CT Findings of Completely Regressed Hepatocellular Carcinoma with Main Portal Vein Tumor Thrombosis after Transcatheter Arterial Chemoembolization

윤정희,김효철,정진욱,윤정환,제환준,박재형 대한영상의학회 2010 Korean Journal of Radiology Vol.11 No.1

Objective: The objective of this study was to determine the sequential CT findings of controlled hepatocellular carcinoma (HCC) with main portal vein (MPV) thrombosis with the use of transcatheter arterial chemoembolization and additional intra-arterial cisplatin infusion. Materials and Methods: From January 2004 to September 2006, 138 patients with HCC invading MPV were referred to the angiography unit of our institution for chemoembolization and additional intra-arterial cisplatin infusion. Until August 2008, seven (5%) of 138 patients were followed-up and found not to have tumor recurrence. CT scans were retrospectively reviewed by two radiologists, focusing on the following parameters: the extent of portal vein thrombosis, the diameter of the affected portal vein, and enhancement of portal vein thrombosis. Results: The extent of portal vein thrombosis at the initial presentation was variable: left portal vein (LPV) and MPV (n = 1), right portal vein (RPV) and MPV (n = 3), as well as RPV, LPV and MPV (n = 3). The extent and diameter of the affected portal vein decreased during follow-up examinations. In addition, the degree of enhancement for tumor thrombi and serum alpha-feto-protein levels decreased after the transcatheter arterial chemoembolization. Portal vein thrombosis was found to be completely resolved in one patient, whereas residual thrombus without viability was persistent in six patients. Conclusion: If chemoembolization is effective in patients with HCC that invades the portal vein, the extent and enhancement of portal vein thrombosis is reduced, but residual thrombosis frequently persists for months or years, without evidence of a viable tumor. Objective: The objective of this study was to determine the sequential CT findings of controlled hepatocellular carcinoma (HCC) with main portal vein (MPV) thrombosis with the use of transcatheter arterial chemoembolization and additional intra-arterial cisplatin infusion. Materials and Methods: From January 2004 to September 2006, 138 patients with HCC invading MPV were referred to the angiography unit of our institution for chemoembolization and additional intra-arterial cisplatin infusion. Until August 2008, seven (5%) of 138 patients were followed-up and found not to have tumor recurrence. CT scans were retrospectively reviewed by two radiologists, focusing on the following parameters: the extent of portal vein thrombosis, the diameter of the affected portal vein, and enhancement of portal vein thrombosis. Results: The extent of portal vein thrombosis at the initial presentation was variable: left portal vein (LPV) and MPV (n = 1), right portal vein (RPV) and MPV (n = 3), as well as RPV, LPV and MPV (n = 3). The extent and diameter of the affected portal vein decreased during follow-up examinations. In addition, the degree of enhancement for tumor thrombi and serum alpha-feto-protein levels decreased after the transcatheter arterial chemoembolization. Portal vein thrombosis was found to be completely resolved in one patient, whereas residual thrombus without viability was persistent in six patients. Conclusion: If chemoembolization is effective in patients with HCC that invades the portal vein, the extent and enhancement of portal vein thrombosis is reduced, but residual thrombosis frequently persists for months or years, without evidence of a viable tumor.

Endovascular Treatment for Iliac Vein Compression Syndrome: a Comparison between the Presence and Absence of Secondary Thrombosis

Wen-Sheng Lou,Jian-Ping Gu,Xu He,Liang Chen,Hao-Bo Su,Guo-Ping Chen,Jing-Hua Song,Tao Wang 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.2

