Abstract
May-Thurner syndrome (MTS) has been recognized as a clinical entity for almost six decades. The true incidence rate of MTS is unknown and perhaps ranges from 22 to 32% according to the autopsy studies in the early twentieth century. However, MTS related deep venous thrombosis (DVT) accounts for only 2%-3% of all lower limb DVTS. In MTS, the left common iliac vein is compressed against the fifth lumbar vertebrae by the right common iliac artery, as it crosses in front of the vein. Chronic pulsation of the artery is thought to cause elastin, collagen deposition, and intimal fibrosis leading to formation of venous spur and venous thrombosis. MTS can present as acute or chronic DVT leading to pulmonary embolism (PE), chronic leg pain, chronic ulcers, or skin pigmentation changes. In this case report we have described an interesting case of a 28-year-old Caucasian female who presented for evaluation of shortness of breath (SOB) associated with cough for one week. SOB was found to be secondary to massive bilateral pulmonary embolism resulting from extensive MTS related DVT of the left lower extremity. Patient underwent pharmacomechanical treatment with local thrombolysis, thrombectomy, and venoplasty along with stent placement that extended to inferior vena caval junction. Subsequently patient was discharged on coumadin. MTS should be considered in differentials when faced with a case of unilateral DVT particularly in younger age group.
Highlights
Virchow in 1851 observed that iliofemoral deep venous thrombosis (DVT) was five times more likely to occur in the left leg as compared to the right
In this paper we have described an interesting case of a young female patient who presented with worsening acute shortness of breath due to massive bilateral pulmonary embolism resulting from May-Thurner syndrome (MTS) related extensive DVT of the left leg
On the subsequent day patient underwent repeat venography which showed no significant thrombus burden but revealed narrowing of the left common iliac vein (Figures 3(d) and 3(e)) which confirmed the diagnosis of MTS, venoplasty was done, and two stents made of nitinol measuring 14 mm × 8 cm and 14 mm × 3 cm were deployed in iliocaval junction with a good flow through stent into inferior vena cava (IVC) (Figure 3(f))
Summary
Virchow in 1851 observed that iliofemoral deep venous thrombosis (DVT) was five times more likely to occur in the left leg as compared to the right. In 1957, May and Thurner provided an explanation of this phenomenon by discovering an anatomical variation of left common iliac vein They found that the left common iliac vein had a vascular thickening at the point where it was crossed and compressed against the fifth lumbar vertebrae by overlying right common iliac artery [1]. They called this lesion, “a venous spur” and postulated that a chronic pulsation of the overlying iliac artery is responsible for formation of this spur and that it is the spur, that leads to a venous obstruction. In this paper we have described an interesting case of a young female patient who presented with worsening acute shortness of breath due to massive bilateral pulmonary embolism resulting from MTS related extensive DVT of the left leg
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