May-Thurner syndrome (MTS) is a rare cause of deep venous thrombosis (DVT), characterized by the external compression of the left common iliac vein by the right common iliac artery against bony structures. Risk factors for MTS include female sex (postpartum, multiparous, and using oral contraceptive pills), spinal abnormalities like scoliosis, prior aortoiliac vascular stent placement, dehydration, and hypercoagulability. MTS patients with partial obstruction can be asymptomatic, but progression to extensive symptomatic DVT and/or chronic venous insufficiency can occur. MTS can be diagnosed by non-invasive imaging studies including ultrasound (US), computed tomography (CT) scan, magnetic resonance imaging (MRI), venogram, catheter-based venogram, and intravascular US. For MTS patients with moderate to severe symptoms, we suggest thrombectomy, angioplasty, and stenting of the affected segment. In this case report, we highlight a 44-year-old male with a recent diagnosis of left-sided DVT on apixaban who presented with worsening leg swelling. DVT, pulmonary embolism (PE), and MTS were diagnosed with a lower extremity US, chest CT angiography, and abdominal/pelvic CT scan and venography, respectively. The patient underwent interventional radiology-guided local thrombolysis, thrombectomy, and venoplasty along with stent placement in the left common iliac vein. Subsequently, the patient was discharged on rivaroxaban.

暂无摘要。

BACKGROUND Stenting of the iliac vein remains one of the therapeutic options for the treatment of May-Thurner syndrome. Embolization of peripheral venous stents due to improper technique is a feared complication with an estimated incidence of 1% to 3%. Here we describe an interesting case of an embolized iliac vein stent in the right heart that was successfully extracted via a surgical approach. CASE REPORT A 52-year-old woman with a past medical history of hypertension, diabetes mellitus, and iliac vein stent (16×60 mm Zilver Vena) placement for May-Thurner syndrome presented for evaluation of shortness of breath, chest pain, and dizziness. A chest X-ray was performed, revealing a large stent in the cardiac silhouette. An echocardiogram showed a dense material across the tricuspid valve extending from the right atrium into the right ventricle. A percutaneous endovascular attempt to retrieve the stent was unsuccessful and led only to partial stent retrieval. An open sternotomy approach by a cardiac surgeon revealed the embolized stent across the tricuspid valve covered by endothelial tissue. The stent was successfully extracted without any need for tricuspid valve repair or replacement, followed by an uneventful postoperative recovery. CONCLUSIONS The percutaneous approach is the preferred initial option for the extraction of embolized iliac vein stents into the heart. However, when such an approach fails, the surgical approach remains a feasible option. As reported in this case, the surgical retrieval of a stent can be done without any need for either tricuspid valve repair or replacement.

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.

Deep venous thrombosis is a significant medical condition that results in life-threatening complications such as pulmonary embolism. Various factors can contribute to the formation of deep venous thrombosis, including prolonged immobility, surgery, and specific health conditions. May-Thurner syndrome is an underrecognized cause of deep venous thrombosis due to the compression of the left common iliac vein by the right common iliac artery. It poses diagnostic challenges due to its varied clinical presentations. This report discusses a 42-year-old female with no notable medical history who presented with acute onset of left leg swelling, pain, and discoloration. Despite the absence of common risk factors for deep venous thrombosis, investigations revealed a massive left-sided deep venous thrombosis. Additional imaging studies revealed the diagnosis of May-Thurner syndrome, manifesting as significant compression of the left common iliac vein. The patient underwent anticoagulation therapy, catheter-directed thrombolysis, and stent placement, resulting in symptomatic improvement and no recurrence over a six-month follow-up period. This case underscores the necessity of considering anatomical variations like May-Thurner syndrome in patients with unexplained deep venous thrombosis, particularly without typical risk factors. It highlights the importance of a comprehensive diagnostic approach, including advanced imaging techniques, to uncover underlying causes of deep venous thrombosis.

