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Case Reports
. 2021 Sep 13;16(11):3534-3539.
doi: 10.1016/j.radcr.2021.08.045. eCollection 2021 Nov.

May-Thurner syndrome with inferior mesenteric vein drainage and porta system - Case report

Guadalupe Mercedes Lucia Guerrero Avendaño  1 , Rocio Enriquez García  1 , Javier Eduardo Barranco Carvajal  2 , Carlos Alberto Saldivar Rodea  1
Affiliations
Case Reports

May-Thurner syndrome with inferior mesenteric vein drainage and porta system - Case report

Guadalupe Mercedes Lucia Guerrero Avendaño et al. Radiol Case Rep. .

Erratum in

Abstract

We present the case of a 12-year-old girl with a history of vascular anomalies in the lower pelvic limbs and back, who developed unilateral deep vein thrombosis of the left lower limb after her pubertal development, she was diagnosed with May-Thurner syndrome with an abnormal venous drainage of the pelvic structures through the superior hemorrhoidal veins to the inferior mesenteric vein towards the porta system, this being a chronic manifestation. This kind of behavior has not been documented in the reviewed medical literature. Secondarily, balloon angioplasty was performed without breaking the stenotic ring. As a second attempt, it was decided to place the venous stent, with satisfactory resolution of the symptoms. There are controversies about the indications for the use of anticoagulants and antiplatelet agents, or the indications to place a venous stent in children. We must consider an approach to for effective therapeutic treatment in these cases is to control bleeding, the main goal being trying to avoid ulcerations in the lower limb due to venous insufficiency with irreversible affectation of the valvular system.

Keywords: Case report; Iliac vein; Inferior mesenteric vein drainage; May-Thurner; Venous stent; extremity deep vein thrombosis.

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Figures

Fig 1
Fig. 1
Phlebography of the right leg, with venous ectasia, malformed secondary to vascular anomaly. Some valves of the deep venous system are insufficient and there is bulging in these.
Fig 2
Fig. 2
Contrast tomography of the lower members in coronal cut, where common vascular venous anomalies are observed in both legs, with muscular affectation. (Arrows).
Fig 3
Fig. 3
Sequences of axial tomographies of the abdomen in contrast phase where the compression by the common right iliac artery (Thick Arrow) on the left iliac vein is observed (Arrowhead). In figure C, the filling defect is observed regarding partial venous thrombosis. (Curved Arrow).
Fig 4
Fig. 4
Phlebography with digital subtraction in AP. The left external iliac vein is observed, with reduced flow and turbulence at the expense of thrombus attached to the medial wall (Thick Arrow), as well as extrinsic compression of the common left iliac vein and venue reflux of the left internal iliac vein. (Curved Arrow).
Fig 5
Fig. 5
Reconstruction in 3 dimensions (3D) where dilation of the aneurysmatic aspect of the inferior mesenteric vein is observed (Arrowhead), associated with pelvic venous congestion and splenomegaly. (Arrows).
Fig 6
Fig. 6
Phlebography corresponding to plasty performed on stenosis presented by the common left iliac vein, with partial reduction of stenosis. It is molded and could not break the fibrous ring.
Fig 7
Fig. 7
Phlebography corresponding to the release of the venous stent on the left iliac vein.
See this image and copyright information in PMC

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