Objective: To evaluate the value of early identification and endovascular treatment of iliac vein compression syndrome (IVCS), with or without deep vein thrombosis (DVT). Materials and Methods: Three groups of patients, IVCS without DVT (group 1, n = 39), IVCS with fresh thrombosis (group 2, n = 52) and IVCS with non-fresh thrombosis (group 3, n = 34) were detected by Doppler ultrasonography, magnetic resonance venography, computed tomography or venography. The fresh venous thrombosis were treated by aspiration and thrombectomy, whereas the iliac vein compression per se were treated with a self-expandable stent. In cases with fresh thrombus, the inferior vena cava filter was inserted before the thrombosis suction, mechanical thrombus ablation, percutaneous transluminal angioplasty, stenting or transcatheter thrombolysis. Results: Stenting was performed in 111 patients (38 of 39 group 1 patients and 73 of 86 group 2 or 3 patients). The stenting was tried in one of group 1 and in three of group 2 or 3 patients only to fail. The initial patency rates were 95% (group 1), 89% (group 2) and 65% (group 3), respectively and were significantly different (p = 0.001). Further, the six month patency rates were 93% (group 1), 83% (group 2) and 50% (group 3), respectively, and were similarly significantly different (p = 0.001). Both the initial and six month patency rates in the IVCS patients (without thrombosis or with fresh thrombosis), were significantly greater than the patency rates of IVCS patients with non-fresh thrombosis. Conclusion: From the cases examined, the study suggests that endovascular treatment of IVCS, with or without thrombosis, is effective. Objective: To evaluate the value of early identification and endovascular treatment of iliac vein compression syndrome (IVCS), with or without deep vein thrombosis (DVT). Materials and Methods: Three groups of patients, IVCS without DVT (group 1, n = 39), IVCS with fresh thrombosis (group 2, n = 52) and IVCS with non-fresh thrombosis (group 3, n = 34) were detected by Doppler ultrasonography, magnetic resonance venography, computed tomography or venography. The fresh venous thrombosis were treated by aspiration and thrombectomy, whereas the iliac vein compression per se were treated with a self-expandable stent. In cases with fresh thrombus, the inferior vena cava filter was inserted before the thrombosis suction, mechanical thrombus ablation, percutaneous transluminal angioplasty, stenting or transcatheter thrombolysis. Results: Stenting was performed in 111 patients (38 of 39 group 1 patients and 73 of 86 group 2 or 3 patients). The stenting was tried in one of group 1 and in three of group 2 or 3 patients only to fail. The initial patency rates were 95% (group 1), 89% (group 2) and 65% (group 3), respectively and were significantly different (p = 0.001). Further, the six month patency rates were 93% (group 1), 83% (group 2) and 50% (group 3), respectively, and were similarly significantly different (p = 0.001). Both the initial and six month patency rates in the IVCS patients (without thrombosis or with fresh thrombosis), were significantly greater than the patency rates of IVCS patients with non-fresh thrombosis. Conclusion: From the cases examined, the study suggests that endovascular treatment of IVCS, with or without thrombosis, is effective.

간세포암에 동반된 문맥혈전의 임상상

김상희 ( Sang Hee Kim ),김미성 ( Mi Sung Kim ),안현택 ( Hyun Taek Ahn ) 대한내과학회 2006 대한내과학회지 Vol.71 No.1

Background: Hepatocellular carcinoma is frequently accompanied by portal vein thrombosis. In the setting of cirrhosis, refractory ascites, variceal bleeding and hepatic encephalopathy leads to dramatic course. Portal vein thrombosis is a negative prognostic factor for therapy. We conducted this retrospective study to evaluate the relationship between hepatocellular carcinoma and portal vein thrombosis. We also studied the predictable factor of portal vein thrombosis by biochemical tests. Methods: A total of 153 hepatocellular carcinoma were examined. We investigated the relationship between hepatocelluar carcinoma and the presence of portal vein thrombosis by CT scan. Correlations between the existence of portal vein thrombosis and the result of biochemical tests were examined. Results: Portal vein thrombosis was found 60 patients (39%). The presence of portal vein thrombosis was not associated with size or number of tumor. Significant differences were seen in total bilirubin, AST, alkaline phosphatase, prothrombin time and AFP. Conclusions: Our result suggest that hepatocellular carcinoma can accompany portal vein thrombosis in spite of small size and uninodule. So we should be alert to find portal vein thrombosis in early stage of tumor. In such an event, it would be beneficial to additional information concerning the probability of portal vein thrombosis from elevated total bilirubin, AST and alkaline phosphatase.(Korean J Med 71:52-57, 2006)

