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Affect Of Iliac Venous Compression In The Setting Of Scoliosis
Nisarg Patel, Kathryn Byerly, Adam Tanious, MD, MBA, MMSc.
MUSC, Charleston, SC, USA.
OBJECTIVES: May-Thurner Syndrome (MTS) refers to compression of one of the common iliac veins by the respective or contralateral common iliac artery (CIA). This leads to altered blood flow and potential complications such as leg swelling and potentially deep vein thrombosis. Scoliosis refers to abnormal, sideways curvature of the spine. Despite the anatomy of the spine being crucial to development of MTS, no studies have considered incidence and diagnosis of MTS in scoliosis patients.
METHODS: A total of 272 charts from patients with scoliosis were reviewed for clinical leg swelling diagnosis (as a non-invasive indicator of MTS), degree of scoliosis, and the shortest artery to spine distance (A-S). For the A-S distance, computed tomography (CT) or magnetic resonance imaging (MRI) was used to measure the distance from the right and left common iliac arteries (RCIA & LCIA respectively) and lumbar vertebra along the track of the bilateral common iliac veins. The mean A-S distance was then compared in patients with leg swelling vs no leg swelling in the total cohort, patients in which the RCIA affected compression, and patients in which the LCIA affected compression. Lastly, the degree of scoliosis was correlated to the A-S distance.
RESULTS: Of the 272 individuals, 190 were over 18 years old and had imaging for computing A-S distance. 62 had reported swelling with a mean A-S distance of 6.519 mm and the other 128 had no swelling and a mean A-S distance of 7.259. Analysis revealed significant difference (p = 0.0246) between these groups as well as swelling vs no swelling in patients where the LCIA affected compression most (p = 0.0128). Interestingly, there was no significant difference of the A-S distance in swelling vs no swelling in patients where the RCIA affected compression most (p = 0.6446). Analysis found no significance between degree of scoliosis and A-S distance (p = 0.2799).
CONCLUSIONS: Patients with scoliosis and clinical signs of swelling are likely to have reduced A-S distance resulting in compression from the CIA. Significant differences in the A-S distance between swelling vs no swelling in LCIA-affected patients but not RCIA-affected patients demonstrates the altered spine anatomy changes how we should consider the anatomy of and pathophysiology of May Thurner syndrome in scoliosis patients.
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