Shima Yuki, Shimada Takenobu, Tanaka Hiroyuki, Kadota Kazushige
Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
SAGE Open Med Case Rep. 2020 Jul 2;8:2050313X20938222. doi: 10.1177/2050313X20938222. eCollection 2020.
An 82-year-old woman presented with persistent left leg swelling despite 3 months anticoagulation for deep vein thrombosis. Ultrasound showed venous blood flowing back into the toe. Enhanced computed tomography scans and angiography showed occlusion of the left common iliac vein and a large number of arteriovenous fistulas. We made a diagnosis of May-Thurner syndrome coexisting with arteriovenous fistulas and we performed endovascular therapy only for the common iliac vein. We considered embolization for arteriovenous fistulas, but it seemed to be difficult to perform because of the possibility of development of collateral circulation and a large number of arteriovenous fistulas. After percutaneous balloon angioplasty, antegrade venous blood flow was restored, and stent implantation was not performed. After the procedure, swelling of the leg gradually reduced. She had no symptoms for the following 1 year.
一名82岁女性，尽管已接受3个月的抗凝治疗以治疗深静脉血栓形成，但仍存在左腿持续肿胀。超声显示静脉血回流至脚趾。增强计算机断层扫描和血管造影显示左髂总静脉闭塞以及大量动静脉瘘。我们诊断为May-Thurner综合征合并动静脉瘘，仅对髂总静脉进行了血管内治疗。我们考虑对动静脉瘘进行栓塞，但由于可能形成侧支循环以及存在大量动静脉瘘，似乎难以实施。经皮球囊血管成形术后，顺行静脉血流得以恢复，未进行支架植入。术后，腿部肿胀逐渐减轻。在接下来的1年里她没有症状。
