Author + information
- Received November 12, 2015
- Accepted November 19, 2015
- Published online March 14, 2016.
- Paul L. Hermany, MDa,
- Apurva O. Badheka, MBBSb,
- Carlos I. Mena-Hurtado, MDa and
- Robert R. Attaran, MBBSa,∗ ()
- aDepartment of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
- bThe Everett Clinic, Everett, Washington
- ↵∗Reprint requests and correspondence:
Dr. Robert R. Attaran, Department of Cardiovascular Medicine, Yale University School of Medicine, 15 York Street, P.O. Box 208017, New Haven, Connecticut, 06520-8017.
A 75 year-old woman with peripheral artery disease presented with left leg discomfort and edema shortly after undergoing bilateral common iliac artery stenting. Examination revealed palpable pedal pulses, small varicose veins, and peripheral edema most notably in the left leg. A venous duplex ultrasound ruled out lower extremity deep vein thrombosis.
The patient underwent invasive aorto-iliac angiography and bilateral iliac venography (Figures 1 and 2). Iliac artery stents were patent. Intravascular ultrasound (Volcano, San Diego, California) revealed extrinsic compression of the proximal left common iliac vein (Figures 3, 4, and 5). A 14 × 60 mm Wallstent (Boston Scientific, Marlborough, Massachusetts) was deployed within the vein at the level of compression (Figure 6). Repeat intravascular ultrasound demonstrated improved luminal gain. At 2-week and 6-month follow-up visits, she reported complete resolution of her presenting symptoms and significant improvement in her lower extremity edema.
Iliac vein compression as a consequence of arterial intervention is a rare and likely under-reported entity (1,2). These images demonstrate venous outflow obstruction due to extrinsic compression from previous arterial stenting, which responded dramatically to subsequent venous stenting.
Dr. Mena has a consulting relationship with and has received honoraria from Medtronic, Bard, and Cook Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 12, 2015.
- Accepted November 19, 2015.
- American College of Cardiology Foundation
- Pandit A.S.,
- Hayes M.,
- Guiney-Borgelt A.,
- et al.
- Rosen E.,
- Groben L.,
- George J.