Introduction: There is currently no consistent classification of the extent of left common iliac vein compression syndromes such that clinicians working in the area have a common terminology. Hypothesis: To create a c...Introduction: There is currently no consistent classification of the extent of left common iliac vein compression syndromes such that clinicians working in the area have a common terminology. Hypothesis: To create a classification of left common iliac vein compression based on the end point of triplanar pelvic phlebogrpahy. Methods: Based on 61 consecutive patients found to have left common iliac vein compression on triplanar phlebography in the course of treatment of venous disease, clinical presentation and symptomatology were retrospectively used to create a classification of left common iliac vein compression. Treatment of left common iliac vein compression was also retrospectively correlated with staging. Results: The following classification was arrived at: Stage 0, no compression and no intraluminal fibrous bands;Stage 1, evidence of compression by surrounding anatomical structures with or without the presence of fibrous bands;Stage 2: evidence of compression with or without fibrous bands as evidenced by cross-pelvic collaterals;Stage 3: compression of the left common iliac vein. Fibrous bands replaced by localised occlusion, with collateralisation and no involvement of adjacent venous segments;Stage 4a: as for Stage 3 but with the addition of thrombotic involvement of adjacent venous segments;Stage 4b: as for Stage 4a but with involvement of distal venous segments, femoral and popliteal. Stages 3, 4a or 4b correlated well with clinical presentations of DVT, PE, venous ulceration, vulval or cross-pelvic collaterals, ipsilateral limb swelling and claudication. The presence of varicose veins or recurrent varicose veins was a common finding amongst all groups. Conclusion: Acceptance of this classification system would provide a common terminology to allow more transparent assessment of modalities of treatment for this condition.展开更多
BACKGROUND Oblique lumbar interbody fusion is a mini-open retroperitoneal approach that uses a wide corridor between the left psoas muscle and the aorta above L5.This approach avoids the limitations of lateral lumbar ...BACKGROUND Oblique lumbar interbody fusion is a mini-open retroperitoneal approach that uses a wide corridor between the left psoas muscle and the aorta above L5.This approach avoids the limitations of lateral lumbar interbody fusion,is considered less invasive than anterior lumbar interbody fusion,and is similarly effective for indirect decompression and improving lordosis while maintaining a low complication profile.Including L5-S1,when required,adds to these advantages,as this allows single-position surgery.However,variations in vascular anatomy can affect the ease of access to the L5-S1 disc.The nuances of three different oblique anterolateral techniques to access L5-S1 for interbody fusion,namely,left-sided intra-bifurcation,left-sided pre-psoas,and right-sided pre-psoas approaches,are illustrated using three representative case studies.CASE SUMMARY Cases of three patients who underwent multilevel oblique lumbar interbody fusion including L5-S1,using one of the three different techniques,are described.All patients presented with symptomatic degenerative lumbar pathology and failed conservative management prior to surgery.The anatomical considerations that affected the decisions to utilize each approach are discussed.The pros and cons of each approach are also discussed.A parasagittal facet line objectively assesses the relationship between the left common iliac vein and the L5-S1 disc and assists in choosing the approach to L5-S1.CONCLUSION Oblique retroperitoneal access to L5-S1 in the lateral decubitus position is possible through three different approaches.The choice of approach to L5-S1 may be individualized based on a patient’s vascular anatomy using preoperative imaging.While most surgeons will rely on their experience and comfort level in choosing the approach,this article elucidates the nuances of each technique.展开更多
文摘Introduction: There is currently no consistent classification of the extent of left common iliac vein compression syndromes such that clinicians working in the area have a common terminology. Hypothesis: To create a classification of left common iliac vein compression based on the end point of triplanar pelvic phlebogrpahy. Methods: Based on 61 consecutive patients found to have left common iliac vein compression on triplanar phlebography in the course of treatment of venous disease, clinical presentation and symptomatology were retrospectively used to create a classification of left common iliac vein compression. Treatment of left common iliac vein compression was also retrospectively correlated with staging. Results: The following classification was arrived at: Stage 0, no compression and no intraluminal fibrous bands;Stage 1, evidence of compression by surrounding anatomical structures with or without the presence of fibrous bands;Stage 2: evidence of compression with or without fibrous bands as evidenced by cross-pelvic collaterals;Stage 3: compression of the left common iliac vein. Fibrous bands replaced by localised occlusion, with collateralisation and no involvement of adjacent venous segments;Stage 4a: as for Stage 3 but with the addition of thrombotic involvement of adjacent venous segments;Stage 4b: as for Stage 4a but with involvement of distal venous segments, femoral and popliteal. Stages 3, 4a or 4b correlated well with clinical presentations of DVT, PE, venous ulceration, vulval or cross-pelvic collaterals, ipsilateral limb swelling and claudication. The presence of varicose veins or recurrent varicose veins was a common finding amongst all groups. Conclusion: Acceptance of this classification system would provide a common terminology to allow more transparent assessment of modalities of treatment for this condition.
文摘BACKGROUND Oblique lumbar interbody fusion is a mini-open retroperitoneal approach that uses a wide corridor between the left psoas muscle and the aorta above L5.This approach avoids the limitations of lateral lumbar interbody fusion,is considered less invasive than anterior lumbar interbody fusion,and is similarly effective for indirect decompression and improving lordosis while maintaining a low complication profile.Including L5-S1,when required,adds to these advantages,as this allows single-position surgery.However,variations in vascular anatomy can affect the ease of access to the L5-S1 disc.The nuances of three different oblique anterolateral techniques to access L5-S1 for interbody fusion,namely,left-sided intra-bifurcation,left-sided pre-psoas,and right-sided pre-psoas approaches,are illustrated using three representative case studies.CASE SUMMARY Cases of three patients who underwent multilevel oblique lumbar interbody fusion including L5-S1,using one of the three different techniques,are described.All patients presented with symptomatic degenerative lumbar pathology and failed conservative management prior to surgery.The anatomical considerations that affected the decisions to utilize each approach are discussed.The pros and cons of each approach are also discussed.A parasagittal facet line objectively assesses the relationship between the left common iliac vein and the L5-S1 disc and assists in choosing the approach to L5-S1.CONCLUSION Oblique retroperitoneal access to L5-S1 in the lateral decubitus position is possible through three different approaches.The choice of approach to L5-S1 may be individualized based on a patient’s vascular anatomy using preoperative imaging.While most surgeons will rely on their experience and comfort level in choosing the approach,this article elucidates the nuances of each technique.
