Left Leg DVT Secondary to IVCS

30-year-old female, on oral contraceptives, with severe left leg swelling after a long car ride. Ultrasound showed left iliofemoral deep venous thrombosis (DVT). The patient was started on anticoagulation. 5 days later, the patient still had severe swelling and pain. Pharmacomechanical thrombolysis using TPA and the Angiojet was performed with removal of the bulk of…

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Post Thrombotic IVCS in a Triathlete

36-year-old female with a left lower extremity iliofemoral deep venous thrombosis (DVT) and pulmonary embolism (PE) 9 years prior. Increasing problems with left leg venous claudication with exercise. Symptoms limiting the patient’s ability to be active. MR venography showed occlusion of the left iliac venous system typical of May Thurner syndrome or iliac vein compression syndrome…

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Ulceration due to External Iliac Vein Compression

A 65-year-old male presented with a right lower extremity venous ulcer. During workup, the patient was found to have extensive incompetence of the superficial and deep venous systems. This prompted evaluation for venous outflow obstruction. CT Venography showed compression of the proximal right external iliac vein at the right common iliac artery bifurcation between the external…

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Recurrent Leg DVT

72-year-old male patient with 3 left lower extremity DVTs. The patient was developing severe post-thrombotic syndrome (PTS). The patient was positive for Lupus anticoagulant was being treated with oral anticoagulation. Apart from a lower extremity venous ultrasound, no investigation of the pelvic venous system was done. Imaging of the venous outflow in the abdomen and pelvis…

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Chronic Pelvic and Low Back Pain

A 51-year-old female with chronic pelvic complaints undiagnosed for many years. She was referred after her doctor saw a presentation I gave about pelvic venous disease in females. Workup of her pelvic pain using trans-vaginal and trans-abdominal ultrasound demonstrated an incompetent left internal iliac vein. CT venography was obtained, confirming severe compression of the left…

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30 Years of Pelvic Pain

62-year-old female correctly diagnosed over 15 years ago with pelvic congestion syndrome (PCS). The patient was offered a hysterectomy which is not the first line of treatment for this condition. She declined. The patient was identified by her chiropractor as have PCS and was referred for treatment. In this patient, the primary cause of PCS…

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Prostate Cancer with Left Leg Swelling

65-year-old male, T3a prostate cancer. Prior robotic lymph node dissection for staging. Post-operative lymphocele developed along the left external iliac vein. Percutaneous drainage decompressed the fluid collection and improved the leg swelling. Collection re-occurred, and the leg swelling worsened with severe pain. Venography and intravascular ultrasound (IVUS) showed severe narrowing of the external iliac vein…

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Chronic Iliofemoral DVT in a Young Male

22 year old with severe post thrombotic syndrome 6 months after left leg deep venous thrombosis (DVT). Initial attempt at catheter directed thrombolysis without iliac vein stenting resulted in re-thrombosis. The patient had severe restriction in activity due to venous claudication and he wanted to see if anything could be done. He underwent stenting and…

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