An Extensive Unprovoked Left Lower Extremity Deep Vein Thrombosis Secondary to an Anatomical Anomaly: A Case of May-Thurner Syndrome

Abstract

May-Thurner syndrome (MTS) also known as Cockett’s syndrome is a rare condition responsible for 2%-3% of all cases of deep venous thrombosis (DVT). The thrombosis results from mechanical compression of the left common iliac vein against the body of the fifth lumbar vertebra by the right common iliac artery. Repetitive hyperplasia of the venous wall by compression results in spur formation that in turn causes venous flow obstruction and results in the DVT. Our case is a young female who had acute extensive proximal DVT due to MTS that was successfully managed using mechanical thrombectomy with a venous stent. MTS although a rare entity should be suspected especially in young patients with unilateral DVT with extensive clots especially on left lower extremity without any antecedent risk factors.

Endovascular management of extensive iliocaval thrombosis secondary to synchronous uterine myoma compression and May-Thurner syndrome

“…Among anatomically acquired risk factors of DVT, compression by right common iliac artery is a common pattern seen in 22% of the normal population and is responsible for 2%-3% of all lower extremity DVT and 18%-49% of left sided lower extremity DVT [7]. It is more common in young, otherwise healthy women between ages 20-50 years of age [8]. There have been multiple case reports published regarding MTS secondary to arterial reconstruction or stenting, aneurysm formation, or anatomical variants.…”

Sudden death due to pulmonary embolism after minor ankle surgery

“…Doppler ultrasound has been found useful for the diagnosis of lower extremity VTE, however its efficiency to visualise a clot on a higher level is limited by factors like body fat and bowel gases 8. Similarly, duplex scan and impedance plethysmography can be used for screening purposes 9.…”

Iliofemoral Vein Stenting in a Patient with Pelvic Metastasis

“…Huge and unresectable pelvic masses could cause iliofemoral venous occlusion, primarily due to thrombosis and secondarily due to external compression of a mass, malignant invasion, fibrosis, or intraluminal extension of the tumor [ 1 , 2 ]. Iliac vein compression and venous insufficiency result in pain, swelling, stasis ulcer, skin hyperpigmentation, varicosities, and venous claudication, which can compromise the quality of life [ 3 , 4 ]. Endovascular venoplasty and stent placement are minimally invasive techniques that are increasingly being considered as palliative therapy in addition to conventional therapies [ 5 , 6 ].…”