May-Thurner Syndrome with Double Compression of the Iliac Vein: Lessons Based on a Case Report

Abstract

Patient: Female, 73-year-old Final Diagnosis: May-Thurner syndrome with double stenosis of the left common iliac vein Symptoms: Acute onset of worsening dyspnea, with lymphedema of the left lower limb Medication: — Clinical Procedure: — Specialty: Diagnostics, Laboratory • Radiology Objective: Rare disease Background: May-Thurner syndrome, also known as Cockett’s syndrome, is characterized by vascular alterations due to stenosis of the left iliac vein, usually caused by compression against the vertebral column by the right iliac artery. Doppler ultrasound represents the first level of examination for the study of this vascular pathology, and allows a very accurate study of the lower-limb vessels. We describe an unusual presentation with double stenosis of the left common iliac vein. Case Report: A 73-year-old woman came to the clinic for acute onset of worsening dyspnea, with lymphedema of the left lower limb, and was examined using ultrasound and multidetector computed tomography. The Doppler ultra-sound exam showed 2 compressions of the common iliac vein by the right and left iliac artery due to a combination of osteophytosis of the vertebral column and reduced distance between the left iliac vein and the spine. Conclusions: May-Thurner syndrome should be suspected in patients with symptoms of venous stasis of the left lower limb. Doppler ultrasound identified stenosis of the common iliac vein and the consequent flow changes. Failure to diagnose and treat May-Thurner syndrome could expose patients to very serious risks to their health.

Acute left iliofemoral vein thrombosis: Comparison between simple and bony May-Thurner syndrome in CT venography

“…Farina et al reported that dual compression of the LCIV was found due to osteophytes. 25 Similarly, in our study, compression of the distal LCIV was due to narrowing between lumbar degenerative change and the LCIA, and it accounted for half of bony MTS cases. Degenerative lumbar change is more likely to occur broadly rather than focally, and a larger range of the LCIV is more likely to be compressed in bony MTS.…”

Unveiling May-Thurner Syndrome in a Case of Recurrent Deep Venous Thrombosis With Bilateral Pulmonary Embolism

“…Meng et al also prescribed rivaroxaban (10 mg/day) to MTS patients upon discharge [ 16 ]. However, Farina et al recommended a much higher dose rate (15 mg rivaroxaban twice a day in the first four weeks and 10 mg oral rivaroxaban with 100 mg aspirin per day for six months) compared to our study [ 17 ]. Several other case studies have also reported the use of rivaroxaban to prevent the recurrence of MTS [ 18 , 19 ].…”

Intravascular Ultrasound in Treating Iliac Vein Compression With Endovascular Stenting: A Necessary Tool for Optimal Outcomes

“…1 Atypical cases of MTS including compression of the left external iliac vein, right iliac vein or the IVC, some of them depicted on DUS causing double vein compression have been reported in the literature. 11 Nevertheless, DUS has been shown to be a less reliable diagnostic test for iliac vein stenosis as it yields a smaller cross-sectional image of CIV and EIV compared to IVUS. 7 Furthermore, venography has been shown to be less accurate compared to IVUS regarding the location of the iliac stenosis and the ilio-caval confluence, as well as the distal landing zone when planning for stent placement.…”