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. 2012 Jul;25(3):231-3.
doi: 10.1080/08998280.2012.11928834.

May-Thurner syndrome: a not so uncommon cause of a common condition

Matthew Peters  1 , Rashad Khazi Syed, Morgan Katz, John Moscona, Christopher Press, Vikram Nijjar, Mohannad Bisharat, Drew Baldwin
Affiliations

May-Thurner syndrome: a not so uncommon cause of a common condition

Matthew Peters et al. Proc (Bayl Univ Med Cent). 2012 Jul.

Abstract

May-Thurner syndrome is a rarely diagnosed condition in which patients develop iliofemoral deep venous thrombosis (DVT) due to an anatomical variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. This variant has been shown to be present in over 20% of the population; however, it is rarely considered in the differential diagnosis of DVT, particularly in patients with other risk factors. Systemic anticoagulation alone is insufficient treatment, and a more aggressive approach is necessary to prevent recurrent DVT. Herein, we present a patient with multiple risk factors for DVT. With a comprehensive diagnostic approach, she was found to have May-Thurner syndrome. Local infusion of thrombolytics as well as mechanical thrombectomy failed to resolve the thrombus. Subsequently the patient underwent successful stent placement in the area that was compressed followed by 6 months of chronic anticoagulation with warfarin. There has been no recurrence of DVT in the ensuing 18 months.

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Figures

Figure 1
Figure 1
Thrombus appearing as a filling defect in the iliofemoral vein (proximal to the white arrow). The site of dye injection was distal to SFV and DFV bifurcation. LCIV indicates left common iliac vein; EIV, external iliac vein; GSV, greater saphenous vein; CFV, common femoral vein; DFV, deep femoral vein; SFV, superficial vein.
Figure 2
Figure 2
Residual left iliofemoral thrombus and stenosis (proximal to the EIV arrow) noted after tissue plasminogen activator and heparin administration. EIV indicates external iliac vein; CFV, common femoral vein.
Figure 3
Figure 3
Trellis device (arrows) used for mechanical thrombectomy.
Figure 4
Figure 4
Left iliofemoral thrombus (proximal to the EIV arrow) improved after mechanical thrombectomy but with residual stenosis. EIV indicates external iliac vein; CFV, common femoral vein.
Figure 5
Figure 5
Installation of smart stent (between white bars) shows appearance of dye proximal to the previous area of stenosis. EIV indicates external iliac vein; CFV, common femoral vein.
See this image and copyright information in PMC

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