Dataset Information

External iliac vein compression secondary to osteolysis-induced hematoma in total hip arthroplasty.

ABSTRACT: A 62-year-old man with a history of right total hip arthroplasty, who was managed conservatively for moderate osteolysis, presented with acute-onset, painless, significant, and diffuse right lower extremity edema. Initial laboratory markers were negative for infection. Advanced imaging demonstrated a complex extrapelvic fluid mass along the psoas sheath causing compression of the external iliac vein. Intraoperatively, significant hematoma was removed from the iliopsoas sheath, followed by metal head and liner exchange as well as bone grafting of the osteolytic defects adjacent to the hip implant. Postoperative imaging showed adequate decompression, no deep vein thrombosis, and a patent external iliac vein. At 2 weeks, postoperative swelling completely resolved. At 3 months, the patient recovered to normal baseline level and underwent contralateral total hip arthroplasty for symptomatic osteoarthritis.

SUBMITTER: Shieh AK

PROVIDER: S-EPMC6728436 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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External iliac vein compression secondary to osteolysis-induced hematoma in total hip arthroplasty.

Shieh Alvin K AK Lum Zachary C ZC Singh Avreeta K AK Pereira Gavin C GC

Arthroplasty today 20190619 3

A 62-year-old man with a history of right total hip arthroplasty, who was managed conservatively for moderate osteolysis, presented with acute-onset, painless, significant, and diffuse right lower extremity edema. Initial laboratory markers were negative for infection. Advanced imaging demonstrated a complex extrapelvic fluid mass along the psoas sheath causing compression of the external iliac vein. Intraoperatively, significant hematoma was removed from the iliopsoas sheath, followed by metal ...[more]

PMID: 31516965

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Project description:BackgroundIliac vein compression syndrome (IVCS) is an underlying cause of varicose vein (VV) recurrence after venous surgery. However, the management of recurrent varicose veins (RVVs) combined with IVCS has rarely been reported. This study aimed to investigate the outcomes of a one-stop procedure to correct outflow obstruction and superficial reflux for patients with RVVs and IVCS.MethodsA retrospective analysis was conducted of 102 consecutive patients diagnosed with RVVs. Computed tomography venography (CTV) was performed to confirm IVCS. The cases were divided into 2 groups: the IRVVs group, including patients with RVVs and IVCS (n=48), and the RVVs group, including patients with RVVs only (n=54). The characteristics, vein reflux, and clinical, etiological, anatomical, and pathophysiological (CEAP) distribution were investigated. Then, the IRVVs group patients who underwent endovenous laser ablation (EVLA) (n=39) were divided into a further 2 groups: the EVLA + S group (n=19), who received EVLA and stenting of iliac vein, and the EVLA group (n=20), who received EVLA treatment alone. The great/small saphenous vein (GSV/SSV) trunk occlusion, VV recurrence, visual analogue scale (VAS), and venous clinical severity score (VCSS) were investigated.ResultsThe prevalence rate of femoral vein reflux was 81.2% in IRVVs group and 50% in RVVs group (P<0.05). In the IRVVs group, 72.9% of patients manifested as CEAP clinical class >3, which was higher than that in RVVs group (48.1%) (P<0.05). The 12-month GSV/SSV occlusion rate in the EVLA + S and EVLA groups were 94.7% and 90.0%, respectively. Totals of 9 patients in EVLA + S group and 6 patients in EVLA group had active venous ulcers, and the ulcer healing time in EVLA + S group was significantly shorter (27.22±7.12 vs. 46.67±9.83 days, P<0.05). The reductions in the VAS and VCSS values between baseline, 1 month, and 12 months in the EVLA + S group were more obvious than those in EVLA group (P<0.05).ConclusionsThe one-stop combination treatment of iliac venous stenting and EVLA in patients with RVVs and IVCS is safe and effective and provides prominent symptom relief, improved quality of life, and a more satisfactory ulcer healing than EVLA alone.

Dataset Information

External iliac vein compression secondary to osteolysis-induced hematoma in total hip arthroplasty.

Publications

External iliac vein compression secondary to osteolysis-induced hematoma in total hip arthroplasty.

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