A 10-Year Single-Center Experience of Catheter-Related Thrombosis in Neonates

( Ji Hye Shin ),( Mi Hyeon Gang ),( Yong Wook Lee ),( Hong-ryang Kil ),( Mea-young Chang ) 대한주산의학회 2021 Perinatology Vol.32 No.3

Objective: Central catheterization is one of the major iatrogenic risk factors of neonatal thrombosis. We conducted this study to investigate the clinical features of neonatal catheter-related thrombosis. Methods: This is a single-center retrospective study which reviewed medical records of neonates who were admitted to our neonatal intensive care unit (NICU) from May 2010 to April 2020. Results: Among the 4,978 neonates hospitalized in our NICU, 2,773 neonates were inserted central catheter. Thirteen neonates (0.47%) were diagnosed with catheter-related thrombosis. Median gestational age was 29 weeks 5 days and median birth weight was 1,080 g. The incidence of thrombosis with each catheter was 0.64% for infants with umbilical artery catheter, 1.35% with umbilical venous catheter, 0.28% with peripherally inserted central catheter and 0.38% with subclavian venous catheter. The type of thrombus was 69.2% as venous and 15.4% as intracardiac and arterial, respectively. The symptoms that led to the diagnosis of thrombosis were color changes, swelling in the insertion site and cardiac murmur. Doppler ultrasound and echocardiography were performed for diagnosis. Their postnatal age at diagnosis was 22±12 days and the mean duration of catheterization was 10±4 days. Seven neonates (53.8%) were treated with low molecular weight heparin. Eight neonates (61.5%) demonstrated resolution of thrombosis. Mean time for resolution was 198±212 days. There was one mortality (7.7%) from pulmonary thromboembolism related to the superior vena cava thrombosis. Conclusion: In newborns, the risk of thrombosis is high and careful monitoring is required. Antithrombotic treatment should be considered in newborn with clinically significant thrombosis and follow- up observation is also required.

LETTER TO THE EDITOR : Unexpected development of acute abdominal aortic thrombosis during percutaneous coronary intervention

( Sang Jin Ha ),( Joo Hyeong Oh ),( Soo Joong Kim ) 대한내과학회 2014 The Korean Journal of Internal Medicine Vol.29 No.5

