Abstract：
BACKGROUND: May-Thurner syndrome (MTS) is an extrinsic venous compression by the arterial system against bony structures in the iliocaval territory. The most common variant of MTS is due to compression of the left iliac vein between the overlying right common iliac artery and the fifth lumbar vertebrae. The prevalence of MTS is unknown; therefore, there are only a few publications about MTS in kidney transplant recipients. Risk factors that may progress from usually asymptomatic to symptomatic MTS are female sex, scoliosis, dehydration, coagulation disorders, and radiation. Clinical presentations include acute extremity pain and swelling, venous claudication, and chronic signs of venous insufficiency.
METHODS: We describe a 63-year-old man who underwent kidney transplantation (left iliac fossa). Four days after transplantation, a graftectomy was done due to graft rupture caused by renal vein thrombosis. After imaging studies, a diagnosis of MTS was established. The patient had no typical symptoms of MTS. However, an incidence of right lower limb thrombosis was observed, and due to vertebral discopathy, the patient underwent surgery with implantation of a vertebral implant.
RESULTS: After a successful second transplantation on the right side, incidents of thrombosis were observed: superficial thrombosis of the upper limbs and massive deep vein thrombosis of the right lower limb. Thrombophilia was recognized, the graft function is stable, and anticoagulation therapy is being continued.
CONCLUSIONS: Asymptomatic MTS in the case of coincidence of other risk factors, such as coagulation disorders, history of vertebral operation, and additional pressure of the graft, can result in graft failure.
METHODS: We describe a 63-year-old man who underwent kidney transplantation (left iliac fossa). Four days after transplantation, a graftectomy was done due to graft rupture caused by renal vein thrombosis. After imaging studies, a diagnosis of MTS was established. The patient had no typical symptoms of MTS. However, an incidence of right lower limb thrombosis was observed, and due to vertebral discopathy, the patient underwent surgery with implantation of a vertebral implant.
RESULTS: After a successful second transplantation on the right side, incidents of thrombosis were observed: superficial thrombosis of the upper limbs and massive deep vein thrombosis of the right lower limb. Thrombophilia was recognized, the graft function is stable, and anticoagulation therapy is being continued.
CONCLUSIONS: Asymptomatic MTS in the case of coincidence of other risk factors, such as coagulation disorders, history of vertebral operation, and additional pressure of the graft, can result in graft failure.
摘要：
背景：May-Thurner综合征（MTS）是动脉系统对髂静脉区域骨结构的外在静脉压迫。MTS最常见的变体是由于上覆的右髂总动脉和第五腰椎之间的左髂静脉受压。MTS的患病率未知；因此，关于肾移植受者的MTS的出版物很少。可能从通常无症状发展到有症状的MTS的危险因素是女性，脊柱侧弯,脱水,凝血障碍，和辐射。临床表现包括急性四肢疼痛和肿胀，静脉性跛行,静脉功能不全的慢性体征.
方法：我们描述了一名63岁的男子，他接受了肾脏移植（左髂窝）。移植后四天,由于肾静脉血栓形成引起的移植物破裂，进行了移植物切除术。影像学检查后,建立了MTS的诊断。患者没有典型的MTS症状。然而,观察到右下肢血栓的发生率，由于脊椎的交错觉,患者接受了植入椎体植入物的手术。
结果：在右侧成功进行第二次移植后，观察到血栓形成事件：上肢浅表血栓形成和右下肢大量深静脉血栓形成。血栓形成被确认,移植物功能稳定,抗凝治疗仍在继续。
结论：在其他危险因素一致的情况下，无症状的MTS，如凝血障碍，脊椎手术史,和移植物的额外压力，可导致移植物失败。
方法：我们描述了一名63岁的男子，他接受了肾脏移植（左髂窝）。移植后四天,由于肾静脉血栓形成引起的移植物破裂，进行了移植物切除术。影像学检查后,建立了MTS的诊断。患者没有典型的MTS症状。然而,观察到右下肢血栓的发生率，由于脊椎的交错觉,患者接受了植入椎体植入物的手术。
结果：在右侧成功进行第二次移植后，观察到血栓形成事件：上肢浅表血栓形成和右下肢大量深静脉血栓形成。血栓形成被确认,移植物功能稳定,抗凝治疗仍在继续。
结论：在其他危险因素一致的情况下，无症状的MTS，如凝血障碍，脊椎手术史,和移植物的额外压力，可导致移植物失败。
