 2011
Khan IR et al: Simultaneous arterial and venous ultrasound-assisted thrombolysis for phlegmasia cerulea dolens. Ann Vasc Surg. 25(5):696, 2011
Maleti O et al: Reconstructive surgery for deep vein reflux in the lower limbs: techniques, results and indications. Eur J Vasc Endovasc Surg. 41(6):837-48, 2011
Popuri RK et al: The role of thrombolysis in the clinical management of deep vein thrombosis. Arterioscler Thromb Vasc Biol. 31(3):479-84, 2011
Sarlon G et al: Congenital anomalies of inferior vena cava in young patients with iliac deep venous thrombosis. Ann Vasc Surg. 25(2):265, 2011
Donati F et al: An uncommon clinical condition: chronic thrombosis of the inferior vena cava. A case report and review of literature. Monaldi Arch Chest Dis. 74(1):36-9, 2010
Golarz SR et al: Use of Wall stent to exclude a thrombosed inferior vena cava filter. Ann Vasc Surg. 24(5):690, 2010
Suwanabol PA et al: Syndromes associated with the deep veins: phlegmasia cerulea dolens, May-Thurner syndrome, and nutcracker syndrome. Perspect Vasc Surg Endovasc Ther. 22(4):223-30, 2010
Muranishi H et al: Thrombo-occlusion of inferior vena cava filter in a patient with polycythemia vera. J Cardiol. 54(2):307-10, 2009
Wicky ST: Acute deep vein thrombosis and thrombolysis. Tech Vasc Interv Radiol. 12(2):148-53, 2009
Protack CD et al: Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement. J Vasc Surg. 45(5):992-7; discussion 997, 2007
Forauer AR et al: Intravascular ultrasound in the diagnosis and treatment of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 13(5):523-7, 2002
Left iliac vein compressed obliquely & anteriorly by right iliac artery
Right iliac artery compresses vein against spine
Occurs near iliac venous confluence into IVC
Produces endoluminal fibrous venous scar
Well seen by intravascular US (IVUS)
Termed venous "spur" by surgeons & pathologists
Phlegmasia alba dolens: Massive venous thrombosis-associated lower extremity swelling without cyanosis
Phlegmasia cerulea dolens: Massive venous thrombosis-associated lower extremity swelling with limb-threatening cyanosis of lower extremity
Proximal/distal thrombus: Society for Vascular Surgery (SVS) recommends use of precise anatomic terminology (e.g., iliofemoral, femoropopliteal, calf) instead of describing thrombus as proximal/distal
Report with/without extension into IVC
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
Society Guidelines
PROCEDURE
Procedure-Specific Goals
Patient Position/Location
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Problems
Complications
Expected Outcomes
Selected References
Kutsenko O et al: Iliac vein stenosis: is the data strong enough for stenting in the young pelvic venous disorders (PeVD) population? Tech Vasc Interv Radiol. 24(1):100733, 2021
Robertson B et al: Technical success and short-term results from mechanical thrombectomy for lower extremity iliofemoral deep vein thrombosis using a computer aided mechanical aspiration thrombectomy device. J Vasc Surg Venous Lymphat Disord. ePub, 2021
Shah NG et al: Management of inferior vena cava thrombosis with the FlowTriever and ClotTriever systems. J Vasc Surg Venous Lymphat Disord. 9(3):615-20, 2021
Stevens SM et al: Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 160(6):e545-608, 2021
Vedantham S et al: Clinical outcomes of a pharmacomechanical catheter-directed venous thrombolysis strategy that included rheolytic thrombectomy in a multicenter randomized trial. J Vasc Interv Radiol. 32(9):1296-1309.e7, 2021
Benarroch-Gampel J et al: Technical success and short-term outcomes after treatment of lower extremity deep vein thrombosis with the ClotTriever system: a preliminary experience. J Vasc Surg Venous Lymphat Disord. 8(2):174-81, 2020
Kahn SR et al: Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 8(1):8-23.e18, 2020
Masuda E et al: The 2020 appropriate use criteria for chronic lower extremity venous disease of the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, and the Society of Interventional Radiology. J Vasc Surg Venous Lymphat Disord. 8(4):505-525.e4, 2020
Expert Panel on Interventional Radiology: ACR Appropriateness Criteria® radiologic management of venous thromboembolism-inferior vena cava filters. J Am Coll Radiol. 16(5S):S214-26, 2019
