Final Round — Maria Rios acknowledgement + Tangdu inquiry (临床数据版)

Sent: 2026-07-07

📧 邮件 1/2 — 给 Maria 的跟进邮件

To: riosale625@gmail.com From: 434338480@qq.com Subject: Re: Nutcracker + May Thurner — your detailed clinical answers, next steps

Hi Maria,

Thank you so much for this incredibly detailed clinical summary — it is exactly what the team at Tangdu needs to do a meaningful remote review. Reading through it, your case is very well-documented:

• Anterior Nutcracker Syndrome (left renal vein compressed, aortomesenteric angle 21°, distance 4.3mm, pressure gradient 6–8 mmHg)
• Concurrent May Thurner Syndrome (left common iliac vein abrupt caliber change 1.2mm → 6mm)
• Pelvic congestion syndrome with varicose gonadals
• 4.5-year symptom history; renouncement of work and studies; significant weight loss (60 kg → 43.5 kg at 1.56 m)

Two small confirmations first:

1. Nationality / location for the medical visa — you noted you are a Colombian citizen with residence in the Netherlands, contact phone +31 615580429. We will use this on the visa invitation letter when the time comes. Please tell us if any detail is wrong.

2. Airport pickup clarification — to be transparent: airport pickup (the leg from Xi'an Xianyang International Airport to your hotel/hospital) is not included in the arrangement we are offering you free of charge. You would arrange that yourself; we will gladly suggest reliable options once we have your travel dates. Everything else under the Pre-Arrival Coordination umbrella stays fully covered.

Next steps

We have already prepared a formal inquiry to the International Medical Services team (涉外医疗科) at Tangdu Hospital and we will send it today, including your summary findings and a request for remote imaging review. We expect an initial response from them within 2–3 business days.

If the team confirms your case as a candidate for both procedures, we will then come back to you with:

• A clear written treatment plan (Nutcracker + May Thurner, in the same admission if feasible)
• An itemized cost estimate (surgery + hospital stay + pre-op workup)
• The earliest available admission window
• The visa invitation letter process and timeline

We will keep you in copy on every step so you can see the conversation in real time.

On case sharing — a small request in return

Since you have kindly agreed to document your experience in exchange for our coordination support, we would warmly invite you to keep a small running note over the coming weeks of:

• day-to-day symptom patterns (what makes things better or worse)
• conversations you have with doctors in Spain or the Netherlands as you continue evaluating options
• feelings and concerns going into the trip
• during treatment: how each step feels, what surprises you, what is hard, what goes better than expected
• recovery: small wins and small setbacks

A mix of written notes, photos, and short videos (as you mentioned earlier) would be wonderful. No deadline, no script, no pressure — just honest, in-the-moment material captured whenever something strikes you. We will always send anything you produce to you for approval before it is published, and you can decline any portion you are not comfortable sharing.

Your story, especially for combined Nutcracker + May Thurner in a young patient — is genuinely rare and will help a lot of people searching for answers at 2am the way you did.

We will be back to you within 2–3 business days.

Warm regards,

Weiye China Hospitals Guide https://chinahospitalsguide.com Email: 434338480@qq.com WhatsApp / WeChat: +86 157 6310 7083

📧 邮件 2/2 — 给唐都涉外医疗科

TO: tangdu_foreign@fmmu.edu.cn CC: riosale625@gmail.com (Maria 让她看到) From: 434338480@qq.com Subject: International Inquiry – Nutcracker + May Thurner, Remote Review Request (Colombia / Netherlands patient)

Dear International Medical Services Team (涉外医疗科),

My name is Weiye from China Hospitals Guide (https://chinahospitalsguide.com), an international patient-coordination service based in China. I am writing on behalf of one of our patients, Ms. Maria Rios, who is hoping to be considered by your urology / vascular surgery team for evaluation and treatment of combined Nutcracker Syndrome (left renal vein entrapment) and May Thurner Syndrome (left common iliac vein compression) — preferably in the same hospital admission.

The 3D-printed PEEK extravascular stent approach your team pioneered (He et al., Frontiers in Bioengineering and Biotechnology, 2020) is the specific procedure Ms. Rios is asking us to inquire about.

