Poster No. 043 A Case of Post Thrombotic Syndrome and AV Fistula arising from Recurrent DVT Secondary to May – Thurner Syndrome (MTS) in an Elderly Woman

Abstract

Abstract May-Thurner Syndrome (MTS) remains to be an overlooked condition wherein the right common iliac artery compresses the left common iliac vein. Rarely reported, MTS has other different variants with the iliac vein being compressed by an ipsilateral artery. Iliofemoral DVT poses a significant impact because of venous claudication and DVT recurrence. MTS usually occurs in women, ages 20–40 y/o, and is thus rarely included in differential diagnosis of DVT in elderly patients presenting with persistent unilateral leg swelling. Treatment of DVT alone with anticoagulation is insufficient to address thrombotic MTS. Failure to address the mechanical compression leads to poor quality of life due to high predisposition to recurrent DVT, and at times to other complications such as post-thrombotic syndrome and formation of AV fistulas. We present a case of an 89 year old woman, hypertensive, non-smoker, no history of cancer, presenting with progressive left lower extremity swelling with erythema, violaceous discoloration, varicosities, telangiectatic skin lesions, hyperpigmentation and calf tenderness. Ultrasound revealed DVT at common iliac vein extending to the popliteal veins. CT studies showed a left common iliac artery compressing the left common iliac vein with early enhancement of the common femoral vein, indicating presence of fistula. Peripheral angiography and venography findings were consistent with CT scan findings, with incidental findings of multiple small AV fistulas. Anti-coagulation was given and IVC filter was inserted. An attempt to do catheter-directed thrombolysis was unsuccessful. Subsequently, she underwent Palma's surgery which provided significant improvement and was sent home ambulatory.