May-Thurner Syndrome: A Case Report and Review of the Literature

May-Thurner syndrome (MTS) has been recognized as a clinical entity for almost six decades. The true incidence rate of MTS is unknown and perhaps ranges from 22 to 32% according to the autopsy studies in the early twentieth century. However, MTS related deep venous thrombosis (DVT) accounts for only 2%-3% of all lower limb DVTS. In MTS, the left common iliac vein is compressed against the fifth lumbar vertebrae by the right common iliac artery, as it crosses in front of the vein. Chronic pulsation of the artery is thought to cause elastin, collagen deposition, and intimal fibrosis leading to formation of venous spur and venous thrombosis. MTS can present as acute or chronic DVT leading to pulmonary embolism (PE), chronic leg pain, chronic ulcers, or skin pigmentation changes. In this case report we have described an interesting case of a 28-year-old Caucasian female who presented for evaluation of shortness of breath (SOB) associated with cough for one week. SOB was found to be secondary to massive bilateral pulmonary embolism resulting from extensive MTS related DVT of the left lower extremity. Patient underwent pharmacomechanical treatment with local thrombolysis, thrombectomy, and venoplasty along with stent placement that extended to inferior vena caval junction. Subsequently patient was discharged on coumadin. MTS should be considered in differentials when faced with a case of unilateral DVT particularly in younger age group.

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An Anomalous Cause of Deep Venous Thrombosis: A Case Report

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.4.51517 ◽

2021 ◽

Vol 5 (3) ◽

pp. 299-302

Author(s):

Jana Florian ◽

Huy Duong ◽

Jennifer Roh

Keyword(s):

Case Report ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Anatomical Variation ◽

Lumbar Vertebrae ◽

Iliac Vein ◽

Common Iliac Vein ◽

Extrinsic Compression ◽

Common Diagnosis

Introduction: Lower extremity deep venous thrombosis (DVT) is a common diagnosis in the emergency department (ED). Deep venous thromboses can be the result of anatomical variation in the vasculature that predisposes the patient to thrombosis. May-Thurner syndrome (MTS) is one such anatomic variant defined by extrinsic compression of the left common iliac vein between the right common iliac artery and lumbar vertebrae. Case Report: We report such a case of a 39-year-old woman with no risk factors for thromboembolic disease who presented to the ED with extensive unilateral leg swelling and was ultimately diagnosed with MTS. Conclusion: This diagnosis is an important consideration particularly in patients who are young, female, have scoliosis or spinal abnormalities, or are at low risk for DVT yet who present with extensive lower extremity swelling and are found to have proximal thrombus burden. Often further imaging, anticoagulation, angioplasty, or thrombectomy are indicated to prevent morbidity and post-thrombotic syndrome in these patients.

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

International Journal of Angiology ◽

10.1055/s-0038-1661003 ◽

2018 ◽

Vol 28 (04) ◽

pp. 262-266

Author(s):

Toh Ching Han ◽

Ashish Anil Sule

Keyword(s):

Deep Vein Thrombosis ◽

Case Report ◽

Oral Anticoagulants ◽

Lumbar Vertebrae ◽

Iliac Vein ◽

Postthrombotic Syndrome ◽

Common Iliac Vein ◽

Anatomical Variant ◽

Vein Thrombosis ◽

Deep Vein

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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A Case of Inferior Vena Cava Thrombosis Induced by Left Iliac Vein Stents

The Thoracic and Cardiovascular Surgeon Reports ◽

10.1055/s-0038-1672212 ◽

2018 ◽

Vol 07 (01) ◽

pp. e39-e42 ◽

Cited By ~ 1

Author(s):

Wei Wei ◽

Xuemei Jiang ◽

Bo Xu ◽

Yikuan Chen

Keyword(s):

Case Report ◽

Inferior Vena Cava ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Inferior Vena ◽

Vena Cava ◽

Iliac Vein ◽

Common Iliac Vein ◽

Vena Cava Thrombosis ◽

Inferior Vena Cava Thrombosis

AbstractStents have been widely used to restore the patency of the iliac vein in the treatment of its obstruction. However, various complications related to those stents have been reported. This case report covers a 67-year-old male who was diagnosed with left iliofemoral venous post-thrombotic syndrome with recurrent acute deep venous thrombosis. Thrombosis of the inferior vena cava was induced by pronounced extension of left iliac vein stents. Extending stents in this way covers the outlet of the contralateral common iliac vein and may induce thrombosis in the inferior vena cava.

