American Journal of Medical Case Reports
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American Journal of Medical Case Reports. 2016, 4(5), 180-185
DOI: 10.12691/ajmcr-4-5-10
Open AccessCase Report

Endovascular Treatment of Deep Vein Thrombosis Associated with May-Thurner Syndrome: A Case Series

Teresa Arquero Portero1, José Urbano García2, Aránzazu García Raso1, 3, and Ma Pilar Llamas Sillero1

1Department of Hematology, Thrombosis Unit, Fundacion Jimenez Diaz University Hospital, Madrid, Spain

2Department of Radiology, Vascular and Interventional Radiology Unit, Fundacion Jimenez Diaz University Hospital, Madrid, Spain

3Experimental Hematology Laboratory, Health Research Institute IIS-FJD, Madrid, Spain

Pub. Date: May 31, 2016

Cite this paper:
Teresa Arquero Portero, José Urbano García, Aránzazu García Raso and Ma Pilar Llamas Sillero. Endovascular Treatment of Deep Vein Thrombosis Associated with May-Thurner Syndrome: A Case Series. American Journal of Medical Case Reports. 2016; 4(5):180-185. doi: 10.12691/ajmcr-4-5-10


Introduction: May-Thurner syndrome (MTS) is an entity caused by the compression of the left iliac vein that predispose to acute deep vein thrombosis (DVT) of left lower limb. While standar management is anticoagulant therapy, a review of the literature reveals that new endovascular therapies can offer more optimal outcome than anticoagulation alone, preserving normal venous valve function, and avoiding post-thrombotic syndrome. In addition, we have detected that the highest risk of complications appears when MTS is associated with another congenital or acquired prothrombotic factor (thrombophilia). Case presentation: We report four causes of MTS in caucasian patients treated with endovascular techniques in our hospital over the last years. All patients were middle-aged severe symptomatic women with positive venographic findings for acute or chronic extensive left lower-extremity DVT. In addition, all patients were positive for thrombophilia test. Conclusion: DVT study in patients with MTS must include a search for thrombophilia factors, as those patients are most likely to benefit from new technical approaches.

May-Thurner syndrome iliac vein compression syndrome venous thrombosis endovascular therapy stent post-thrombotic syndrome case report

