Case Report: Rare Iliac Vein Compression (May–Thurner) Syndrome in a Pediatric Patient

Iliac vein compression syndrome (IVCS) or May–Thurner syndrome occurs predominantly in young to middle-aged women. Here we reported a case of IVCS in a 5-year-old boy. The child was admitted to our vasculocardiology department with left lower extremity that had been swollen for 1 month. Blood tests revealed coagulation routine and platelets in the normal ranges. Computer tomography angiography (CTA) and magnetic resonance imaging (MRI) showed the left common iliac vein had become narrow before it entered the right common iliac vein. To further clarify, we performed angiography, which clearly showed the stenosis and the blood return of the left common iliac vein. So IVCS was diagnosed. What is more, we found the aorta descended to the right of the spine, and this may be the reason for the apparent compression of the left common iliac vein. Given the young age and mild symptoms of the child, the treatment was conservative mainly including elevation of the affected limb, wearing medical elastic socks, and short-term oral aspirin for anticoagulation. Meanwhile, the boy is being followed up closely. If the swelling of the left lower extremity significantly increases, stent placement may need to be considered in the future.

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Sonography’s Role in the Diagnosis of May–Thurner Syndrome

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479317714796 ◽

2017 ◽

Vol 34 (1) ◽

pp. 65-70 ◽

Cited By ~ 2

Author(s):

Ashley Barry

Keyword(s):

Lower Extremity ◽

Iliac Vein ◽

Postthrombotic Syndrome ◽

Venous Disease ◽

Common Iliac Vein ◽

Vein Thrombosis ◽

Anatomic Variant ◽

Left Lower Extremity ◽

Iliac Vein Compression ◽

Iliac Vein Compression Syndrome

May–Thurner syndrome (MTS), also known as Cockett syndrome or iliac vein compression syndrome, is a condition in which patients develop swelling, deep vein thrombosis (DVT), venous insufficiency, and other symptoms of the left lower extremity due to an anatomic variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. Although it is an uncommonly diagnosed condition, it is estimated to compose up to half of cases of left lower extremity venous disease. Although having some degree of iliac vein compression is considered a normal anatomic variant in an asymptomatic patient, those who experience severe swelling, venous reflux, and DVT often have anatomically abnormal veins with a spur formation. With proper technique and proficiency, transabdominal sonography can be used as a valuable diagnostic tool in the discovery and to facilitate treatment of May–Thurner syndrome. Diagnostic ultrasound also can monitor the development of recurring DVT and identify symptoms of postthrombotic syndrome.

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Case Series of Concomitant Klippel-Trenaunay Syndrome and May-Thurner Syndrome

Vascular and Endovascular Surgery ◽

10.1177/1538574421995011 ◽

2021 ◽

pp. 153857442199501

Author(s):

John F. Charitable ◽

Onur Yilmaz ◽

Caron Rockman ◽

Glenn R. Jacobowitz

Keyword(s):

Lower Extremity ◽

Case Series ◽

Iliac Vein ◽

Symptomatic Improvement ◽

Venous Disease ◽

Common Iliac Vein ◽

Left Common Iliac Vein ◽

Left Lower Extremity ◽

The Right ◽

Klippel Trenaunay Syndrome

Klippel-Trenaunay syndrome is a rare vascular disorder which includes leg swelling, or lower extremity deep venous reflux/thrombosis as a presenting symptom. May-Thurner syndrome is also a rare pathology involving compression of the left common iliac vein, usually by the right common iliac artery. The incidence of concomitant occurrence of these entities is unknown and not well reported. This case series describes 3 patients who underwent evaluation of symptomatic left lower extremity venous disease. All 3 suffered symptomatic Klippel-Trenaunay initially, and were subsequently diagnosed with concomitant May-Thurner Syndrome. They were successfully treated with left common iliac vein stents with symptomatic improvement.

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May-Thurner syndrome – Are we aware enough?

VASA ◽

10.1024/0301-1526/a000775 ◽

2019 ◽

Vol 48 (5) ◽

pp. 381-388 ◽

Cited By ~ 6

Author(s):

Katalin Mako ◽

Attila Puskas

Keyword(s):

Contraceptive Use ◽

Iliac Vein ◽

Common Iliac Vein ◽

Vein Thrombosis ◽

Compression Syndrome ◽

Threatening Condition ◽

Life Threatening ◽

Iliac Vein Compression ◽

Iliac Vein Compression Syndrome ◽

The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

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Unusual cases of right-sided and left-sided May–Thurner syndrome

Cardiology in the Young ◽

10.1017/s1047951114001115 ◽

2014 ◽

Vol 25 (4) ◽

pp. 797-799 ◽

Cited By ~ 6

Author(s):

I. B. Vijayalakshmi ◽

H. S. Natraj Setty ◽

Chitra Narasimhan

Keyword(s):

Aortic Stenosis ◽

Rare Case ◽

Common Iliac Artery ◽

Iliac Vein ◽

Common Iliac Vein ◽

Rare Clinical Entity ◽

Venous Obstruction ◽

Left Common Iliac Vein ◽

Left Lower Extremity ◽

The Right

AbstractMay–Thurner syndrome is a rare clinical entity involving venous obstruction of the left lower extremity. The May–Thurner syndrome is a phenomenon commonly described as an acquired stenosis of the left common iliac vein secondary to compression of the left common iliac vein between the right common iliac artery and the underlying vertebral body. We report one case of May–Thurner syndrome, and another rare case of reverse May–Thurner syndrome, incidently detected during intervention, in a case of aortic stenosis and mitral stenosis with dextrocardia and situs inversus.

