We report a case of a 31-year-old man who presented to the hospital with extensive deep vein thrombosis (DVT) complicated by pulmonary embolism (PE) after a recent trauma and prolonged immobilization. He underwent contrast venography that revealed features of May-Thurner syndrome (MTS). He was managed with therapeutic anticoagulation, inferior vena cava filter placement, mechanical clot aspiration, catheterdirected thrombolytic therapy, and left common iliac vein stenting.MTS is a vascular condition caused by the compression of the left common iliac vein by an overlying right common iliac artery against a vertebral body. This results in indolent endothelial changes secondary to the pulsating nearby artery as well as the compression increasing the susceptibility to venous thrombosis. Females are thought to be more prone to the condition due to the nature of their pelvic anatomy. Most patients are asymptomatic or present with unspecific symptoms, rendering the condition underdiagnosed. The gold standard diagnostic modality is contrast venography that reveals collaterals and a pressure gradient greater than 2 mmHg at rest across the stenotic region. Treatment is revolved around the removal of the thrombus along with the correction of the anatomical defect through interventional or surgical treatment to prevent a recurrence.Untreated MTS complicated with DVT carries a risk of potentially life-threatening complications, such as PE, iliac vein rupture, retroperitoneal hematoma, or refractory DVT that is difficult to treat. Due to the chronicity of this syndrome, its management plan differs from that of other causes of DVT. Proper identification of MTS carries a positive outcome in treating DVT secondary to MTS. Here we are going to discuss a case diagnosed with MTS complicated by saddle PE outlying the possible pathophysiology, clinical manifestation, diagnostic tools, and management of complicated MTS.

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cost and acceptable success rate, so that all group of people will be benefitted. With this background we did a study on glue embolisation of truncal varicosities. Aim of the Study: (1) To evaluate the success rate of adhesive embolisation using N Butyl 2 Cyanoacrylate. (2) To compare the occlusion rate with RFA. (3) To analyse the cost difference between both. Method(s): Study period: October 2017 to October 2018. Inclusion criteria: Incompetent SFJ wth reflux into GSV. Exclusion criteria -Deep vein thrombosis. Glue embolisation of great saphenous vein (GSV) is planned atleast for thirty patients. The great saphenous vein in thigh was punctered directly with 21 G needle atleast at 7 -10 sites with a gap of 5 cms and 0.1-0.2 ml of glue is injected at each sites. After injection, compression is done with ultrasound probe for 45 seconds at that site. The injection is started from the caudal to cranial direction. The procedure is performed without perivenous tumescence. The patients are advised to come for follow up at one week, one month and six months intervals. The Patients will be evaluted for occlusion of GSV as well as complications associated with it. The results are compared with the results of RFA of varicose veins in our institute. Result(s): (1) Glue embolisation occlusion rate at 6 months: 93%. (2) Comparable to RFA at 6 months gap. (3) Decrease in the cost by >300%. Conclusion(s):The efficacy of glue embolisation of varicose veins done with direct puncture is similar to RFA at 6 months follow up and it can be done with decreased cost (<1/4th of RFA).

Inferior vena cava (IVC) duplication is a well-known anatomic variation that is important when relevant procedures are being planned. Duplication of IVC is a relatively rare to detect especially vascular anomaly with a prevalence of 1.5% (range 0.2–3.0%). Knowing this anatomical variation is very important in cases of IVC filter placement. Filter placement in duplicated IVC cases has many options like placing it in both vena cavae, suprarenal filter placement, or coil embolization of the intervenous segment plus placing a filter in the right IVC. We report a case of a patient with newly diagnosed bladder cancer who had a high risk of thrombosis and a recent massive pulmonary embolism. The patient was planned for transurethral resection of the bladder tumor. As a prophylactic measure, an IVC filter placement was requested to prevent further pulmonary emboli that might occur during or after surgery. Cavography showed a duplicated IVC, and the filter placement was performed in the suprarenal portion and was proved to be an adequate and safe procedure. No procedure-related complications were reported. There are few worldwide reported cases of filter placement in a duplicated vena cava, and to our best knowledge, this is the first case reported in Oman.