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Imaging Signs of May-Thurner Syndrome in Asymptomatic Patients: Computed Tomography Angiography Analysis of Kidney Donors1

  • Daniel F. Lopes
    Correspondence
    Correspondence: Daniel F. Lopes, MD, Department of Vascular Surgery, Central Institute, Hospital das Clínicas da Universidade de São Paulo, 7th Floor, Av Dr Enéas de Carvalho Aguiar, Instituto Central, 255, São Paulo, SP 05402-000, Brazil Tel.: +55 11 2661-6487 Fax: +55 11 2661-6487 Home Phone number: +55 11 9747-0706
    Affiliations
    Department of Vascular and Endovascular Surgery, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
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  • Antonio E. Zerati
    Affiliations
    Department of Vascular and Endovascular Surgery, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
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  • Nelson De Luccia
    Affiliations
    Department of Vascular and Endovascular Surgery, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
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  • William C. Nahas
    Affiliations
    Department of Urology and Renal Transplant, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
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  • Pedro Puech-Leão
    Affiliations
    Department of Vascular and Endovascular Surgery, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
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Published:August 01, 2022DOI:https://doi.org/10.1016/j.avsg.2022.07.003

      Highlights

      • -
        We evaluated the distance between the right common iliac artery and lumbar vertebra
      • -
        Distances were greater in men
      • -
        There was a statistically significant relationship with age
      • -
        Linear regression model showed a strong correlation between LVBIAD and LCIVD

      Abstract

      Objective

      The current study aimed to evaluate the distance between the right common iliac artery (RCIA) and lumbar vertebra in asymptomatic patients in order to determine whether such distance was statistically correlated with the left common iliac vein (LCIV) diameter (LCIVD) and to investigate if both measures were related to demographic characteristics and anthropometric data, such as sex, age, height, and body mass index (BMI).

      Methods

      In this descriptive and uncontrolled anatomic study, data from high-definition computed tomography (CT) angiography images of living kidney donors without a medical history of chronic venous insufficiency or past deep vein thrombosis (DVT) were analyzed. The RCIA crossed over the LCIV in 311 individuals, who were then included in this study. CT scans were reviewed to measure (1) the narrowest space between the RCIA and fifth lumbar vertebral body and (2) the LCIVD. Measures were subjected to normality tests and were divided according to the sex of the study population. Correlations of measures with age, BMI, and height were calculated.

      Results

      Of the 311 patients analyzed, 66.6% (n = 207) were female. The mean lumbar vertebral body–iliac artery distance (LVBIAD) was 7.2 mm, whereas the mean LCIVD was 8.5 mm; both were higher in men (P < .001). The statistical analysis of LVBIAD and LCIVD distributions revealed no normality pattern (P < .05). The analysis of the correlation between them showed a weak statistically significant relationship with age. A linear regression model considering the normality percentile interval indicated a strong positive correlation between LVBIAD and LCIVD (R2 = .884).

      Conclusions

      The LVBIAD was <5 mm and <3 mm in 25% and 5% of asymptomatic individuals, respectively. The LCIVD correlated with the space between the RCIA and lumbar vertebra. The distance between the RCIA and lumbar vertebra and the LCIVD were higher in male subjects and older patients, but did not correlate with BMI and height.

      Keywords

      Abbreviations:

      BMI (body mass index), CIV (common iliac vein), CT (computed tomography), DVT (deep vein thrombosis), IVC (inferior vena cava), IVUS (intravascular ultrasound), LCIA (left common iliac artery), LCIV (left common iliac vein), LCIVD (left common iliac vein diameter), LVBIAD (lumbar vertebral body–iliac artery distance), MRI (magnetic resonance imaging), RCIA (right common iliac artery), RCIV (right common iliac vein)
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