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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

Global Heart ◽

10.1016/j.gheart.2014.03.2204 ◽

2014 ◽

Vol 9 (1) ◽

pp. e273

Author(s):

Jaime M. Aherrera ◽

Edgar Timbol ◽

Antonio Faltado ◽

Agnes Mejia ◽

Mark Vicente

Keyword(s):

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Iliac Artery ◽

Common Iliac Artery ◽

Iliac Vein ◽

Common Iliac Vein ◽

Left Common Iliac Vein ◽

The Right ◽

High Output

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Iatrogenic Venous Compression Syndrome due to Surgical Lumbar Hardware

National Journal of Health Sciences ◽

10.21089/njhs.53.0140 ◽

2021 ◽

Vol 5 (3) ◽

pp. 140-145

Author(s):

Muhammad Akram Khan ◽

◽

Zahoor Khan ◽

Abeera Azam ◽

◽

...

Keyword(s):

Iliac Vein ◽

Pelvic Surgery ◽

Venous Disease ◽

Common Iliac Vein ◽

Vein Thrombosis ◽

Compression Syndrome ◽

Left Lower Extremity ◽

Venous Compression ◽

Iliac Vein Compression ◽

Iliac Vein Compression Syndrome

Abstract: Background: The Iliac vein compression syndrome (IVCS) is most commonly due to May-Thurner variant, an anatomic variant where in the right common iliac artery overlies the left common iliac vein and compresses it against the lumbar spine. The compression of the common venous outflow tract of the left lower extremity may cause discomfort, swelling, or deep vein thrombosis in the iliofemoral veins. The role of the pelvic surgery particularly the lumbar hardware in the development of symptomatic Venous compression syndrome in patients with May-Thurner syndrome is not well understood. The incidence is presumably very low. Herein, we present six patients who developed IVCS after Lumbar hardware. Method: The cases were diagnosed between Nov. 2016 to Oct. 2019 in the Outpatient Cath Lab of McKinney, TX. The patient’s medical records were retrospectively analyzed looking for risk factors, clinical features, venogram findings, and post venogram. The evaluation of each case was described, and common trends were later presented in a cross-case analysis. Conclusion: The cases presented in this report suggest that the hardware used in lumbar/spinal surgery could lead to an IVCS. Patient’s symptoms are unspecific. Venogram/venoplasty is the gold standard for diagnosis and treatment. It is imperative having a high level of suspicion and familiarizing with the natural history of IVCS due to the invasive nature of venogram and the relevance of an early diagnosis to reduce the occurrences of complications. Keywords: Venous disease, Iliac vein compression, May-Thurner syndrome, Lumbar surgery complications, Unexplained edema of left leg, May-Thurner Syndrome, Lumbar hardware, Venous compression, IVUS, Venogram, Angioplasty

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Absence of the Right Common Iliac Vein with the Right Internal Iliac Vein Arising from the Left Common Iliac Vein: Case Report

Cureus ◽

10.7759/cureus.4575 ◽

2019 ◽

Cited By ~ 1

Author(s):

Karishma Mehta ◽

Joe Iwanaga ◽

R. Shane Tubbs

Keyword(s):

Case Report ◽

Iliac Vein ◽

Common Iliac Vein ◽

Left Common Iliac Vein ◽

Internal Iliac Vein ◽

Internal Iliac ◽

The Right

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Clinical correlation of anatomical location of non-thrombotic iliac vein lesion

Vascular ◽

10.1177/1708538116682906 ◽

2016 ◽

Vol 25 (4) ◽

pp. 359-363 ◽

Cited By ~ 5

Author(s):

Afsha Aurshina ◽

Borislav Kheyson ◽

Justin Eisenberg ◽

Anil Hingorani ◽

Arkady Ganelin ◽

...

Keyword(s):

Lower Extremity ◽

Intravascular Ultrasound ◽

Iliac Vein ◽

Clinical Findings ◽

Common Iliac Vein ◽

Anatomical Location ◽

Clinical Correlation ◽

Common Site ◽

External Iliac Vein ◽

Left Lower Extremity

Objective Treatment of non-thrombotic iliac vein lesions is an active area of research. Intravascular ultrasound allows its localization. We chose intravascular ultrasound to clarify the exact anatomical location of non-thrombotic iliac vein lesions and correlate it with clinical findings. Materials and methods Over seven months, we performed ilio-femoral intravascular ultrasound studies on 217 patients, in 141 women and 76 men. The average age ± standard deviation was 68 ± 14 years. We used intravascular ultrasound intraoperatively to measure the ilio-femoral veins and compared it with adjacent non-stenotic ilio-femoral veins. If more than 50% area or diameter reduction was found, it was treated with appropriate balloon and stent. Results We identified 244 lesions, 124 in left lower extremity and 120 in the right lower extremity. The most common site was the proximal common iliac vein 38.7% (22.5% females and 16.12% males) in left lower extremity and middle external iliac vein 29.16% (18.33% females and 10.83% males) in right lower extremity. The least common site was the distal external iliac vein in 3.2% (all 3.2% females) and the distal external iliac vein 7.5% (5% females and 2.5% males) in right lower extremity. Clinical correlation was noted between laterality and location of the NIVL lesion ( p < 0.0001). Conclusion This analysis gives an insight into understanding the exact anatomical locations of the non-thrombotic iliac vein lesions helping clinicians and researchers guide their treatment and research.

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