Acute aortic occlusion by a thrombus is an uncommon vascular emergency during percutaneous coronary intervention (PCI), which may lead to shock and death. We report on a patient who experienced acute thrombosis at the aortoiliac bifurcation and was treated by aspirating a thrombus and implanting a stent in the aorta. An 82-year-old female with a history of hypertension, diabetes, atrial fibrillation, and cerebral infarction was referred to the Cardiology Department due to chest discomfort and elevated cardiac biomarkers (creatinine kinase/ creatinine kinase-MB, 33/7.0 IU/L; troponin I, 0.18 ng/mL) before a colorectal f istula operation. Coronary angiography was performed under the impression of a non-ST elevation myocardial infarction, which clearly showed a high-grade stenosis in the mid-portion of the left anterior descending (LAD) artery with minimal luminal area < 2 mm2 on the intravascular ultrasound evaluation (Fig. 1). Unfractionated heparin (70 units/ kg) was administered initially. Then, activated clotting time was monitored and maintained at 200 to 300 seconds by an additional injection of heparin during PCI. When a guiding catheter (JL 7 Fr) was engaged into the LAD artery, central blood pressure decreased and unusual f lat pattern pressure curves appeared, together with dizziness (Fig. 2A). We retracted the guiding catheter and performed aortography through the contralateral femoral artery. No aortic dissection was detected in the ascending or descending aorta. However, aortography showed a huge, lumen-occluding thrombi at the level of aortoiliac bifurcation (Fig. 2B). We initially infused 200,000 U tissue plasminogen activator into the aortic bifurcation through the guiding catheter and manually aspirated using a 9-Fr long sheath, but huge thrombi remained in the aortoiliac bifurcation, and an angiogram showed no pathological evidence of abdominal aorta bifurcation such as severe occlusive disease, aortic dissection, or abdominal aortic aneurysm (Fig. 2C). The aspirated material was a 6-cm black-colored thrombus (Fig. 2D). We inserted a stent in the aorta and two self-expandable aortic stents (10 mm × 6 cm at the left side and 10 mm × 8 cm at the right side (Zilver, Cook Medical, Bloomington, IN, USA) were implanted at the aortoiliac bifurcation. After deployment of the stents, additional ballooning (8 mm × 4 cm, Rider, Cook Medical) was performed. A final angiogram showed a good result (Fig. 3). The patient recovered well after stent implantation, with blood pressure of 110/70 mmHg. She underwent PCI successfully at the mid-LAD artery and was discharged uneventfully 7 days later. Acute thrombotic occlusion of the aorta during PCI is a rare event, resulting in disastrous consequences unless an early diagnosis is made and appropriate management initiated [1]. The cause of an occlusion is a saddle embolus at the aortoiliac bifurcation or acute in situ thrombosis on a background of severe occlusive disease, aortic dissection, acute thrombosis of an abdominal aortic aneurysm, vasculitis, hypercoagulability, or aortic trauma [2]. Other uncommon causes include a fungal infection, acute thrombosis of abdominal aortic stent-graft in heparin-induced thrombocytopenia, or chemotherapy-related thrombosis [3-5]. Compared with other causes of acute aortic occlusion, acute thrombosis at the aortoiliac bifurcation during PCI is extremely rare. As a prerequisite check before guiding catheter engagement, we assessed the activated partial thromboplastin time and flushed the femoral sheath with saline, but no abnormal findings were detected. In this case, no abnormal findings in the aorta were observed, including aneurysm, dissection, or trauma. We also examined protein C and S activity, erythrocyte sedimentation rate, C-reactive protein, complement 3 and 4, and antineutrophil cytoplasmic antibody to evaluate hypercoagulability and vasculitis, but no abnormal results were found. No fungal infection was identified. Atrial fibrillation was another possible contributor to embolic occlusion but there was no thrombus in the left atrial appendage or left ventricle on echocardiography. Therefore, we finally suspected a saddle embolus originating from the femoral sheath and an in situ thrombosis at the aortoiliac bifurcation as a possible cause of this PCI-related aortic complication. Anticoagulation should be initiated immediately once the diagnosis of acute thrombotic occlusion in aorta is made, and early revascularization should be the goal. Possible revascularization approaches include thromboembolectomy, aortic reconstruction, anatomic or extra-anatomic bypass, and thrombolysis. The choice of approach depends on the etiology, anatomy, and patient factors. Surgical thrombectomy has frequently been used for treatment of an acute aortic occlusion. However, recent advances in endovascular techniques could decrease the high mortality rate associated with surgical treatment of this disease and warrants consideration as a treatment option. In this case, we decided on endovascular treatment for revascularization with thrombolysis, thrombus aspiration, and stent implantation using a contralateral approach. In conclusion, acute thrombosis can occur at the aortoiliac bifurcation during PCI. Therefore, operators should pay attention to the development of aortic complications upon encountering an abnormal central blood pressure pattern and consider an appropriate treatment method.including an endovascular approach.for acute aortic thrombosis.

심부정맥혈전증의 병인 분석

이제환 ( Lee Je Hwan ),박선양 ( Park Seon Yang ),계경채 ( Gye Gyeong Chae ),정철원 ( Jeong Cheol Won ),신현춘 ( Sin Hyeon Chun ),이진학 ( Lee Jin Hag ),양성현 ( Yang Seong Hyeon ),김병국 ( Kim Byeong Gug ),김노경 ( Kim No Gyeon 대한내과학회 1993 대한내과학회지 Vol.44 No.3

