Anticoagulant Therapy in a Pregnant Woman with May-Thurner Syndrome

Abstract

A 39-year-old woman with a 9-week abdominal pregnancy noted pain in her lower abdomen and left leg. Since successive thrombi were observed extending from the left common iliac vein to the popliteal vein along with a thrombus in the left pulmonary artery, we diagnosed her with pulmonary thromboembolism with deep venous thrombosis (DVT). May-Thurner syndrome may have contributed to DVT in the left leg when the left iliac vein was compressed by the right iliac artery. She underwent anticoagulant therapy with heparin, followed by the subcutaneous injection of heparin at home after discharge. We herein report the case of a pregnant woman with May-Thurner syndrome who safely gave birth.

May-Thurner Syndrome in Pregnancy: A Case Report

“…For moderate to severe symptoms, endovascular therapy [7,8]. Anticoagulation alone can decrease post-thrombotic syndrome to <10% but is not recommended as primary therapy [5,6]. We propose conservative management with anticoagulation can be effective mode of treatment in pregnant patients to reduce VTE and encourage more research into treatment options of MTS in pregnancy.…”

“…Our patient experienced domestic violence at 17 weeks' gestation and her twin sister had no symptoms. Review of the literature shows limited cases discovered in pregnancy with no cases showing deep venous thrombosis as the presenting symptom [4][5][6]. The purpose of this case report to highlight the need for improving diagnostic criteria for MTS and prevention of venous thromboembolism in pregnancy.…”

“…First described by May and Thurner in 1957, May-Thurner Syndrome is described as left iliac vein compression by the right common iliac artery, which can lead to increased risk of deep vein thrombosis or lymphedema [1]. There have been limited cases shown to be identified during pregnancy, mostly in the postpartum period and particularly with presentation of DVT partly owed to the hypercoagulable status of pregnancy [4][5][6]. We present a case of a 31-year-old woman presenting at 28 weeks' gestation with progressive history of lower left leg edema since 21 weeks' gestation.…”

Management of May Thurner Syndrome in Pregnant Patients

“…Doppler ultrasound demonstrated extensive thrombus extending from the left posterior tibial and peroneal veins into the left common femoral vein (CFV), involving the left greater saphenous vein (GSV) (Figure 2A). MRI/MRA/MRV of the pelvis demonstrated extension throughout the external and common iliac veins, and extrinsic compression of the left common iliac vein (LVIC), as well as May Thurner anatomy has been implicated in 2-5% as the underlying etiology of patients being evaluated for symptomatic lower extremity venous disorder, and up to 20% of patients presenting with thromboembolism, particularly those presenting with extensive left-sided, or recurrent disease [2,3]. During pregnancy, physiologic compression of the inferior vena cava (IVC) and LCIV by both the gravid uterus, and the exaggerated lordosis associated with pregnancy, can exacerbate the compression associated with MTS, resulting in a higher risk of thrombosis in this patient population.…”

May-Thurner syndrome: a review

“…[3][4][5] RCIA is considered to cause this partial obstruction by direct mechanical compression of LCIV also, intimal hyperplasia in LCIV due to shear stress on anterior, posterior walls of LCIV secondary to pulsation of overlying RCIA contributes to venous obstruction and subsequent thrombosis. 6 An association of between 2-5% is estimated in patients with MTS and symptomatic venous disease of the lower limbs and 20% of patients who present thromboembolism, especially in those with recurrent thromboembolic disease, 7 this syndrome is usually diagnosed in patients with symptoms of chronic edema or DVT in the lower limbs. 8 There are certain physiological changes such as pregnancy, where compression of the inferior vena cava, both by the gravid uterus and the associated exaggerated lordosis, can exacerbate the compression associated with MTS, which can result in an increased risk of thrombosis in this population.…”