C62. May-Thurner syndrome, a diagnosis and endovascular treatment in adult women with no risk factor: a case report and literature review

Abstract

Abstract May-Thurner syndrome (MTS) is a venous compression syndrome in which the left common iliac vein (LCIV) is compressed between the lower lumbar spine and the right common iliac artery (RCIA). This syndrome is suspected when a patient presents with recurrent or chronic venous insufficiency (CVI) or deep vein thrombosis (DVT) on his/her left lower extremity; although MTS’ clinical presentation varies. A history of recurrent left lower extremity DVT and symptoms associated with chronic venous hypertension, including varicosities, venous ulcers, lower limb swelling, and pain in the inguinal, calf, or upper leg regions suggests MTS diagnosis. We present a case report and conduct a literature review on a patient presenting with painful, numb, and swollen left leg since three months before admission. Intermittent claudication was found. Doppler ultrasonography confirmed no thrombus, yet suggested that the RCIA compressed the LCIV. Doppler’s finding was confirmed using computed tomography (CT) scan, and RCIA compression seemed to cause an obstruction. MTS diagnosis is often missed in patients with lower limb pain because the block is not caused by a thrombus and a clinician often misses to conduct Doppler examination on the iliac artery/vein. This study highlights the importance of considering MTS in a patient with left lower limb pain, and chronic DVT which is unresponsive to pharmacological treatment, hence, endovascular treatment may be warranted.