PW054 Acquired Arteriovenous Fistula of the Right Common Iliac Artery and Left Common Iliac Vein and Bilateral Lower Extremity Deep Venous Thrombosis in a Woman Presenting as High Output Failure

The authors describe the abnormal confluence of the right internal iliac vein into a left common iliac vein compressed by the overlying right common iliac artery. The prevalence of this combination of abnormalities, evaluated in cadavers and in living subjects by CT, was 0.9%. The possible obstacle to venous pelvic return by these anomalies is pointed out.

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A rare case of May-Thurner-like syndrome in an elderly lady

Case Reports in Internal Medicine ◽

10.5430/crim.v1n2p19 ◽

2014 ◽

Vol 1 (2) ◽

pp. 19

Author(s):

Kapil Sahnan ◽

Chris Pui Yan Yee ◽

Robert Hywel Thomas ◽

Kaji Sritharan

Keyword(s):

Iliac Artery ◽

Common Iliac Artery ◽

Imaging Modality ◽

Lumbar Vertebrae ◽

Kidney Injury ◽

Iliac Vein ◽

Common Iliac Vein ◽

Left Common Iliac Vein ◽

Extrinsic Compression ◽

Duplex Imaging

An elderly lady presented with decreased mobility, sputum production and intermittent confusion. She was treated for chest sepsis, fast atrial fibrillation, and acute kidney injury, and also noted to have a swollen left leg. Venous duplex imaging showed extensive thrombus within the left common iliac, left external iliac and left common femoral veins. A CT Venogram showed compression of the left common iliac vein between an osteophyte at L5 and a calcified ipsilateral common iliac artery. It also showed a pelvic kidney with an extra renal pelvis and large renal cyst which was indirectly contributing to venous compression by splinting the left iliac artery. A decision was made after discussion at the Vascular MDT that the patient was not fit enough for surgery and to manage her medically with anticoagulation. Discussion: Proximal DVT’s are rarer than distal thrombosis, but have similar causes. One of the rarer causes of proximal DVT is May-Thurner syndrome and its variants known collectively as non-thrombotic iliac vein lesions. May-Thurner originally described DVT formation caused by extrinsic compression of the left common iliac vein between the overriding contralateral (right) common iliac artery and adjacent lumbar vertebrae. The best imaging modality is a CT Venogram. Duplex ultrasonography can be used, although it can be difficult to visualize the iliac veins. The mainstay of management is surgical thrombectomy, or thrombolysis, followed by stenting of the affected vessel. However, if intervention is not appropriate, then it can be managed medically with anticoagulation.

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Iliocaval Compression Syndrome

Phlebology The Journal of Venous Disease ◽

10.1177/026835558700200310 ◽

1987 ◽

Vol 2 (3) ◽

pp. 173-179 ◽

Cited By ~ 5

Author(s):

Syde A. Taheri ◽

Paul Nowakowski ◽

David Pendergast ◽

Julie Cullen ◽

Steve Pisano ◽

...

Keyword(s):

Iliac Artery ◽

Common Iliac Artery ◽

Vena Cava ◽

Signs And Symptoms ◽

Iliac Vein ◽

Venous Hypertension ◽

Common Iliac Vein ◽

Compression Syndrome ◽

Extrinsic Compression ◽

The Right

The iliocaval compression syndrome is a disorder, frequently found in young women, in which extrinsic compression of the left iliocaval junction produces signs and symptoms of lower extremity venous insufficiency. The anatomic variant which gives rise to this syndrome consists of compression of the left common iliac vein by the overlying right common iliac artery, near its junction with the vena cava. Additional reduction of outflow results from intraluminal venous webs and tight adhesions between the iliac artery and vein. Pain, swelling, pigmentation, and venous claudication characterize this syndrome, which affects predominantly the left leg. The syndrome may progress to iliofemoral thrombosis, phlegmasia cerulea dolens, and venous gangrene. Longstanding iliocaval stenosis may produce valvular incompetence. Exercise plethysmography is a non-invasive test useful in screening patients for iliocaval compression. The definitive diagnosis is made by venography, both ascending and descending, to determine the degree of outflow stenosis. Iliocaval patch angioplasty with retrocaval positioning of the right iliac artery, decreases venous hypertension and leads to improvement in the clinical condition. To date, we have performed iliocaval angioplasty, with retrocaval repositioning of the right common iliac artery, on 18 patients. Of these, 83% have had good results as determined by hemodynamic and clinical assessment.

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A RARE CASE OF MAY- THURNER SYNDROME

10.36106/gjra/8100743 ◽

2021 ◽

pp. 17-19

Author(s):

B. Santhi ◽

Manigandan Manigandan ◽

Nishok Nishok

Keyword(s):

Iliac Artery ◽

Lower Limb ◽

Rare Case ◽

Common Iliac Artery ◽

Iliac Vein ◽

Common Iliac Vein ◽

Middle Aged ◽

Unique Case ◽

Left Common Iliac Vein ◽

Left Lower Limb

May-Thurner syndrome (MTS) is a venous outow obstruction disorder characterized by compression of the left common iliac vein by an overriding right common iliac artery. MTS primarily affects young to middle-aged women, although many patients remain entirely asymptomatic.We report a unique case of a 25 -year-old male who presented with MTS-related multiple varicosities in left lower limb.