May-Thurner syndrome (MTS) is caused by compression of the left common iliac vein by the right common iliac artery against the spinal column. It can range from asymptomatic or present with subtle and unspecific signs and symptoms and rarely exhibit severe complications such as pulmonary embolism (PE). The diagnosis is confirmed by typical imaging findings. Treatment may include conservative measures, anticoagulation, endovascular or even surgical options. We report the case of a 20-year-old female who presented with cardiac arrest caused by an acute massive PE. Further study showed partial thrombosis of the internal iliac veins resulting from MTS. She continued anticoagulation therapy with low-molecular-weight heparin and then switched to edoxaban with a good clinical outcome. She was also referred to Vascular Surgery to discuss the possibility of iliac vein stenting. Abdominopelvic vascular compression syndromes include a large spectrum of conditions, and they are rarely considered as an etiology for venous thromboembolism. The clinical presentation of PE varies with several triggering factors and atypical presentation is more common in nonmalignant causes. The combination of noninvasive and invasive imaging modalities might be beneficial to establish a definitive diagnosis. Nevertheless, invasive procedures are often restricted to doubtful cases or to guide endovascular procedures which is the current treatment of choice. There is little evidence using nonvitamin K oral anticoagulants, but there are some case reports detailing their successful use. This case aims to point out the need for a profound understanding of different causes of deep vein and pulmonary thromboembolism; common entities in our practice but with a variety of clinical presentations and potentially caused by rare underlying conditions. MTS can be the origin of serious and deadly complications, hence the importance of early recognition and treatment.

Postural orthostatic tachycardia syndrome (POTS) is mainly characterized by orthostatic intolerance and positional tachycardia although it frequently involves a myriad of non-specific symptoms that seem to overlap with existing medical conditions. Recent efforts have been made to further classify subtypes of POTS and associated conditions to better delineate underlying pathophysiology in an effort to guide diagnosis and tailor treatment. Here, we present a 22-year-old female with debilitating symptoms of POTS who reported pelvic pain on review of systems and underwent vascular ultrasound of the inferior vena cava, iliac veins, and bilateral lower extremities which revealed the characteristic left common iliac vein compression of May-Thurner syndrome prompting venous stenting which provided systemic symptomatic relief.

An ilio-iliac arteriovenous fistula (AVF) is rare. Common factors leading to ilio-iliac AVF include congenital malformations, iatrogeny, and trauma. There is limited documentation in the literature of cases involving ilio-iliac AVF with May-Thurner syndrome. Here, we present a case of an ilio-iliac AVF with May-Thurner syndrome in an 80-year-old male. CT and angiography confirmed extensive ilio-iliac AVF. Successful endovascular procedures for ilio-iliac AVF were performed using several variable-sized coils and 1400-2000 µm gelatin particles. After embolization, follow-up abdominopelvic CT revealed an improvement in edema in the left leg.
장골동맥-장골정맥루는 드문 질환으로 일으키는 주요 요인으로는 선천성 이상 발생, 의인성, 외상 등이 있다. 그중에서도 May-Thurner 증후군과 동반된 장골동맥-장골정맥루에 대한 문헌은 매우 드물다. 이에 따라, 저자들은 80세 남성에서 발생한 May-Thurner 증후군과 동반된 장골동맥-장골정맥루의 증례를 보고하고자 한다. 컴퓨터단층촬영 및 혈관조영술을 통해 매우 넓은 범위의 장골동맥-장골정맥루를 확인하였고 이에 대해 다양한 크기의 색전용 코일 및 1400–2000 µm 크기의 젤라틴 입자를 사용하여 색전술을 시행하였다. 색전술 이후, 추적을 위해 시행한 복부-골반 컴퓨터단층촬영에서 왼쪽 다리의 부종이 개선됨을 확인하였다.

May-Thurner syndrome (MTS), also known as iliocaval venous compression syndrome, is a vascular condition characterized by extrinsic venous compression within the iliocaval territory. While traditionally considered a condition predominantly affecting women, this case report presents an atypical presentation in a middle-aged male patient. The patient initially presented with left lower extremity pain and swelling, which was attributed to deep venous thrombosis (DVT) in the left calf and femoral vein. Despite anticoagulation therapy, his symptoms persisted, leading to further diagnostic evaluation and the identification of MTS. This report highlights the clinical presentation, diagnostic challenges, and successful management of MTS in a male patient. Endovascular interventions, including balloon dilation and stent placement, were employed to address refractory stenosis and thrombus burden. The case emphasizes the importance of considering MTS as a potential diagnosis in patients with unexplained lower limb symptoms, irrespective of traditional risk factors or gender. Early identification and appropriate interventions can lead to symptom relief, obstruction resolution, and improved long-term outcomes for patients with MTS. This case underscores the need for heightened clinician awareness regarding MTS and its potential impact on patient care.

May-Thurner syndrome (MTS) also known as iliac vein compression syndrome, is a congenital anatomical variant, that results from the extrinsic compression of the left common iliac vein by the right iliac artery with resultant formation of left venous thrombosis. We report a case of a young man with recurrent unprovoked left lower extremity DVT in the setting of May Thurner syndrome who required endovascular intervention and was discharged on oral anticoagulation.