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Abstract
Introduction May Thurner Syndrome (MTS), an anatomical variant present in over 20% of the population, can present with iliofemoral deep venous thrombosis (DVT) caused by compression of the common iliac vein by the adjacent iliac artery.
History of presentation An 86-year-old male with hypertension, dyslipidemia, coronary artery disease status post remote drug-eluting stent placement, and a history of DVT presented with a three-week history of unilateral left lower extremity swelling. He had been increasingly sedentary over the past several months.
Investigations Whole-leg duplex ultrasonography was performed which showed extensive DVT from the knee to the ankle (Fig. 1a). Dense echoes were seen throughout with absent flow to the superficial femoral vein, popliteal vein, and posterior tibial vein, consistent with extensive left lower extremity DVT. Laboratory results revealed mild leukocytosis.
Management The patient was initiated on a heparin drip. Using Inari, 90% of the clot was retrieved through the popliteal vein via thrombectomy of the left superficial femoral vein and the left iliac vein. Balloon angioplasty of the left iliac vein was then performed. Repeat venography revealed nearly complete resolution of the clot in the left superficial femoral vein from the entry point into the common femoral vein. Intravascular ultrasound showed >80% compression remaining in the common iliac and external iliac veins. The left iliac vein was dilated with a 14.0 balloon and then stented on the way out extending from the ostium of the left iliac to the mid-femoral head. The underlying etiology was assessed as iliac vein subtotal occlusion secondary to May-Thurner syndrome.
Discussion: Association with current guidelines/position papers/current practice MTS, an anatomical variant present in over 20% of the population, can present with iliofemoral DVT caused by compression of the common iliac vein by the adjacent iliac artery. Due to a lack of recognition of MTS, patients are often treated as unprovoked DVT and committed to extended anticoagulant therapy. Complications include post-thrombotic syndrome, chronic venous insufficiency, and pulmonary embolism.
Presentation Type
Poster
Recommended Citation
Cha, Myung-Jin; Appareddy, Shyama; Rojas Huen, Jennifer; Sheriff, Usman; and Ramos, Jose, "Subtotal Iliac Vein Occlusion Secondary To May-Thurner Syndrome" (2024). Research Colloquium. 19.
https://scholarworks.utrgv.edu/colloquium/2023/posters/19
Included in
Subtotal Iliac Vein Occlusion Secondary To May-Thurner Syndrome
Introduction May Thurner Syndrome (MTS), an anatomical variant present in over 20% of the population, can present with iliofemoral deep venous thrombosis (DVT) caused by compression of the common iliac vein by the adjacent iliac artery.
History of presentation An 86-year-old male with hypertension, dyslipidemia, coronary artery disease status post remote drug-eluting stent placement, and a history of DVT presented with a three-week history of unilateral left lower extremity swelling. He had been increasingly sedentary over the past several months.
Investigations Whole-leg duplex ultrasonography was performed which showed extensive DVT from the knee to the ankle (Fig. 1a). Dense echoes were seen throughout with absent flow to the superficial femoral vein, popliteal vein, and posterior tibial vein, consistent with extensive left lower extremity DVT. Laboratory results revealed mild leukocytosis.
Management The patient was initiated on a heparin drip. Using Inari, 90% of the clot was retrieved through the popliteal vein via thrombectomy of the left superficial femoral vein and the left iliac vein. Balloon angioplasty of the left iliac vein was then performed. Repeat venography revealed nearly complete resolution of the clot in the left superficial femoral vein from the entry point into the common femoral vein. Intravascular ultrasound showed >80% compression remaining in the common iliac and external iliac veins. The left iliac vein was dilated with a 14.0 balloon and then stented on the way out extending from the ostium of the left iliac to the mid-femoral head. The underlying etiology was assessed as iliac vein subtotal occlusion secondary to May-Thurner syndrome.
Discussion: Association with current guidelines/position papers/current practice MTS, an anatomical variant present in over 20% of the population, can present with iliofemoral DVT caused by compression of the common iliac vein by the adjacent iliac artery. Due to a lack of recognition of MTS, patients are often treated as unprovoked DVT and committed to extended anticoagulant therapy. Complications include post-thrombotic syndrome, chronic venous insufficiency, and pulmonary embolism.