May–Thurner syndrome, a diagnosis to consider in young males with no risk factors: a case report and review of the literature

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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Ilio-Femoral Deep Vein Thrombosis Secondary to May-Thurner Syndrome With Ipsilateral Lower Limb Arterio-Venous Graft In-Situ

Vascular and Endovascular Surgery ◽

10.1177/1538574421994782 ◽

2021 ◽

pp. 153857442199478

Author(s):

Brjan Kaiji Betzler ◽

Li zhang ◽

Kai Siang Chan ◽

Enming Yong ◽

Ivan Kuang Hsin Huang ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Lower Limb ◽

Duplex Ultrasound ◽

Iliac Vein ◽

Common Iliac Vein ◽

Arteriovenous Graft ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Deep Vein

Ilio-femoral deep vein thrombosis (DVT) is rare in patients with lower limb arterio-venous grafts due to a state of high blood flow. May-Thurner syndrome (MTS) is an anomaly where the left common iliac vein is compressed by the right common iliac artery. We present a rare case of ilio-femoral deep vein thrombosis in a patient with May-Thurner Syndrome and an underlying arteriovenous graft in-situ who presented with acute lower limb swelling. The patient underwent catheter-directed thrombolysis, pharmaco-mechanical thrombectomy, venoplasty and iliac vein stenting. Follow-up surveillance duplex ultrasound showed patency of the iliac vein stent and arteriovenous graft at 1-year postoperatively.

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Correlation of clinical features with the risk of lower limb deep vein thrombosis assessed by duplex ultrasound

Jornal Vascular Brasileiro ◽

10.1590/s1677-54492013000200005 ◽

2013 ◽

Vol 12 (2) ◽

pp. 118-122

Author(s):

Liz Andrea Villela Baroncini ◽

Graciliano Jose Franca ◽

Aguinaldo de Oliveira ◽

Enrique AntonioVidal ◽

Carlos Eduardo Del Valle ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Clinical Symptoms ◽

Clinical Signs ◽

Duplex Ultrasound ◽

Iliac Vein ◽

Vein Thrombosis ◽

Below The Knee ◽

Clinical Conditions ◽

Deep Vein

BACKGROUND: Symptoms and clinical signs suggestive of deep vein thrombosis (DVT) are common but may have numerous possible causes. OBJECTIVES: 1) To identify the most frequent clinical symptoms and correlate them with duplex ultrasound scan (DS) findings; 2) to identify high-risk clinical conditions for DVT; and 3) to evaluate time since the onset of symptoms and DS examination. METHODS: A total of 528 patients with a clinical suspicion of DVT were evaluated by DS performed by experienced vascular ultrasonographists. RESULTS: DVT was present in 192 (36.4%) of the patients. The external iliac vein was involved in 53 patients (10.04%), the femoral veins in 110 (20.83%), the popliteal vein in 124 (23.48%), and veins below the knee were involved in 157 (29.73%) of the cases. Limb swelling was present in 359 cases (68%), and 303 (57.4%) complained of pain. Sixty nine patients received a DS due to suspected or proven pulmonary embolism (PE); 79 patients were in postoperative period. In the multivariate analysis, independent risk factors for DVT included age>65 years (OR=1.49; 95% confidence interval [95%CI] 1.01-2.18; p=0.042), edema (OR=2.83; 95%CI 1.72-4.65; p<0.001), pain (OR=1.99; 95%CI 1.3-3.05; p=0.002), cancer (OR=2.32; 95%CI 1.45-3.72; p<0.001), and PE (OR=2.62; 95%CI 1.29-5.32; p=0.008).Time since the onset of symptoms did not differ between the groups. CONCLUSIONS: In the present study, 36.4% of the patients referred to DS had DVT. Age > 65 years, presence of limb swelling, pain, cancer, and suspected or proven PE should be considered as major risk factors for DVT.

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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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Stenting of Common Iliac Vein Obstructions Combined with Regional Thrombolysis and Thrombectomy in Acute Deep Vein Thrombosis

Journal of Vascular Surgery ◽

10.1016/j.jvs.2007.05.011 ◽

2007 ◽

Vol 46 (1) ◽

pp. 174-175

Author(s):

M.J. Husmann ◽

G. Heller ◽

C. Kalka ◽

H. Savolainen ◽

D.D. Do ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Iliac Vein ◽

Common Iliac Vein ◽

Vein Thrombosis ◽

Acute Deep Vein Thrombosis ◽

Deep Vein

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Acute pulmonary embolism complicating deep vein thrombosis in a young patient with stroke

BIRDEM Medical Journal ◽

10.3329/birdem.v11i2.53137 ◽

2021 ◽

Vol 11 (2) ◽

pp. 142-144

Author(s):

