Treatment of Deep Vein Thrombosis in May–Thurner's Syndrome with a Novel Oral Anticoagulant: A Case Report

May–Thurner's syndrome (MTS) is an anatomical variant where the left common iliac vein (CIV) is compressed by the overlying right common iliac artery and the underlying lumbar vertebrae, leading to stenosis in the left CIV. Endovascular intervention followed by anticoagulation currently constitute the mainstay of management of MTS associated with recurrent deep vein thrombosis (DVT).Warfarin appears to be the anticoagulant of choice in most studies conducted in patients with MTS. There is little evidence of treatment using nonvitamin K oral anticoagulants. This case report serves to describe a patient with MTS who was successfully treated with catheter-directed therapy followed by anticoagulation using rivaroxaban.A 64-year-old women presented with left lower limb swelling. Her duplex ultrasound and computed tomography (CT) showed extensive DVT and underlying narrowing of the left CIV, respectively.She underwent catheter-directed therapy, involving stent placement in the left CIV, and was subsequently started on rivaroxaban. She developed partial thrombosis of the external iliac vein at 5 months postprocedure and partial stent thrombosis at 1 year postprocedure while on rivaroxaban, requiring repeat stenting and continuation of anticoagulation. On follow-up, there was no recurrence of symptoms related to MTS, no postthrombotic syndrome, and no clinically significant bleeding as a side effect of rivaroxaban.This case report shows that rivaroxaban is a safe agent that can be successfully used in the treatment of MTS after stenting.

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May–Thurner syndrome causing deep vein thrombosis in the postoperative patient

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212690 ◽

2021 ◽

Vol 10 (7) ◽

pp. 2899

Author(s):

Ashwini Vishalakshi L. ◽

Meenakshi V. ◽

Amritha Ganesh ◽

Pallavee P.

Keyword(s):

Deep Vein Thrombosis ◽

Common Iliac Artery ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Iliac Vein ◽

Common Iliac Vein ◽

Postoperative Patient ◽

Anatomical Variant ◽

Vein Thrombosis ◽

Deep Vein

May–Thurner syndrome is a rare cause of left iliac deep vein thrombosis due to an anatomical variant in which right common iliac artery overlies and compresses left common iliac vein against lumbar spine. Patients with May–Thurner syndrome usually present in their 2nd to 4th decade of life. Pregnancy and intra-abdominal surgeries are known precipitating factors in acute May–Thurner syndrome. We report the case of a woman in her 3rd decade of life who presented with May–Thurner syndrome following total abdominal hysterectomy. This case report hopes to bring attention to the high variant of patient population with May–Thurner syndrome and the necessity for surgical intervention of stent placement to prevent recurrence.

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Pharmacomechanical Thrombolysis for Deep Vein Thrombosis in May-Thurner Syndrome

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000408 ◽

2017 ◽

Vol 12 (6) ◽

pp. 466-471

Author(s):

Mayank Roy ◽

Morris Sasson ◽

Armando Rosales-Velderrain ◽

Savannah Moon ◽

Mark Grove ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Stent Placement ◽

Patency Rate ◽

Iliac Vein ◽

Postthrombotic Syndrome ◽

Common Iliac Vein ◽

Vein Thrombosis ◽

Acute Deep Vein Thrombosis ◽

Deep Vein

Objective Patients with May-Thurner syndrome presenting with acute deep vein thrombosis benefit from early lysis of clot and endovascular treatment. We evaluated the outcome of patients with May-Thurner syndrome who presented with deep vein thrombosis, managed with pharmacomechanical thrombolysis as the primary mode of intervention, in combination with angioplasty and stent placement. Methods We reviewed all patients with May-Thurner syndrome managed in our institution between January 2009 to December 2015. Patency rate and postthrombotic syndrome were evaluated as primary end points. Results A total of seven patients (6 females, 1 male) with a mean ± SD age of 48 ± 17 years and mean ± SD body mass index of 29.64 ± 7.25 kg/m2 were identified. Six patients presented with acute deep vein thrombosis and one presented with chronic venous insufficiency. Five patients underwent pharmacomechanical thrombolysis (TRELLIS and altepase) with concomitant stenting of the common iliac vein, one had only angioplasty with stent placement, and one had only pharmacomechanical thrombolysis. Median time from presentation to pharmacomechanical thrombolysis was 4 days (range = 1–9). Patency rate and postthrombotic syndrome at 12 months were 100% and 0%, respectively. No patient experienced major bleeding or pulmonary embolism. The median length of stay was 3 days (range = 0–4). There was no mortality associated with the procedure. The mean ± SD follow-up was 26 ± 15 months. Conclusions In patients with May-Thurner syndrome, pharmacomechanical thrombolysis is an effective approach for the management of acute deep vein thrombosis, decreasing thrombus burden, and long-term postthrombotic syndrome when used in conjunction with stenting.

