Yamanaka Tetsuo, Ishihara Tatsuhiko, Hara Toru, Ichinohe Yoshimaro, Fukatsu Toru
Department of Cardiology, Tokyo Teishin Hospital, 2-14-23 Fujimi, Chiyoda-ku, Tokyo 102-8798, Japan.
Department of Cardiology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, 6-25-1 Kamiyouga, Setagaya-ku, Tokyo 158-8531, Japan.
Eur Heart J Case Rep. 2024 Jan 9;8(1):ytae011. doi: 10.1093/ehjcr/ytae011. eCollection 2024 Jan.
In its normal anatomical relationship, the inferior vena cava is located on the right side of the abdominal aorta. Iliac vein compression syndrome (IVCS) is a pathological condition in which a blood clot is formed due to blood flow obstruction when the left common iliac vein is compressed between the right common iliac artery and the vertebral body. Therefore, right-sided IVCS (RIVCS) is rare. The effectiveness of treatment for RIVCS has not been sufficiently investigated.
A 51-year-old man developed deep vein thrombosis in the right lower extremity and non-massive pulmonary embolism during steroid treatment for IgA nephropathy. Magnetic resonance angiography (MRA) suggested iliac compression syndrome. Symptoms improved with the use of direct oral anticoagulants and compression stockings. At the 8-month follow-up, the clinical course was uneventful.
The causes of RIVCS in this case are believed to be the effects of steroids, prolonged sitting, and compression of the right external iliac vein. However, considering that deep vein thrombosis did not form in the left lower limb where there was no venous compression, it can be considered that the compression of the right external iliac vein had a significant impact. This case has been followed up for 8 months with anticoagulants and is progressing well. This is the first case to report the course of RIVCS treated conservatively with anticoagulant therapy for 8 months. This case suggested that conservative treatment is effective for RIVCS.
在正常解剖关系中，下腔静脉位于腹主动脉右侧。髂静脉压迫综合征（IVCS）是一种病理状态，即左髂总静脉在右髂总动脉和椎体之间受压时，因血流受阻而形成血栓。因此，右侧髂静脉压迫综合征（RIVCS）较为罕见。RIVCS的治疗效果尚未得到充分研究。
一名51岁男性在接受IgA肾病类固醇治疗期间，右下肢出现深静脉血栓形成和非大面积肺栓塞。磁共振血管造影（MRA）提示髂静脉压迫综合征。使用直接口服抗凝剂和弹力袜后症状改善。在8个月的随访中，临床过程平稳。
该病例中RIVCS的病因被认为是类固醇的作用、长时间坐位以及右髂外静脉受压。然而，考虑到在无静脉受压的左下肢未形成深静脉血栓，可认为右髂外静脉受压有显著影响。该病例使用抗凝剂随访8个月，进展良好。这是首例报道采用抗凝治疗保守治疗RIVCS 8个月病程的病例。该病例提示保守治疗对RIVCS有效。