Background : The formation of deep vein thrombosis reflects a balance between the effects of thrombogenic stimuli and a series of protective mechanisms. Substantial progress has been made in the last several decades in identifying hereditary and acquired risk factors predisposing to deep vein trombosis. Even so, a large number of patients still have no identifiable underlying cause for recurrent venous thrombosis. Elucidation of specific predisposing factor (s) is required for proper management of thrombosis. For the Korean patients, these factors have not been well characterized. Methods : We analyzed clinical profiles of the patients with venous thromboembolism and investigated the laboratory abnormalities known to be associated with increased risk of thrombosis. Results : 1) The male-female ratio was 1 : 1. 13 and age distribution showed 24.7% in fifth decade, 22.4% in sixth, 18.8% in fourth, 11.7% in third, 10.6% in seventh, 7.1% over 70 years old, and 4.7% under 20 years. 2) The thromboses were most commonly located in lower extremities (74.1%), and intraabdominal thromboses were 16 cases (18.8%), thromboses of upper extremities 4 cases (4.7%), superior vena cave thrombosis 1 case (1.2%) and pulmonary embolism without evidence of deep vein thrombosis 1 case (1.2%). Thirty-four percent of the cases were diagnosed as having pulmonary embolism. 3) The clinical risk factors for venous thromboembolism were old age(17.0%), malignancy (15.3%), prior history of venous thromboembolism (12.9%), postoperative state (10.6%), immobilization (8.2%), hyperlipidemia (5.9%), systemic lupus erythemato년 (4.7%), obesity (4.7%), stasis (4.7%), nephrotic syndrome (3.5%), diabetes mellitus (3.5%), Behcet`s disease (2.4%), estrogen (2.4%). Twenty-nine percent of the cases had no indentifiable clinical risk factors. 4) The laboratory abnormalities associated with venous thromboembolism were increase of anticardiolipin antibody (19.4%), decrese of protein C activity (16.7%), decrease of protein S (free form) antigenicity (10.7%), decrease of antithrombin Ⅲ activity (5.9%), decrease of tissue-type plasminogen activator (t-PA) (22.7%), increase of plasminogen activator inhibitor type 1 (PAI-1) (29.4%) and decrease of fibrinolytic activity (42.4%). Conclusion : Clinical and laboratory risk factors have been determined in 85 patients with deep vein thrombosis and/or pulmonary embolism in Korea. Major clinical risk factors for venous thromboembolism included old age, malignancy, prior history, postoperative state and immobilization. Among the laboratory abnormalities associated with venous thromboembolism, increase of PAI-1 and/of decrease of t-PA, and increase of anticardiolipin antibody were most frequently observed.

Impact of monthly arteriovenous fistula flow surveillance on hemodialysis access thrombosis and loss

Ara Ko,Miyeon Kim,Hwa Young Lee,Hyunwoo Kim 제주대학교 의과학연구소 2023 The Journal of Medicine and Life Science Vol.20 No.3

Arteriovenous fistula flow dysfunction is the leading cause of vascular access thrombosis and loss in patients undergoing hemodialysis. However, data regarding the influence of access flow rate measurements on the long-term outcomes of access are limited. This study aims to identify accesses at a high risk of thrombosis and loss among patients undergoing hemodialysis by measuring the access flow rate and exploring an optimal threshold value for predicting future access thrombosis. We enrolled 220 patients with arteriovenous fistula undergoing hemodialysis. The primary outcome was the occurrence of access thrombosis. Access flow rates were measured monthly using the ultrasound dilution method and were averaged using all measurements from patients with patent access. In patients experienced access thrombosis, those immediately before the thrombosis were selected. Using these data, we calculated the access flow rate threshold for thrombosis occurrence by analyzing the receiver operating characteristic curve, and the patients were divided into two groups according to whether access flow rates were higher or lower than 400 mL/min. During a median follow-up period of 3.1 years, 4,510 access flows were measured (median measurements per patient, 33 times; interquartile range, 11-54). A total of 65 access thromboses and 19 abandonments were observed. Access thrombosis and loss were higher in the lowflow group than in the high-flow group. This study revealed that low access flow rates are strongly associated with access thrombosis occurrence and subsequent loss of arteriovenous fistulas in patients undergoing hemodialysis.