Mohammed Mirazur Rahman ◽

Farjana Binte Habib ◽

Ahmed Imran Kabir ◽

Samprity Islam ◽

Rajashish Chakrabortty ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Lower Limb ◽

Acute Pulmonary Embolism ◽

Successful Outcome ◽

Shortness Of Breath ◽

Vein Thrombosis ◽

Doppler Study ◽

Left Lower Limb ◽

Deep Vein

Acute pulmonary embolism is one of the most common causes of vascular death after myocardial infarction and cerebrovascular accidents. It usually presents with severe chest pain and shortness of breath and occasionally occurs in the background of deep vein thrombosis. A 32-year-old male presented with swelling of left lower limb and shortness of breath. Subsequent investigations revealed that he developed DVT of left lower limb and pulmonary embolism. However, in general, if left untreated, pulmonary embolism is associated with an overall mortality of up to 30 percent compared with 2 to 11 percent in those treated with anticoagulation. Early diagnosis by D-dimer, computed tomograpgy pulmonary angiogram and doppler study of the left lower limb and prompt intervention through low molecular weight heparin and rivaroxaban led to a successful outcome in our case. Birdem Med J 2021; 11(2): 142-144

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Deep Vein Thrombosis of the Left Lower Limb in a 12 Year-Old Female Child with Ulcerative Colitis – Case Report

Polish Journal of Radiology ◽

10.12659/pjr.894529 ◽

2016 ◽

Vol 81 ◽

pp. 65-68

Author(s):

Elżbieta Krzesiek ◽

Urszula Zaleska- Dorobisz ◽

Barbara Iwańczak ◽

Andrzej T. Dorobisz

Keyword(s):

Ulcerative Colitis ◽

Deep Vein Thrombosis ◽

Case Report ◽

Lower Limb ◽

Female Child ◽

Vein Thrombosis ◽

Left Lower Limb ◽

Deep Vein

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D-Dimer Level Significance for Deep Vein Thrombosis Screening in The Third Trimester : A Retrospective Study

10.21203/rs.3.rs-753804/v1 ◽

2021 ◽

Author(s):

Keisuke Miyamoto ◽

Hiroaki Komatsu ◽

Masayo Okawa ◽

Yuki Iida ◽

Daiken Osaku ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Lower Limb ◽

Third Trimester ◽

Vein Thrombosis ◽

The Third ◽

Deep Vein ◽

D Dimer ◽

Compression Ultrasonography

Abstract BackgroundVenous thromboembolism often develops after surgery and childbirth, resulting in death in some cases. Although early deep vein thrombosis (DVT) detection can predict pulmonary thromboembolism, there is no early screening method for DVT in pregnant women. Lack of consensus regarding significance or setting and cut-off value interpretation of D-dimer levels further impedes venous thromboembolism screening in pregnant women.This study aimed to examine the utility of third-trimester serum D-dimer levels for screening test for DVT during pregnancy.to determine the frequency of asymptomatic DVT using lower-limb compression ultrasonography.MethodsThis single-center retrospective study included 497 pregnant women who underwent elective cesarean section at term in our hospital between January 2013 and December 2019. Serum D-dimer levels were preoperatively measured at 32–37 gestation weeks. The presence or absence of DVT in patients with serum D-dimer levels ≥ 3.0 µg/ml, the cut-off value, was examined using compression ultrasonography. In all patients, the presence or absence of clinical venous thrombosis (symptoms such as lower-limb pain, swelling, and heat sensation) was examined within 4 postoperative weeks.The Royal College of Obstetricians and Gynecologists Guideline 2015 was referred to determine risk factors for the onset of venous thrombosis during pregnancy. Among those, we examined the risk factors for DVT that result in high D-dimer levels during pregnancy.ResultsThe median age and body mass index were 35 (20–47) years and 21.2 (16.4–41.1) kg/m2, respectively. Further, the median gestational age and D-dimer levels were 37 weeks and 2.1 (0.2–16.0) µg/ml, respectively. Compression ultrasonography was performed on 135 (26.5%) patients with a D-dimer level ≥3.0 µg/ml, with none of the patients showing DVT. All patients were followed up for 4 postoperative weeks, with none presenting with venous thromboembolism. Multivariate analysis showed that hypertensive disorders of pregnancy is an independent risk factor for venous thromboembolism that causes high D-dimer levels (odds ratio: 2.48, 95% confidence interval: 1.05–6.50, P=0.04).ConclusionThere may be low utility in screening for DVT using D-dimer levels in the third trimester. Further, prepartum asymptomatic DVT has a low frequency, indicating the low utility of compression ultrasonography.Trial registrationInstitutional Review Board of Tottori University Hospital (IRB no. 20A149).

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