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Endovascular repair of a spontaneous ilio-iliac fistula presenting as pulmonary embolism

VASA ◽

10.1024/0301-1526/a000100 ◽

2011 ◽

Vol 40 (3) ◽

pp. 246-250 ◽

Cited By ~ 4

Author(s):

Melas ◽

Saratzis ◽

Abbas ◽

Sarris ◽

Saratzis ◽

...

Keyword(s):

Pulmonary Embolism ◽

Endovascular Repair ◽

Therapeutic Option ◽

Artery Aneurysm ◽

Iliac Vein ◽

Massive Pulmonary Embolism ◽

Long Term Results ◽

Common Iliac Vein ◽

Iliac Artery Aneurysm ◽

Common Iliac Artery Aneurysm

Spontaneous rupture of a common iliac artery aneurysm into the common iliac vein is a rare phenomenon. We report the case of a 68 year old man admitted with acute cardiac failure and massive pulmonary embolism as a complication of a spontaneous ilio-iliac fistula, secondary to aneurysmal rupture. The aneurysm was successfully excluded using an aorto-uni-iliac stent graft. No complications were noted at 9 months follow-up. Arteriovenous fistulae should be considered in patients with aortic or iliac aneurysms who develop a pulmonary embolism or symptoms of venous congestion. Endovascular repair of these pathologies is a feasible therapeutic option; however long term results remain unknown.

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Abstract 241: Piggyback and Horseshoe Balloon Catheter Models for Simultaneous Thrombolysis and Venous Angioplasty in Acute Ileofemoral Venous Thrombosis After IVC Filter Insertion

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.32.suppl_1.a241 ◽

2012 ◽

Vol 32 (suppl_1) ◽

Author(s):

Mark Arokiaraj ◽

Luis Guerrero ◽

Robert Levine ◽

Igor Palacios

Keyword(s):

Venous Thrombosis ◽

Balloon Catheter ◽

Iliac Vein ◽

Common Iliac Vein ◽

Ivc Filter ◽

Vein Thrombosis ◽

Internal Iliac ◽

Filter Insertion ◽

Venous Angioplasty ◽

Side Port

Background: To investigate the potential role of balloon mediated thrombolysis and venous angioplasty in acute ileofemoral thrombosis and to develop novel balloon catheter models for the same purpose. Methods: 2 patients and 1 patient on followup with extensive acute ileofemoral and popliteal vein thrombosis and partially extending into the inferior venacava (IVC) with diffuse swelling of lower limb and gluteal region were studied. The second patient stopped anticoagulation and presented with ileofemoral thrombosis in contralateral limb on followup. In both patients Gunther Tulip (Cook) IVC filter was placed. A 5F Multipurpose catheter with sideholes was placed in common iliac vein bifurcation and thrombolysis was done for 18 hours with streptokinase at 5000U/hr. Post thrombolysis IVC angiogram showed mild recanalisation of left common iliac veins leaving a stump. On the next day, the left common iliac vein was cannulated through a 5F Torcon catheter and a Terumo 035 J tipped wire was advanced through the clots. A 5cm x 4mm peripheral balloon was advanced and balloon directed 24 hour thrombolysis with streptokinase was done at 5000U/hr. The balloon was pulled back and multiple serial dilatations were done in femoral, internal iliac and common iliac veins. In both patients thrombolysis was started on the third day after the onset of symptoms. Results: Post procedure the venous channels were opened and were draining adequately. Limb edema subsided and there was no bleeding or embolic complications. Both patients are on oral anticoagulation and now on follow-up for 8 months being asymptomatic at present. Based on these interventions two novel balloon models to thrombolyse and to perform venous angioplasty simultaneously in a single procedure was developed. The first is a piggyback model which has a side port attached to the shaft of the balloon (5cm length and 4mm breath). The other model is a horse shoe balloon catheter which has a 14cm long and 4mm wide compliant balloon with 0.75mm diameter side port for thrombolysis till the balloon tip and on cross section gives a horse shoe appearance. Conclusion: Balloon mediated thrombolysis and venous angioplasty after IVC filter insertion is useful and novel balloon catheter models may be used in ileofemoral venous thrombosis.

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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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