Treatment modalities include use of anticoagulant, catheter directed thrombolysis, stent placement, placement of filters, surgical approaches including vein patch angioplasty with excision of intraluminal bands, division of the right common iliac artery and relocation behind the left common iliac vein
or inferior vena cava and saphenous vein graft bypass to the inferior vena cava or ipsilateral common femoral vein.2 Reestablishment of vessel patency by removing the thrombus, relieving the acute symptoms in order to prevent recurrent thrombosis and pulmonary embolism and to reserve venous valve function, thus preventing post-thrombotic syndrome is the main purpose of treatment for postpartum DVT.
The median sacral artery and left common iliac vein
are just superior to the promontorium and the internal iliac artery with the ureter are in close connection at the lateral part.
Caption: Figure 1: Magnetic resonance venogram of the pelvis showing compression of the left common iliac vein
(arrow) just after its origin suggestive of May-Thurner syndrome.
Occlusion of left common iliac vein
by a distended urinary bladder in a male with paraplegia due to spinal cord injury.
Computed tomography venogram image (coronal view) indicating the position of a long-term femoral haemodialysis catheter relative to the common iliac vein
In this case, we initially intended to treat the patient via surgical resection; however, we abandoned the total resection because the tumor was found to be ill-defined and adherent to the sacrum and common iliac vein
during the intraoperative examination.
(c) R-CIV: right common iliac vein
; L-CIV: left common iliac vein
; RL10: trajectory 10[degrees] lateral to the insertion point; RL-10: trajectory 10[degrees] medial to the insertion point on the right side.
Retroperitoneal exploration revealed a 13mm laceration on the posterior aspect of the left common iliac vein
, a 10mm laceration on the postero-medial aspect of the right common iliac artery.
Veress needle and primary trocar entry require critical attention to the angle and direction of the thrust relative to the abdominal cavity, with a midline entry angle of 45[degrees] to 60[degrees] recommended to avoid the aorta and left common iliac vein
Congenital atresia of the inferior vena cava, common iliac veins
, and left innominate vein.
In 11 (19.6%) cases the floating thrombus localized in the iliac vein (more frequently in the common iliac vein
Extreme care should be exercised during the procedure to avoid any damage to the underlying common iliac vein
or the ureter.