Magnuson EA et al: Cost-effectiveness of pharmacomechanical catheter-directed thrombolysis versus standard anticoagulation in patients with proximal deep vein thrombosis: results from the ATTRACT trial. Circ Cardiovasc Qual Outcomes. 12(10):e005659, 2019
Chick JFB et al: Endovascular iliocaval reconstruction for chronic iliocaval thrombosis: the data, where we are, and how it is done. Tech Vasc Interv Radiol. 21(2):92-104, 2018
Shamimi-Noori SM et al: Venous stents: current status and future directions. Tech Vasc Interv Radiol. 21(2):113-6, 2018
Tritschler T et al: Venous thromboembolism: advances in diagnosis and treatment. JAMA. 320(15):1583-94, 2018
Mousa AY et al: Catheter-directed thrombolysis versus full anticoagulation alone in treating proximal iliofemoral deep venous thrombosis. Vascular. 25(1):111-2, 2017
Kearon C et al: Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 149(2):315-52, 2016
Birn J et al: May-Thurner syndrome and other obstructive iliac vein lesions: meaning, myth, and mystery. Vasc Med. 20(1):74-83, 2015
Comerota AJ: Catheter-directed thrombolysis for iliofemoral deep vein thrombosis: helpful or hurtful? Expert Rev Hematol. 8(2):131-3, 2015
Du GC et al: Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis. Vasa. 44(3):195-202, 2015
Kahn SR et al: Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet. 383(9920):880-8, 2014
Enden T et al: Health-related quality of life after catheter-directed thrombolysis for deep vein thrombosis: secondary outcomes of the randomised, non-blinded, parallel-group CaVenT study. BMJ Open. 3(8):e002984, 2013
Vedantham S et al: Rationale and design of the ATTRACT study: a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis. Am Heart J. 165(4):523-530.e3, 2013
Enden T et al: Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet. 379(9810):31-8, 2012
Kearon C et al: Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 141(2 Suppl):e419S-94S, 2012
Meissner MH et al: Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 55(5):1449-62, 2012
Broholm R et al: Acute iliofemoral venous thrombosis in patients with atresia of the inferior vena cava can be treated successfully with catheter-directed thrombolysis. J Vasc Interv Radiol. 22(6):801-5, 2011
Chinsakchai K et al: Trends in management of phlegmasia cerulea dolens. Vasc Endovascular Surg. 45(1):5-14, 2011
Jaff MR et al: Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 123(16):1788-830, 2011
Karthikesalingam A et al: A systematic review of percutaneous mechanical thrombectomy in the treatment of deep venous thrombosis. Eur J Vasc Endovasc Surg. 41(4):554-65, 2011
Khan IR et al: Simultaneous arterial and venous ultrasound-assisted thrombolysis for phlegmasia cerulea dolens. Ann Vasc Surg. 25(5):696, 2011
Maleti O et al: Reconstructive surgery for deep vein reflux in the lower limbs: techniques, results and indications. Eur J Vasc Endovasc Surg. 41(6):837-48, 2011
Popuri RK et al: The role of thrombolysis in the clinical management of deep vein thrombosis. Arterioscler Thromb Vasc Biol. 31(3):479-84, 2011
Sarlon G et al: Congenital anomalies of inferior vena cava in young patients with iliac deep venous thrombosis. Ann Vasc Surg. 25(2):265, 2011
Donati F et al: An uncommon clinical condition: chronic thrombosis of the inferior vena cava. A case report and review of literature. Monaldi Arch Chest Dis. 74(1):36-9, 2010
Golarz SR et al: Use of Wall stent to exclude a thrombosed inferior vena cava filter. Ann Vasc Surg. 24(5):690, 2010
Suwanabol PA et al: Syndromes associated with the deep veins: phlegmasia cerulea dolens, May-Thurner syndrome, and nutcracker syndrome. Perspect Vasc Surg Endovasc Ther. 22(4):223-30, 2010
Muranishi H et al: Thrombo-occlusion of inferior vena cava filter in a patient with polycythemia vera. J Cardiol. 54(2):307-10, 2009
Wicky ST: Acute deep vein thrombosis and thrombolysis. Tech Vasc Interv Radiol. 12(2):148-53, 2009
Protack CD et al: Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement. J Vasc Surg. 45(5):992-7; discussion 997, 2007
Forauer AR et al: Intravascular ultrasound in the diagnosis and treatment of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 13(5):523-7, 2002
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