J Korean Med Sci.  2022 Jun;37(24):e194. 10.3346/jkms.2022.37.e194.

Case 1: A 44-Year-Old Woman Presented With Unexplained Painful Left Leg Swelling

• Lee M
• Sa YK
• Park MW

• KMID: 2530506
• DOI: http://doi.org/10.3346/jkms.2022.37.e194

Figure

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  Fig. 1 Photograph of the patient’s lower extremity (prone position). Despite anticoagulation therapy, the patient’s left whole lower extremity shows diffuse swelling with mild erythema.

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  Fig. 2 Initial CT of lower extremity. CT scan shows that the left iliac vein is externally compressed (arrow) between the right common iliac artery and spinal body (A), resulting in complete occlusion of the left iliac vein (B) with extensive thrombus (arrows) involving the left iliac vein (B), left femoral vein (C), and left popliteal vein (D). The patient’s left lower extremity exhibits marked swelling.(B, C, D) Arrows indicate thrombus in the left iliac, left femoral, and left popliteal vein, respectively.CT = computed tomography.

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  Fig. 3 Venography shows (A) the multiple large thrombi and complete occlusion of the left iliac and common femoral vein with extensive venous collaterals. (B) After advancing a guidewire into the inferior vena cava, balloon angioplasty showed a “waist” in the balloon (arrow) at the site of left common iliac vein compression by the right common iliac artery and spinal body. (C) Following balloon angioplasty, stents were implanted from the left common iliac vein to the femoral vein. Because post-stent venography revealed significant residual thrombi in the stent lumen, catheter-directed thrombolysis with alteplase (arrow) was performed. (D) The following day, venography shows well-positioned, patent stents and restored flow from the femoral vein to the inferior vena cava.

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  Fig. 4 The follow-up CT of the lower extremity at 6-months after endovascular intervention. CT shows complete resolution of thrombus in the entire left lower extremity and well-positioned vein stents (arrows in A, B, and C) without stenosis.CT = computed tomography.

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