Thrombolytic Therapy Using Urokinase for Management of Central Venous Catheter Thrombosis

손정탁,민선영,김재일,최평화,허태길,이명수,김철남,김홍용,이성윤,이혜란,노영남 대한혈관외과학회 2014 Vascular Specialist International Vol.30 No.4

Purpose: The management of central venous catheters (CVCs) and catheter throm-bosis vary among centers, and the efficacy of the methods of management of catheter thrombosis in CVCs is rarely reported. We investigated the efficacy of bedside thrombolysis with urokinase for the management of catheter thrombosis.Materials and Methods: We retrospectively reviewed data from patients who had undergone CVC insertion by a single surgeon in a single center between April 2012 and June 2014. We used a protocol for the management of CVCs and when catheter thrombosis was confirmed, 5,000 U urokinase was infused into the catheter.Results: A total of 137 CVCs were inserted in 126 patients. The most common catheter-related complication was thrombosis (12, 8.8%) followed by infection (8, 5.8%). Nine of the 12 patients (75%) with catheter thrombosis were recanalized successfully with urokinase. The rate of CVC recanalization was higher in the peripherally inserted central catheter (PICC) group (87.5%) than the chemoport group (50%). Reintervention for catheter-related thrombosis was needed in only 2.2% of patients when thrombolytic therapy using urokinase was applied. Age <60 years (P=0.035), PICC group (P=0.037) and location of the catheter tip above the superior vena cava (P=0.044) were confirmed as independent risk factors for catheter thrombosis.Conclusion: Thrombolysis therapy using urokinase could successfully manage CVC thrombosis. Reintervention was rarely needed when a protocol using urokinase was applied for the management of CVC thromboses.

Free flap thrombosis in patients with hypercoagulability: A systematic review

Biben, Johannes Albert,Atmodiwirjo, Parintosa Korean Society of Plastic and Reconstructive Surge 2019 Archives of Plastic Surgery Vol.46 No.6

Background Even with satisfactory anastomosis technique and adequate experience of the surgeon, flap loss due to thrombosis can still occur due to the patient's underlying condition. Patients with hypercoagulability due to etiologies such as malignancy, hereditary conditions, and acquired thrombophilia are among those who could benefit from free flap procedures. This review aimed to evaluate the risk of free flap thrombosis in patients with hypercoagulability and to identify the most effective thromboprophylaxis regimen. Methods This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The PubMed, Embase, and Cochrane Library databases were explored. Types of free flaps, types of hypercoagulable states, thrombosis prevention protocols, thrombosis complication rates, and flap vitality outcomes were reviewed. Samples from the included studies were pooled to calculate the relative risk of free flap thrombosis complications in patients with hypercoagulability compared to those without hypercoagulability. Results In total, 885 articles underwent title, abstract, and full-text screening. Six articles met the inclusion criteria. The etiologies of hypercoagulability varied. The overall incidence of thrombosis and flap loss in hypercoagulable patients was 13% and 10.3%, respectively. The thrombosis risk was two times higher in hypercoagulable patients (P=0.074) than in controls. Thromboprophylaxis regimens were variable. Heparin was the most commonly used regimen. Conclusions Hypercoagulability did not significantly increase the risk of free flap thrombosis. The most effective thromboprophylaxis regimen could not be determined due to variation in the regimens. Further well-designed studies should be conducted to confirm this finding.

