scholarly journals May-Thurner Syndrome and Recurrent DVT: A Case Report

2020 ◽  
Vol 1 (1) ◽  
pp. 13-16 ◽  
Author(s):  
Neha Tarannum ◽  
H.V.V.S.S. Lakshman K. ◽  
Mohammed Sadiq Azam ◽  
Rajendra Kumar Premchand

May-Thurner syndrome/Cockets syndrome/ileocaval syndrome is a rarely diagnosed, anatomical and pathologically variable condition, causing venous flow obstruction in iliocaval territory. We report a case of 64 year old male patient who presented with unprovoked proximal deep venous thrombosis (DVT) of left lower limb. Evaluated for hypercoagulable state, which was negative, the patient underwent catheter guided thrombolysis and anticoagulation for 6 months. Two years later, he developed left lower limb swelling, and venous doppler revealed acute DVT; CT venogram was consistent with left common iliac vein compression by right common iliac artery suggestive of May-Thurner syndrome. Catheter-guided thrombolysis was done, and percutaneous transluminal peripheral angioplasty/stent was placed from inferior vena cava to left common iliac vein. This case highlights the importance of high index of suspicion in managing patients with DVT for possible ileocaval syndrome wherein anticoagulation alone is insufficient and needs more aggressive and definitive treatment to relieve the obstruction and to prevent recurrence.

2021 ◽  
pp. 17-19
Author(s):  
B. Santhi ◽  
Manigandan Manigandan ◽  
Nishok Nishok

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.


Author(s):  
Sreenivasa Narayana Raju ◽  
Rengarajan Rajagopal ◽  
Niraj Nirmal Pandey ◽  
Amarinder Singh ◽  
Sanjeev Kumar

AbstractWe report the case of 8-year-old girl with left lower limb edema due to superficial venous incompetence and varicosities. Color Doppler demonstrated compression of the left common iliac vein by an ectopic left kidney, which was partly relieved in right lateral decubitus position. CT demonstrated ectopic malrotated pelvic kidney, compressing the left common iliac vein against the L5 vertebra. A “May–Thurner” like syndrome due to visceral compression needs to be suspected in children with unilateral left lower limb varicosities.


2019 ◽  
Vol 12 (7) ◽  
pp. e229511
Author(s):  
Kay Tai Choy ◽  
Sherab Bhutia

May-Thurner syndrome (MTS) is a differential diagnosis to be considered in a patient with recurrent unilateral cellulitis. A 73-year-old woman initially presented with recurrent unilateral cellulitis of her left lower limb. A CT scan demonstrated a stenosed left common iliac vein (CIV) narrowed at its origin by the proximal right common iliac artery consistent with MTS. The chronicity of the condition at the time of diagnosis made attempts to recanalise the CIV unsuccessful. A diagnosis of MTS should be considered in a patient with chronic unilateral limb oedema/cellulitis as it represents a potentially treatable condition if detected early.


2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Lori Jia ◽  
Jason Alexander ◽  
Nedaa Skeik

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.


2021 ◽  
Vol 10 (1) ◽  
pp. 89-96
Author(s):  
D. G. Gitelson ◽  
A. G. Faibushevich ◽  
D. A. Maximkin ◽  
G. I. Veretnik ◽  
V. Yu. Baranovich ◽  
...  

May-Turner syndrome is a condition where the left common iliac vein is compressed between the lumbar spine and the overlying right common iliac artery. Left iliac vein compression is common (up to 24%) in the general population, but clinical manifestations occur in a few patients. This syndrome should be considered in case of unexplained edema of the left lower extremity since routine duplex ultrasound does not possess optimal sensitivity and specificity in the study of the iliac veins and the inferior vena cava. Intravascular ultrasound is the most accurate diagnostic method. However, the advent of computed tomography angiography and magnetic resonance angiography providing high-quality images of the vasculature have become a promising alternative to invasive intravascular ultrasound. Treatment for May-Turner syndrome usually involves stenting of the left common iliac vein along with medical therapy, including antithrombotic (anticoagulant and antiplatelet) therapy combined with phlebotonics. Our review reports modern methods of diagnosis and treatment of May-Turner syndrome.


Author(s):  
Wan Nuraisyah Azzahrah Wan Zuki

Phlegmasia cerulea dolens (PCD) is a rare syndrome caused by venous thrombosis and characterised by a triad of limb oedema, cyanosis and pain. It requires early recognition as delay of treatment can cause gangrene, limb amputation and in extreme cases, death. A 67- year-old Chinese lady, with underlying hypertension, diabetes mellitus and dyslipidaemia presented to the emergency department with a 2 days history of pain, oedema and bluish discoloration over the entire left leg. She had a history of fall 6 months prior and since then she used a walking stick for mobilization. This patient underwent ultrasound doppler left lower limb , which showed features suggestive of long-segment left lower limb deep vein thrombosis. A diagnosis of PCD was made. Subsequently, she went for a CT angiogram and venography of the left lower limb which confirmed thrombosis of the left calf vein extending to the long segment of the left common iliac vein. She was commenced on intravenous heparin infusion and then underwent inferior vena cava filter insertion and catheter directed thrombolysis. Repeat venogram showed successful catheter directed thrombolysis of the left lower limb deep venous thrombosis (DVT). Treatment should be initiated as soon as the diagnosis of PCD is suspected. Currently, guidelines for treatment are lacking however 3 therapeutic options are advocated alone or in combination: anticoagulants, thrombolytic therapy, and venous thrombectomy. An early recognition of PCD and appropriate decision regarding the treatment is essential to preserve the limb.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S16


