ENDOVASCULAR TREATMENT FOR POSTTHROMBOTIC SYNDROME DUE TO UTERINE FIBROIDS
Keywords:Uterine fibroids, Deep venous thrombosis, Post-thrombotic syndrome, Endovascular, Ilio-caval stenting
Uterine fibroids are the most common solid pelvic tumors in women, frequently causing hypomenorrhea.
They normally do not carry an increased risk for deep venous thrombosis (DVT) unless they reach a considerable size conditioning inferior vena cava and pelvic veins compression.
Postthrombotic iliac vein obstructive lesions resulting from a prior episode of DVT may lead to clinical signs and
symptoms of chronic vein disease.
There is no role for prophylactic treatment of silent lesions. However, if patients develop advanced symptoms (CEAP C3-C6 classification) despite best medical treatment, patients are candidates for endovascular correction with stenting. Endovenous correction of ilio-caval pathology is associated with high technical success rate and reduced complications, around 0.4%.
The authors describe a clinical case of a 47 years-old female patient that developed post-thrombotic syndrome due to a DVT, caused by compression from a large uterine fibroid, treated with endovascular surgery.
Jacques Donnez, et al, Uterine fibroid management: from the present to the future, Hum Reprod Update. 20016 Nov; 22(6): 665-686;
Faria J, Godinho C, Rodrigues M. Miomas uterinos: revisao da literatura. Acta Obstet Ginecol Port2008;2(3):131-142.
Wallach E E, Vlahos N F. Uterine myomas: an overview of development, clinical features and management. Obstet Gynecol 2004; 104(2): 393 – 406
Chong , Y.S., et al, Deep vein thrombosis in patients with large uterine myomata, Obstet. Gynecol., 9, 707;
Dekel,A., et aal, Thrombosis of the pelvic veins associated with a large myomatous uterus. Obstet. Gynecolo., 92, 646-647;
Tanaka, H., et al, Venous thromboembolic diseases associated with uterine myomas diagnosed before hysterectomy. A report
of two cases, J. Obstet. Gynaecol. Res., 28, 300-303;
Pedro Tiago Silva et al, Consenso Nacional sobre Miomas uterinos – tratamento médico 2017
Hans van Overhagen and Jim A. Reekers; Uterina artery embolization for symptomatic leiomyomata, Cardiovascuar and Interventional radiology 38, 536-542 (2015)
Pascarella L, Schonbein GW, Bergan JJ. Microcirculation and venous ulcers: a review. Ann Vasc Surg. 2005;19(6):921–927
Hartung O, Loundou AD, Barthelemy P, Arnoux D, Boufi M, Alimi YS. Endovascular management of chronic disabling ilio-caval obstructive lesions: long-term results. Eur J Vasc Endo- vasc Surg 2009;38:118e24
Kristijonas Milinis et al; Antithrombotic Therapy following venous stenting: International Delphi Consensus
Xicheng Zhang et al, Long-term follow up of the stenting across the iliocaval confluence in patients with iliac venous lesions
Guillen K et al, Endovascular stenting for chronic femoro-iliac venous obstructive disease: clinical efficacy and short-term
Alhalbouni S, Hingorani A, Shiferson A, Gopal K, Jung D, Novak D, et al. Iliac-femoral venous stenting for lower ex- tremity venous stasis symptoms. Ann Vasc Surg 2012;26: 185e9
Neglen P, Berry MA, Raju S. Endovascular surgery in the treatment of chronic primary and post-thrombotic iliac vein
obstruction. Eur J Vasc Endovasc Surg 2000;20:560e71
Anton N. Sidawy, et al, Rutherford's Vascular surgery and endovascular therapy 9th edition