An Unusual Endovascular Therapeutic Approach for a Rare Case of May-Thurner Syndrome

Abstract

Patient: Male, 69Final Diagnosis: May-Thurner syndrome secondary to left common iliac artery aneurysmSymptoms: Left lower extremity edema • left lower extremity erythema • left lower extremity painMedication: —Clinical Procedure: Endovascular aneurysm repair (EVAR) of the infra-renal abdominal aorta aneurysm and right common iliac artery aneurysmSpecialty: CardiologyObjective:Unknown ethiologyBackground:The etiology of deep venous thrombosis (DVT) may pose a significant diagnostic challenge because truly reversible causes of DVT are rare. In this regard, known pelvic anatomic abnormalities such as aortic and iliac aneurysms should be seriously considered as a complicating factor in patients presenting with acute DVT so as not to miss a potentially curable etiology of May-Thurner syndrome (MTS).Case Report:We report the case of a 69-year-old man with a known abdominal aortic aneurysm and bilateral iliac artery aneurysms who presented with an acute DVT. A computed tomography scan of the abdomen and pelvis showed increased dilation of his aneurysmal disease with new resultant compression of the left iliac vein representing acquired MTS. The patient underwent endovascular aneurysm repair of the infra-renal abdominal aortic aneurysm and right common iliac artery aneurysm with a Gore Excluder endoprosthesis in lieu of venous stenting, with resolution of symptoms.Conclusions:Infra-renal aortic and iliac aneurysms causing MTS are extremely rare, and patients at risk for MTS through these mechanisms do not fit the classical demographics associated with this syndrome. Furthermore, this is the first case described in which MTS was treated by addressing the aneurysm through an endoprosthetic approach instead of venous stenting, which is the conventional intervention for MTS.

Late-Onset Nonthrombotic Left Common Iliac Vein Compression Secondary to Degenerative Lumbar Disc: A Case Report of May-Thurner Variant

“…Other anatomical variants, pelvic mass, retroperitoneal fibrosis, and a consequence of arterial intervention have been described as a cause of MTS in the literature. 2 –8…”

“…Other anatomical variants, pelvic mass, retroperitoneal fibrosis, and a consequence of arterial intervention have been described as a cause of MTS in the literature. [2][3][4][5][6][7][8] We report a case of an elderly woman with late-onset left leg swelling caused by nonthrombotic venous hypertension due to degenerative intervertebral disc bulge leading to LCIV compression against the left common iliac artery (LCIA) by using multimodality imaging tools.…”