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[1]  Raffini L, Raybagkar D, Cahill AM, et al. May–Thurner syndrome (iliac vein compression) and thrombosis in adolescents. Pediatr. Blood Cancer. 2006;47(6):834-838.
[2]  Gurel K, Gurel S, Karavas E, Buharalıoglu Y, Daglar B. Direct contrast-enhanced MR venography in the diagnosis of May-Thurner Syndrome. European Journal of Radiology. 2011; 80(2):533-536.
[3]  Pianta MJ, Thomson KR. Catheter-Directed Thrombolysis of Lower Limb Thrombosis. Cardiovasc Intervent Radiol. 2010; 34(1):25-36.
[4]  Gordillo-Escobar E, Egea-Guerrero JJ, Revuelto-Rey J, Martín-Bermúdez R. [May-Thurner syndrome: an infrequent cause of spontaneous left iliac vein rupture]. Med Intensiva. 2012; 36(3): 239-240.
[5]  Kibbe MR, Ujiki M, Goodwin AL, et al. Iliac vein compression in an asymptomatic patient population. J. Vasc. Surg. 2004; 39(5): 937-943.
[6]  O'Sullivan GJ, Semba CP, Bittner CA, et al. Endovascular management of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 2000;11(7):823-836.
[7]  Ludwig BB, Han TT, Amundson DD. Post-thrombotic syndrome complicating a case of May-Thurner syndrome despite endovascular therapy: case report and review. Chest. 2006; 129(5): 1382-1386.
[8]  Haig Y, Enden T, Grøtta O, Kløw NE et al. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol. 2016 Feb;3:e64-71.
[9]  Mahnken A, Thomson K, De Haan M, O’Sullivan G. CIRSE Standards of Practice Guidelines on Iliocaval Stenting. Cardiovasc Intervent Radiol (2014) 37:889-897.
[10]  Virchow R. Uber die Erweiterung kleiner Gefasse. Arch Path Anat. 1851; 427.
[11]  May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957;8(5):419-427.
[12]  Cockett FB, Thomas ML. The iliac compression syndrome. Br J Surg. 1965;52(10):816-821.
[13]  Cockett FB. Venous causes of swollen leg. Br J Surg. 1967;54(10):891-894.
[14]  Roebuck DJ, Barnacle AM. May-Thurner syndrome. Pediatr. Blood Cancer. 2011;57(4):701-701.
[15]  Wolpert LM, Rahmani O, Stein B, Gallagher JJ, Drezner AD. Magnetic resonance venography in the diagnosis and management of May-Thurner syndrome. Vasc Endovascular Surg. 2002; 36(1): 51-57.
[16]  Cil BE, Akpinar E, Karcaaltincaba M, Akinci D. Case 76: May-Thurner syndrome. Radiology. 2004;233(2):361-365.
[17]  Patterson BO, Hinchliffe R, Loftus IM, Thompson MM, Holt PJ. Indications for catheter-directed thrombolysis in the management of acute proximal deep venous thrombosis. Arterioscler. Thromb. Vasc. Biol. 2010;30(4):669-674.
[18]  Patterson BO, Karthikesalingam A, Morgan R, et al. Management strategies for acute proximal deep vein thrombosis: a Delphi consensus. Phlebology. 2013;27(8):423-429.
[19]  Plate G, Eklof B, Norgren L, Ohlin P, Dahlstrom JA. Venous thrombectomy for iliofemoral vein thrombosis--10-year results of a prospective randomised study. Eur J Vasc Endovasc Surg. 1997; 14(5):367-374.
[20]  Oguzkurt L, Ozkan U, Ulusan S, Koc Z, Tercan F. Compression of the left common iliac vein in asymptomatic subjects and patients with left iliofemoral deep vein thrombosis. J Vasc Interv Radiol. 2008;19(3):366-370.
[21]  Berger A, Jaffe JW, York TN. Iliac compression syndrome treated with stent placement. J. Vasc. Surg. 1995;21(3):510-514.
[22]  Baron HC, Shams J, Wayne M. Iliac vein compression syndrome: a new method of treatment. Am Surg. 2000;66(7):653–655.
[23]  Heijmen RH, Bollen TL, Duyndam DA, et al. Endovascular venous stenting in May-Thurner syndrome. J Cardiovasc Surg (Torino). 2001;42(1):83–87.
[24]  Holper P, Kotelis D, Attigah N, Hyhlik-Durr A, Bockler D. Longterm results after surgical thrombectomy and simultaneous stenting for symptomatic iliofemoral venous thrombosis. Eur J Vasc Endovasc Surg. 2010;39(3):349-355.
[25]  Jeon UB, Chung JW, Jae HJ, et al. May-Thurner syndrome complicated by acute iliofemoral vein thrombosis: helical CT venography for evaluation of long-term stent patency and changes in the iliac vein. AJR Am J Roentgenol. 2010;195(3):751-757.
[26]  Moudgill N, Hager E, Gonsalves C, et al. May-Thurner Syndrome: Case Report and Review of the Literature Involving Modern Endovascular Therapy. Vascular. 2009;17(6):330-335.
[27]  Suwanabol PA, Tefera G, Schwarze ML. Syndromes associated with the deep veins: phlegmasia cerulea dolens, May-Thurner syndrome, and nutcracker syndrome. Perspect Vasc Surg Endovasc Ther. 2010;22(4):223-230.
[28]  Suresh Vedantham, Samuel Z. Goldhaber, Susan R. Kahn et al. Rationale and Design of the ATTRACT Study - A Multicenter Randomized Trial to Evaluate Pharmacomechanical CatheterDirected Thrombolysis for the Prevention of Post-Thrombotic Syndrome in Patients with Proximal Deep Vein Thrombosis Am Heart J. 2013 April ; 165(4): 523-530.
[29]  Billakanty S, Burket MW, Grubb BP. May-Thurner syndrome: A vascular abnormality encountered during electrophysiologic study. Pacing Clin Electrophysiol. 2006;29(11):1310-1311.