May-Thurner Syndrome with Large Abdominal Varicosity, Treated Successfully Using Multiple Approaches

Abstract

May-Thurner syndrome (MTS) is a venous outflow obstruction disorder characterized by compression of the left common iliac vein by an overriding right common iliac artery. MTS primarily affects young to middle-aged women, although many patients remain entirely asymptomatic. Anatomic variations of MTS, while uncommon, have been described. Treatment usually involves endovascular management, including thrombolysis and/or thrombectomy with or without inferior vena cava filter placement, followed by angioplasty and stenting of the left common iliac vein. We report a unique case of a 31-year-old woman who presented with MTS-related deep vein thrombosis accompanied by symptomatic abdominal and pelvic varicosities. The varicosities were treated successfully using multiple procedures, resulting in complete resolution of all symptoms. Our case discusses a treatment approach for an unusual presentation of MTS-related postthrombotic syndrome, and provides a brief literature review of MTS complications and management.

Deep vein thrombosis causing abdominal wall varicosities

“…Becuase of the patient’s femoral fracture and subsequent edema following his MVA in 2019, it is likely the patient has been experiencing DVT and associated PTS since 2019. Importantly, there have been several case studies published indicating a relationship between DVT’s resulting in May–Thurner syndrome and abdominal varicosities and abdominal pain [ 5 ]. May–Thurner syndrome occurs when the right common iliac artery overrides and compresses the left common iliac vein [ 5 ].…”

“…Importantly, there have been several case studies published indicating a relationship between DVT’s resulting in May–Thurner syndrome and abdominal varicosities and abdominal pain [ 5 ]. May–Thurner syndrome occurs when the right common iliac artery overrides and compresses the left common iliac vein [ 5 ]. Common manifestations of May–Thurner syndrome include lower abdominal pain, groin discomfort, itching, swelling and pelvic/abdominal varicosities [ 5 ].…”

“…May–Thurner syndrome occurs when the right common iliac artery overrides and compresses the left common iliac vein [ 5 ]. Common manifestations of May–Thurner syndrome include lower abdominal pain, groin discomfort, itching, swelling and pelvic/abdominal varicosities [ 5 ]. Although still poorly understood, it is likely the varicosities develop in relation to May–Thurner syndrome due to deterioration of the venous walls and subsequent backflow of blood into abdominal veins, in this case the epigastric veins [ 5 ].…”

“…This involves ‘stab phlebectomy’ of the abdominal varicosities and sclerotherapy of the iliofemoral veins. Following this, a 4–6-week prescription of Aspirin and Clopidogrel must be followed for prevention of recurrent thrombosis with an antiplatelet or anticoagulant therapy being continued indeterminately [ 5 ].…”

May-Thurner Syndrome and Recurrent DVT: A Case Report

“…MTS primarily affects young to middle-aged women, although many patients remain entirely asymptomatic. 1 Anatomic variations of MTS, though uncommon, have been described. Treatment usually involves endovascular management, including thrombolysis and/or thrombectomy with or without inferior vena cava (IVC) filter placement, followed by angioplasty and stenting of the left common iliac vein.…”