May-Thurner Syndrome: A Rare Cause of Deep Venous Thrombosis

Khalid, Sidra; Khalid, Aariez; Meridores, Tessy; Daw, Hamed

doi:10.7759/cureus.2700

Cited by 4 publications

(7 citation statements)

References 7 publications

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“…Endovascular therapy with thrombolysis and stenting is considered the first-line treatment for MTS, because patients with extrinsic causes of obstruction usually tend to respond poorly to balloon angioplasty alone. 4 , 5 Pogorzeski et al 3 also reported that endovascular therapy should be considered as a good method for MTS, which prevents severe disablement in the patient, and stent placement for MTS resulted in 2-year long-term patency.…”

Section: Discussionmentioning

confidence: 99%

Iliac May-Thurner syndrome coexisting with arteriovenous fistula treated by endovascular therapy

Yuki

Shimada

Tanaka

et al. 2020

SAGE Open Medical Case Reports

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An 82-year-old woman presented with persistent left leg swelling despite 3 months anticoagulation for deep vein thrombosis. Ultrasound showed venous blood flowing back into the toe. Enhanced computed tomography scans and angiography showed occlusion of the left common iliac vein and a large number of arteriovenous fistulas. We made a diagnosis of May-Thurner syndrome coexisting with arteriovenous fistulas and we performed endovascular therapy only for the common iliac vein. We considered embolization for arteriovenous fistulas, but it seemed to be difficult to perform because of the possibility of development of collateral circulation and a large number of arteriovenous fistulas. After percutaneous balloon angioplasty, antegrade venous blood flow was restored, and stent implantation was not performed. After the procedure, swelling of the leg gradually reduced. She had no symptoms for the following 1 year.

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Section: Discussionmentioning

confidence: 99%

Iliac May-Thurner syndrome coexisting with arteriovenous fistula treated by endovascular therapy

Yuki

Shimada

Tanaka

et al. 2020

SAGE Open Medical Case Reports

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“…First, it is believed that chronic pulsations of the right iliac artery induce intimal hyperplasia of the underlying left common iliac vein, thus causing venous luminal shrinkage. Second, it is also believed that physical entrapment of the left common iliac vein by the overlying right iliac artery causes the external compression [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…The first and foremost issue to deal with is active iliofemoral venous thrombosis, which should be dealt with as early as possible to prevent impending lethal complications such as post-thrombotic syndrome, iliac vein rupture, and pulmonary embolism. The correction of an anatomical defect of MTS should be done after initial thrombolysis has been achieved [ 1 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Berger et al was the first person who did successful iliac vein stenting in an MTS patient in 1995 [ 7 ]. After that, successful attempts at the correction of an anatomical defect of MTS using angioplasty and stenting dates back to 1998 when Binkert et al reported 100% patency of the left iliac vein stents in eight cases [ 1 ]. However, Moudgill et al reported a one-year patency rate of 95% in a study involving 113 patients of MTS with left iliac vein thrombosis who underwent catheter-based thrombolysis and iliac vein stenting [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…With partial venous obstruction, the condition can be asymptomatic or associated with chronic ipsilateral leg swelling, but venous thrombosis can occur with critical venous outflow obstruction. MTS must be kept as a substantial differential in evaluating a young female patient with persistent unilateral leg swelling and/or deep venous thrombosis (DVT) of no apparent cause [ 1 - 3 ]. Medical treatment with heparin or warfarin is associated with the suboptimal control of DVT as well as a substantial financial burden on the healthcare system [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Clot Mayhem: A Case of May-Thurner Syndrome

Ahmad

Zain

Ashfaq

et al. 2019

Cureus

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May-Thurner syndrome (MTS), also known as the iliac vein compression syndrome, is an anatomic anomaly in which the compression of the left common iliac vein by an overlying right common iliac artery leads to blood stasis, which predisposes to deep venous thrombosis (DVT) in the iliofemoral venous system. We present a case of a female with a history of DVT and currently on warfarin with a therapeutic international normalized ratio (INR), admitted with left leg swelling, redness, and intractable pain. Venous Doppler scan confirmed a massive DVT from the level of the left common femoral vein to the popliteal vein. The clot recurred after an unsuccessful trial of argatroban, in-line pharmacokinetic thrombolysis with local catheter-based alteplase infusion, and interventional radiology (IR)-guided mechanical thrombectomy. Subsequently, the patient was diagnosed as MTS with overlying left common iliac vein compression, as evident on venous Doppler ultrasound. She was managed successfully by venous stent placement and ongoing systemic anticoagulation with fondaparinux.

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A case report of May-Thurner syndrome induced by anterior lumbar disc herniation

Xu¹,

Zhong²,

Huang³

et al. 2019

Medicine

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Rationale: Lumbar degeneration-related May-Thurner syndrome (dMTS) is characterized by venous compression induced by degenerated lower lumbar structures. Treatment strategies for May-Thurner syndrome (MTS) include clearing the thrombus and correcting venous compression. Despite having different etiological factors from other MTS types, treatments for dMTS are similar, including endovascular angioplasty and continuous anticoagulation therapies. Thus, a particular treatment was designed herein to focus on compressive lumbar structures instead of intravenous management. Patient concerns: A 59-year-old female patient with dMTS, which was induced by inferior vena cava (IVC) stenosis compressed by L4-5 anterior disc herniation. Diagnosis: The patient was diagnosed with IVC stenosis and L4-5 lumbar disc herniation based on abdominal computed tomography, ultrasound, and lumbar magnetic resonance imaging findings. Interventions: Radiofrequency thermocoagulation (RF) was applied to the patient to decrease the compression caused by anterior disc herniation. Outcomes: After surgery, the patient's swelling started to improve within 5 hours and completely diminished after 48 hours. Postsurgical abdominal ultrasound showed that her IVC patency increased by 20%. On follow-up, her leg symptoms did not recur at 12 months after surgery. Lessons: We provided a novel idea in the treatment of dMTS, in which we shifted the treatment focus from endovascular patency restoration to extravascular decompression. Our case proved that RF was effective in treating dMTS, which is a complementary treatment modality to angioplasty.

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May-Thurner Syndrome: A Rare Cause of Deep Venous Thrombosis

Cited by 4 publications

References 7 publications

Iliac May-Thurner syndrome coexisting with arteriovenous fistula treated by endovascular therapy

Iliac May-Thurner syndrome coexisting with arteriovenous fistula treated by endovascular therapy

Clot Mayhem: A Case of May-Thurner Syndrome

A case report of May-Thurner syndrome induced by anterior lumbar disc herniation

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