May-Thurner 증후군과 동반된 하지 심부정맥혈전환자에서 혈전제거술과 스텐트삽입술

전용선,조정수,윤용한,백완기,김광호,김정택,김영삼 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.6

배경: May-Thurner 증후군은 좌측장골정맥이 우측장골동맥에 의해 눌리어 정맥 환류장해에 의해 혈전증을 일으키는 것을 말한다. 저자들은 심부 정맥혈전중의 치료를 위해 시행한 혈전 제거-용해술 및 스탠트 삽입술의 결과를 분석하고자 한다. 대상 및 방법: May-Thurner 증후군과 동반된 하지 심부정맥혈전증으로 진단받고 좌측 장골정맥에 스탠트를 삽입한 34명(평균연령 64.6±13.7세, 여자 25 (74%)명)을 대상으로 하였다. 시술은 흡인성 혈전제거와 혈전용해 후 분지성 협착이 있는 곳에 Wall stent를 삽입하고 풍선 확장을 하였다. Multi side hole 카테타를 혈전이 있는 부위에 위치시키고 Urokinase를 시간당 8만에서 12만 International Unit을 1일 또는 2일 동안 주입하였다. 시술 중 폐동맥혈전색전증을 방지 하기 위하여 대부분 환자에서 시술 전 일시적 하대정맥 여과기(IVC Filter)를 삽입하였다. 퇴원 후 3개월간 경구용 와파린을 투여 하였으며 퇴원 전과 퇴원 후 6개월에 Multi Detector Computerized Tomography (MDCT) 혈관촬영을 이용하여 혈전의 유무를 판단하였다. 결과: 시술 48시간 이내 부종과 동통이 완전하게 소실된 환자가 2 (6%)명이었으며 증상의 완화가 있는 환자가 28 (82%)명, 증상의 호전이 없는 환자가 4 (12%)명이었다. 퇴원 시 MDCT혈관촬영에서 9 (26%)명에서 혈전없음, 21 (62%)명에서 부분 혈전, 그리고 4명(12%)에서 폐쇄소견을 보였다. 퇴원 6개월 후에 2명을 제외한 32명이 추적 MDCT혈관촬영을 하였는데 23 (72%)명에서 혈전없음을 9 (26%)명에서는 부분혈전이 관찰 되었다. 평균 5.6개월 관찰기간 동안 2 (6%)명에서 심부정맥혈전이 재발되어 재입원하였으며 하지 부종과 통증을 동반한 혈전 후 증후군은 9예(26%)에서 발생하였다. 결론: May-Thurner 증후군과 동반된 하지 심부정맥혈전환자에서 심부정맥혈전의 제거와 혈전용해술과 함께 시술된 스탠트 삽입은 효과적인 치료 방법으로 생각된다. Background: Compression of the left common iliac vein by the overriding common iliac artery is frequently combined with acute deep vein thrombosis in patients with May-Thurner Syndrome. We evaluate the results of treatment with thrombolysis and thrombectomy followed by stenting in 34 patients with May-Thurner Syndrome combined with lower extremity deep venous thrombosis. Material and Method: The authors retrospectively reviewed the records of 34 patients (mean age: 65±14 year old) who had undergone stent insertion for acute deep vein thrombosis that was caused by May-Thurner syndrome. After thrombectomy and thrombolysis, insertion of a wall stent and balloon angioplasty were performed to relieve the compression of the left common iliac vein. Urokinase at a rate of 80,000 to 120,000 U/hour was infused into the thrombosed vein via a multi-side hole thrombolysis catheter. A retrieval inferior vena cava (IVC) filter was placed to protect against pulmonary embolism in 30 patients (88%). Oral anticoagulation with warfarin was maintained for 3 months, and follow-up Multi Detector Computerized Tomography (MDCT) angiography was done at the date of the patients’ hospital discharge and at the 6 months follow-up. Result: The symptoms of deep venous thrombosis disappeared in two patients (4%), and there was clinical improvement within 48 hours in twenty eight patients (82%), but there was no improvement in four patients (8%). The MDCT angiography at discharge showed no thrombus in 9 patients (26%) and partial thrombus in 21 (62%), whereas the follow-up MDCT at 6.4±5.5 months (32 patients) revealed no thrombus in 23 patients (72%), and partial thrombus in 9 patients (26%). Two patients (6%) had recurrence of DVT, so they underwent retreatment. Conclusion: Stent insertion with catheter-directed thrombolysis and thrombectomy is an effective treatment for May-Thurner syndrome combined with acute deep vein thrombosis in the lower extremity.