Vascular ◽  
2006 ◽  
Vol 14 (1) ◽  
pp. 47-50 ◽  
Author(s):  
Renee M. Burke ◽  
Sunil S. Rayan ◽  
Karthikeshwar Kasirajan ◽  
Elliot L. Chaikof ◽  
Ross Milner

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.


2019 ◽  
Vol 12 (12) ◽  
pp. e232695
Author(s):  
Jack Whooley ◽  
Atakelet Ferede ◽  
Gordon Smyth ◽  
Dilly Little

Duplication of the inferior vena cava (IVC) resulting in an accessory left-sided IVC is a relatively rare vascular anomaly with a reported prevalence of 0.7%. Radiologically, a duplicated left-sided IVC is usually seen as a continuation of the left common iliac vein, crossing anterior to the aorta at the level of the renal vein to join the right-sided IVC. We present a rare case in which an accessory left-sided IVC was discovered intraoperatively, in a 47-year-old living donor, posing significant intraoperative challenges regarding extraction and subsequent transplantation.


2020 ◽  
Vol 5 (4) ◽  
pp. 39-43
Author(s):  
Yu. V. Chumakova ◽  
V. A. Tereshchenkov ◽  
M. A. Kislov ◽  
Е. V. Bulanova

The article is dedicated to a rare case of spontaneous rupture of the pathologically altered left common iliac vein which was a late complication of the cava filter placement. To date this complication has not been described in the national medical literature. In foreign literature only 21 cases of spontaneous rupture of the iliac vein with unclear cause were registered. The article presents a case observed in the practice of the Bureau of forensic medical examination of the Moscow region. It was found that on he background of a number of conditions (occlusion of the inferior vena cava; pathological changes in the venous wall, taking into account its anatomical location; immobilized state of the patient; lack of adequate anticoagulant therapy; predisposing factors in the form of muscle tension) spontaneous rupture of the left common iliac vein should be considered as one of the late cava filter placement complications.Conclusion. Thus, the authors of the article have established the causes of spontaneous rupture of the iliac vein, as well as proposed the inclusion of this pathology in the official list of the late cava filter placement complications. 


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Joel Zhen Khang Hng ◽  
Shu Su ◽  
Noel Atkinson

Abstract Background May–Thurner syndrome is an anatomical condition characterized by compression of the left common iliac vein by the right common iliac artery, causing venous outflow obstruction. It is an uncommon cause of deep vein thrombosis and is more prevalent among women. This paper highlights the importance of considering May–Thurner syndrome in young males without risk factors presenting with left lower limb pain, as endovascular treatment may be required. Case presentation A 23 year-old Caucasian male presented with a 1-week history of left lower limb pain, edema, and pallor. He was found to have an unprovoked deep vein thrombosis on Doppler ultrasound involving the left fibular, soleus, gastrocnemius, popliteal, femoral, common femoral, and external iliac veins. A heparin infusion was commenced as the initial treatment for deep vein thrombosis. Further investigation with computer tomography pulmonary angiogram and computer tomography venography of the abdomen and pelvis showed bilateral pulmonary emboli and left common iliac vein compression with left common, internal, and external iliac vein thrombosis. He was diagnosed with May–Thurner syndrome despite having no risk factors. A retrievable Cook Celect Platinum inferior vena cava filter was placed, and thrombus of the left common femoral, external, and common iliac veins was treated successfully with AngioJet thrombectomy, thrombolysis using 200,000 units of urokinase, angioplasty and stenting using two Cook Zilver Vena venous self-expanding stents. Therapeutic enoxaparin was commenced on discharge. His filter was removed after 10 weeks. Hematological follow-up 4 months later showed an overall negative thrombophilia screen, and anticoagulation was switched to apixaban. He has had no recurrent thrombosis. Conclusions Clinicians should have a low threshold to investigate for May-Thurner syndrome in patients with left lower limb venous thrombotic events regardless of risk factors, as endovascular treatment may be required to minimize the long-term sequelae of deep vein thrombosis. Duplex ultrasound can be used initially for diagnosis, and computer tomography venography used subsequently if the common iliac vein is not visualized on ultrasound. Endovascular treatment is preferred over anticoagulation alone, especially in otherwise fit patients presenting early, the aim being to reduce the chances of chronic venous hypertension in the lower limb.


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