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Late-Onset Nonthrombotic Left Common Iliac Vein Compression Secondary to Degenerative Lumbar Disc: A Case Report of May-Thurner Variant

Vascular and Endovascular Surgery ◽

10.1177/1538574418791884 ◽

2018 ◽

Vol 53 (1) ◽

pp. 62-65 ◽

Cited By ~ 1

Author(s):

Salman Khalid ◽

Young Jin Youn ◽

Michael Azrin ◽

Juyong Lee

Keyword(s):

Iliac Artery ◽

Common Iliac Artery ◽

Late Onset ◽

Multimodality Imaging ◽

Lumbar Disc ◽

Lumbar Vertebrae ◽

Iliac Vein ◽

Common Iliac Vein ◽

Left Common Iliac Vein ◽

Extrinsic Compression

May-Thurner syndrome (MTS) refers to venous outflow obstruction caused by extrinsic compression of the left common iliac vein (LCIV) by the overlying pulsatile right common iliac artery against lumbar vertebrae. The classic clinical presentation is acute unilateral left leg painful swelling due to deep venous thrombosis in a young woman in the second or third decade of life. We present a case of a 66-year-old woman who presented with late-onset left leg swelling caused by nonthrombotic venous hypertension due to degenerative lumbar disc bulge leading to LCIV compression against the left common iliac artery which was confirmed by computed tomography and intravascular ultrasound. Our case highlights the importance of high index of suspicion for MTS in elderly patients with unilateral leg swelling and the importance of multimodality imaging for understanding the mechanism and appropriate treatment of MTS.

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Treatment of acquired arteriovenous fistula with severe hemodynamic effects: therapeutic challenge

Jornal Vascular Brasileiro ◽

10.1590/jvb.2014.007 ◽

2014 ◽

Vol 13 (1) ◽

pp. 34-38 ◽

Cited By ~ 1

Author(s):

Bruna Ferreira Pilan ◽

Andréia Marques de Oliveira ◽

Daniel Emílio Dalledone Siqueira ◽

Ana Terezinha Guillaumon

Keyword(s):

Arteriovenous Fistula ◽

Common Iliac Artery ◽

Severe Heart Failure ◽

Iliac Vein ◽

Common Iliac Vein ◽

First Choice ◽

Iatrogenic Vascular Injury ◽

The Common ◽

The Right ◽

High Output

A 34-year-old female patient with severe heart failure and pulmonary hypertension was diagnosed late with a high-output acquired arteriovenous fistula between the right common iliac vein and artery. The most probable cause was an iatrogenic vascular injury inflicted during a prior laparoscopic cholecystectomy. Treatment was conducted by placement of an endoprosthesis in the common iliac artery, achieving total exclusion of the fistula and complete remission of symptoms. Considering the options available for treating this type of lesion, endovascular techniques are becoming ever more effective and are now the option of first-choice for management of this pathology.

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Treatment of May–Thurner Syndrome in a Patient with an Iliac Artery Stent

Vascular and Endovascular Review ◽

10.15420/ver.2020.10 ◽

2020 ◽

Vol 3 ◽

Author(s):

Raleene Gatmaitan ◽

Keagan Werner-Gibbings ◽

Tommaso Donati ◽

Prakash Saha ◽

Stephen Black

Keyword(s):

Surgical Management ◽

Iliac Artery ◽

Common Iliac Artery ◽

Clinical Manifestations ◽

Iliac Vein ◽

Stent Insertion ◽

Common Iliac Vein ◽

Medical Implants ◽

The Right ◽

Venous Stents

May–Thurner syndrome (MTS) is caused by compression of the left iliac vein by the right iliac artery, leading to clinical manifestations of outflow obstruction in the lower limb and deep vein thrombosis. There have been increasing reports of iatrogenic MTS caused by medical implants. The authors report the case of a 60-year-old man who developed MTS after stenting of the right common iliac artery. Due to the debilitating nature of the patient’s symptoms of venous congestion in the left leg, he proceeded with endovascular venoplasty and venous stent insertion with concurrent intra-arterial balloon angioplasty of the existing right common iliac artery stent. Technical success and primary patency of arterial and venous stents were achieved. The patient remained asymptomatic at 6 weeks and 3 months follow-up and arterial and venous stents were found to be patent on duplex ultrasound. Surgical management of MTS may include thrombolysis, thrombectomy, venoplasty and stenting of the left common iliac vein. Care must be taken to preserve existing medical implants during treatment of MTS. The authors demonstrate that concurrent angioplasty of the right common iliac artery during treatment of the vein is an effective method of preventing arterial stent disruption during surgical management of MTS.

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Unusual Case of Right-Sided May-Thurner Syndrome and Review of Its Management

Vascular ◽

10.2310/6670.2006.00012 ◽

2006 ◽

Vol 14 (1) ◽

pp. 47-50 ◽

Cited By ~ 33

Author(s):

Renee M. Burke ◽

Sunil S. Rayan ◽

Karthikeshwar Kasirajan ◽

Elliot L. Chaikof ◽

Ross Milner

Keyword(s):

Inferior Vena Cava ◽

Iliac Artery ◽

Unusual Case ◽

Inferior Vena ◽

Common Iliac Artery ◽

Vena Cava ◽

Iliac Vein ◽

Common Iliac Vein ◽

Left Common Iliac Vein ◽

Endoluminal Stent

May-Thurner syndrome is a phenomenon commonly described as an acquired stenosis of the left common iliac vein as a result of right common iliac artery compression. We report an unusual case of right-sided May-Thurner syndrome in a patient found to have a left-sided inferior vena cava. We also review the management of this patient using angioplasty, intraoperative thrombolysis, and endoluminal stent placement.

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