Compression of the left common iliac vein by the right common iliac artery is a frequent cause of left-sided deep venous thrombosis, and would lead to poor subsequent recanalization. However, this finding has been difficult to confirm. In this study, we investigated the impact of iliac vein compression on subsequent recanalization by using ultrasonography, computed tomography (CT), and magnetic resonance venography. Twenty-nine patients with left iliac vein thrombosis were studied. The diameter of the left common iliac vein at the site of maximal compression was measured by CT in each patient, and the reduction in diameter of 50% or more was defined as having compression. At the follow-up examination, the individual venous segment was classified into three levels according to the degree of recanalization: totally occluded, partially occluded, and totally recanalized. Twenty-one of 29 patients were judged to have compression. The incidence of iliac compression was significantly higher in women than in men (16/18 vs 5/11). At 1-year follow-up, recanalization of iliac segment in patients with compression was significantly poorer than that without compression. Iliac compression is strongly associated with persistent occlusion of iliac segment.
Peri-graft seromas are complications that occur in loop e-PTFE arterio-venous graft. They are often difficult to treat and recurrence is common. Herein we describe a case of recurrent peri-graft seromas, and investigate the relationship between seroma and blood flow of graft. Seroma with venous hypertension occurred in several weeks after arterio-venous graft placement in the lower arm. The graft blood flow was 1500 ml–1700 ml/min. We performed several managements for the seroma, but finally withdrew the graft because of graft infection. After the control of infection, we created arterio-venous graft in the upper arm. But in several months seroma occurred on the artery side of the graft. In this time the graft flow was decrease from 2150 ml/min to 1290 ml/min. We replaced the artery side e-PTFE graft to polyurethane graft. Then no recurrence was noted after a 6-month follow-up period.
The patient is a 72-year-old man. He showed critical limb ischemia with severe aortic valve stenosis. Although he required the surgical operation for this valvular disease, he could not have an operation because of the risk of infection to the prosthetic aortic valve. In this case, endovascular therapy for critical limb ischemia was preferentially performed and it was considered to have contributed to the prognosis directly.