Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Jul 28;13(7):e16682.
doi: 10.7759/cureus.16682. eCollection 2021 Jul.

May-Thurner Syndrome: An Anatomic Predisposition to Deep Vein Thrombosis

Wasey Ali Yadullahi Mir  1 , Dhan B Shrestha  1 , Barun B Aryal  2 , Victoria Lord  3 , Larissa Verda  1
Affiliations
Case Reports

May-Thurner Syndrome: An Anatomic Predisposition to Deep Vein Thrombosis

Wasey Ali Yadullahi Mir et al. Cureus. .

Abstract

May-Thurner syndrome (MTS) is a rare clinical condition caused by extrinsic compression of the left common iliac vein by the right common iliac artery, leading to venous stasis and predisposing to thrombus formation. Here, we present the case of a 39-year-old female with no obviously known other risk factors predisposing to thrombosis who presented with severe left leg pain and swelling for a week. The international normalized ratio was elevated and the venous Doppler study showed extensive thrombosis extending from the left common iliac vein to the common femoral vein and the popliteal vein. She was diagnosed with MTS and treated with catheter-directed mechanical thrombolysis and thrombectomy, along with angioplasty of the left common iliac vein and external iliac vein, with near-complete resolution post-treatment. MTS should be suspected in patients who present with unilateral limb thrombosis regardless of the presence of predisposing factors. Timely management with endovascular procedures is necessary to help prevent other potential life-threatening complications.

Keywords: deep vein thrombosis; endovascular procedure; iliac artery; iliac vein; may-thurner syndrome; mechanical thrombolysis.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Transverse section of CT pelvis showing compression of the left common iliac vein (black arrow) by the right common Iliac artery (red arrow) in the pelvis.
CT: computed tomography
Figure 2
Figure 2. Pre-thrombectomy venogram showing thrombus in the left iliac vein extending to the femoral vein (black arrow).
Figure 3
Figure 3. Post-thrombolysis and thrombectomy balloon angioplasty with a waist of the balloon (red arrow) due to external compression by the right iliac artery.
Figure 4
Figure 4. Post-angioplasty venogram (black arrow) showing patent flow and minimal residual stenosis.
Figure 5
Figure 5. Ultrasound of the pelvis on the six-month follow-up showing patency of the vein (blue arrow) with no residual obstruction, with red arrow showing the overlying artery.
See this image and copyright information in PMC

References

    1. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. May R, Thurner J. Angiology. 1957;8:419–427. - PubMed
    1. Systematic review of May-Thurner syndrome with emphasis on gender differences. Kaltenmeier CT, Erben Y, Indes J, Lee A, Dardik A, Sarac T, Ochoa Chaar CI. J Vasc Surg Venous Lymphat Disord. 2018;6:399–407. - PubMed
    1. Arterial compression of the right common iliac vein; an unusual anatomical variant. Molloy S, Jacob S, Buckenham T, Khaw KT, Taylor RS. Cardiovasc Surg. 2002;10:291–292. - PubMed
    1. Unusual cases of right-sided and left-sided May-Thurner syndrome. Vijayalakshmi IB, Setty HS, Narasimhan C. Cardiol Young. 2015;25:797–799. - PubMed
    1. "Right-sided" May-Thurner syndrome. Abboud G, Midulla M, Lions C, El Ngheoui Z, Gengler L, Martinelli T, Beregi JP. Cardiovasc Intervent Radiol. 2010;33:1056–1059. - PubMed

Publication types

LinkOut - more resources