Patient profile

• Name: Maria Rios
• Nationality: Colombian citizen; resident in the Netherlands
• Contact (in NL): +31 615580429
• Age / build: adult female, 1.56 m, currently 43.5 kg (down from ~60 kg in 2024) — significant unexplained weight loss
• Symptom history: 4.5 years (since early 2022); unable to work or study since 2023; very poor quality of life on current regimens

Confirmed findings (Colombia / Netherlands workup)

Imaging already performed:

• CT scan (aortomesenteric anatomy)
• Phlebography with pressure-gradient measurements (renal hilum vs IVC)
• Recent eco-Doppler (re-confirmed NCS, identified May Thurner)

Anterior Nutcracker Syndrome:

• Left renal vein compressed
• Aortomesenteric distance: 4.3 mm
• Aortomesenteric angle: 21°
• Pelvic varicose veins / varicose gonadals
• Phlebography pressure gradient: renal hilum 4/5/6 mmHg vs IVC 11/12/12 mmHg → gradient 6–8 mmHg
• Renal hilum congestion; left kidney congested
• Symptoms: left flank pain, severe pelvic pain and heaviness, dyspareunia, back pain, urinary difficulty/pain, foamy urine, pinkish-orange urine, severe headaches, neck pain, dizziness

May Thurner Syndrome:

• Confirmed on recent eco-Doppler
• Abrupt caliber change at left common iliac vein from 1.2 mm to 6 mm
• CT also shows iliac vein anatomy
• Symptoms: severe pelvic pain and heaviness, dyspareunia, significant pain and heaviness in legs and buttocks, cold lower legs and feet with blue toes, feet turning very red and swollen after standing / sitting / exercise
• (No known DVT)

Concurrent:

• Pelvic congestion syndrome
• Undiagnosed gastrointestinal symptoms (nausea, regurgitation, reflux, upper abdominal pain, early satiety, distention, suspected gastroparesis) — not part of the surgical request but worth noting for the team's awareness

Previous treatments tried (Spain; failed): pelvic physiotherapy, pain medication, antibiotics, corticosteroid injections, diet changes, reflux medication. A hospital in the Netherlands offered open left renal vein transposition (sternum-to-pelvis incision), which the patient declined due to its invasiveness and risk profile.

Why she is reaching Tangdu specifically: Ms. Rios identified the 3D-printed PEEK extravascular stent approach via the He et al. 2020 paper and would like to be evaluated for candidacy for this procedure. She is open to May Thurner treatment at the same hospital but has not been offered a specific May Thurner procedure yet — guidance from your team on the recommended approach for her iliac vein component would be very welcome.

What we are requesting

1. Confirmation that the vascular surgery / urology team is willing to review her case (Nutcracker + May Thurner, international patient, English-language imaging available, CT venography with venous phase planned to be sent via your preferred secure transfer)
2. A preliminary remote candidacy opinion based on the imaging and clinical summary, before she commits to traveling to Xi'an
3. Indicative itemized cost estimate covering:
   • Pre-op workup (labs, repeat imaging if needed)
   • The 3D-printed PEEK extravascular stent procedure for Nutcracker Syndrome
   • May Thurner treatment (procedure to be proposed by your team)
   • Hospital stay
4. Earliest available admission window after she is confirmed as a candidate
5. The standard process and timeline for issuing the medical visa (M visa) invitation letter

What we will provide from our side

• Full clinical summary (attached)
• All radiology reports (Spanish + English PDFs)
• DICOM images (CT venography with venous phase) — ready to upload to Tangdu's preferred secure transfer channel upon your indication. A temporary sharing link is available here for your convenience: https://sinosend.com/w/YVdGqQo — if this link is restricted on your network, please advise on your standard encrypted upload portal and we will re-upload immediately.
• A single point of contact on our end (Weiye, the author of this email) who handles all back-and-forth communication and logistics, so your team only deals with clinical and administrative matters

Our service relationship with Ms. Rios is a formal case-coordination arrangement in exchange for her later consent to share her case (de-identified) for educational purposes. We function as her advocate and coordinator, not as a referral broker.

Could you please confirm receipt of this email and let us know what the next step looks like on your end? We are aiming for an initial remote-review response within 2–3 business days so we can share a concrete plan with Ms. Rios.

If a more appropriate department, coordinator, or email address should be used for international inquiries of this kind, please let us know and we will redirect immediately.

Thank you very much for your time and for the pioneering work your team has done on the 3D-printed PEEK extravascular stent — a single paper brought an international patient all the way to your inbox.

Best regards,

Weiye China Hospitals Guide https://chinahospitalsguide.com Email: 434338480@qq.com WhatsApp / WeChat: +86 157 6310 7083

Attachments (will be sent upon confirmation that the email reached your International Medical Services team):

1. Maria_Rios_Clinical_Summary.pdf — patient-authored clinical summary (symptoms, findings, treatment history)
2. Radiology reports (Spanish + English translations) — CT, phlebography, eco-Doppler
3. DICOM images — CT venography with venous phase (to be uploaded via Tangdu's secure channel upon your indication; temporary share at https://sinosend.com/w/YVdGqQo )