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Percutaneous thrombectomy using a novel single session device for acute iliofemoral deep vein thrombosis

VASA ◽

10.1024/0301-1526/a000928 ◽

2021 ◽

Vol 50 (1) ◽

pp. 74-77

Author(s):

Gerard O’Sullivan

Keyword(s):

Deep Vein Thrombosis ◽

Iliac Vein ◽

Left Thigh ◽

Common Iliac Vein ◽

Single Session ◽

Venous Thrombectomy ◽

Vein Thrombosis ◽

Left Common Iliac Vein ◽

Deep Vein ◽

Percutaneous Thrombectomy

Summary: A 74-year-old woman presented with acute symptomatic left thigh and calf swelling; imaging demonstrated evidence of occlusive thrombosis from the upper left common iliac vein to the mid-thigh. Single session zero-thrombolysis venous thrombectomy was performed using the ReVeneTM Thrombectomy Catheter.

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May-Thurner Syndrome with Large Abdominal Varicosity, Treated Successfully Using Multiple Approaches

Case Reports in Vascular Medicine ◽

10.1155/2019/7079307 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Lori Jia ◽

Jason Alexander ◽

Nedaa Skeik

Keyword(s):

Vena Cava ◽

Iliac Vein ◽

Postthrombotic Syndrome ◽

Common Iliac Vein ◽

Filter Placement ◽

Vein Thrombosis ◽

Left Common Iliac Vein ◽

Venous Outflow Obstruction ◽

Angioplasty And Stenting ◽

Deep Vein

May-Thurner syndrome (MTS) is a venous outflow 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. Anatomic variations of MTS, while uncommon, have been described. Treatment usually involves endovascular management, including thrombolysis and/or thrombectomy with or without inferior vena cava filter placement, followed by angioplasty and stenting of the left common iliac vein. We report a unique case of a 31-year-old woman who presented with MTS-related deep vein thrombosis accompanied by symptomatic abdominal and pelvic varicosities. The varicosities were treated successfully using multiple procedures, resulting in complete resolution of all symptoms. Our case discusses a treatment approach for an unusual presentation of MTS-related postthrombotic syndrome, and provides a brief literature review of MTS complications and management.

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A case of May-Thurner Syndrome: An old anomaly but, a new suggestion: A case report

Malawi Medical Journal ◽

10.4314/mmj.v31i3.12 ◽

2019 ◽

Vol 31 (3) ◽

pp. 230-232

Author(s):

Şule Gökçe

Keyword(s):

Case Report ◽

Sports Medicine ◽

Iliac Vein ◽

Common Iliac Vein ◽

Ultrasound Screening ◽

Vascular Abnormalities ◽

Vein Thrombosis ◽

History Of ◽

The Right ◽

Deep Vein

May-Thurner syndrome (MTS) is an anatomical condition resulting in compression of the left common iliac vein between the right common iliac artery and the underlying spine. MTS is rarely diagnosed because diagnostic workup is seldom continued once the diagnosis of a deep vein thrombosis (DVT) has been established. Furthermore, patients with DVT generally have several well-known confounding risk factors. We report a 16-year-old girl with a history of left leg swelling who was incidentally diagnosed with MTS. We hope that our case report will create awareness of vascular abnormalities in sports medicine and suggest that routine venous Doppler ultrasound screening may help to detect MTS or associated anatomical prior to the formation of early thrombosis.

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