Recurrent Iliofemoral Venous Thrombosis in the Setting of May-Thurner Syndrome as the Presenting Symptom of Behcet's Disease

Endovascular Stenting for May-Thurner Syndrome: A Case Report

May-Thurner syndrome, also known as iliocaval compression syndrome, is a rare vascular condition that involves compression of the left common iliac vein by the right common iliac artery. This compression can lead to venous stasis and increase the risk of deep vein thrombosis in the left lower extremity. Treatment options range from conservative measures to endovascular procedures such as venous stenting. Here, we present the case of a 45-year-old female with a history of recurrent deep vein thrombosis in her left leg, who arrived at the emergency department with swelling, pain, and tenderness. She was on warfarin therapy for deep vein thrombosis management. Physical examination and laboratory investigations supported the diagnosis of acute deep vein thrombosis. Further investigations revealed May-Thurner syndrome, with the left common iliac vein being compressed by the right common iliac artery, leading to extensive thrombosis in the left lower extremity. Endovascular stenting was performed to relieve the obstruction and restore venous blood flow. The patient's symptoms improved after the stenting procedure, and she remained asymptomatic during follow-up with continued anticoagulation therapy. Awareness of May-Thurner syndrome is crucial, especially in patients with recurrent deep venous thrombosis and anatomical risk factors. Successful management requires a multidisciplinary approach involving anticoagulation therapy and endovascular stenting.

A Case Report of Behcet's Disease With Thromboses in the Superior Vena Cava and External Iliac Vein

Behcet's disease (BD), also known as Behcet's syndrome, is a rare, chronic, autoimmune disorder of unknown origin. Its manifestations are thought to be caused by vasculitis, resulting in damage to blood vessels of all sizes throughout the body. We report a 25-year-old Pakistani male who is sexually active and presents with a one-year history of shortness of breath, cough, exertional dyspnea, and neck and facial swelling. On examination, he had severe anemia, mouth ulcers, distended neck and chest veins, prominent abdominal veins, and a scrotal ulcer. After going through mandatory investigations to evaluate the presenting signs and symptoms, thromboses were found in the major veins, including the superior vena cava (SVC) and external iliac vein, as well as a positive pathergy test. Accordingly, a diagnosis of Behcet’s disease with cardiomyopathy and venous thrombosis was made. He was treated with anticoagulants, steroids, and azathioprine for six months and subsequently went into remission.

Postinterventional antithrombotic management after venous stenting of the iliofemoral tract in acute and chronic thrombosis: A systematic review

Venous stenting has become a common treatment option for central deep venous outflow obstructions and postthrombotic syndrome. Following successful recanalization and stenting, stent patency is endangered by in-stent thrombosis and recurrent venous thromboembolism. Antithrombotic therapy might reduce patency loss. This systematic review summarizes the literature on antithrombotic therapy following (post)thrombotic venous stenting. A systematic PubMed, MEDLINE, EMBASE, and Cochrane search was performed for studies addressing antithrombotic therapy prescribed following venous stenting of the iliofemoral tract indicated by acute or chronic thrombotic pathology. A total of 277 articles was identified of which 64 (56 original studies) were selected. Overall, a mean primary patency rate of 82.3% was seen 1 year after the intervention, which decreased to 73.3% after 2 years. In the majority (43 of 56 studies, 77%), treatment was based on use of vitamin K antagonists, either with (18%) or without (59%) use of antiplatelet drugs. Only two studies (4%) directly assessed the effect of antithrombotic therapy on treatment outcomes. The impact of postinterventional antithrombotic therapy on stent patency remains unknown because of limited and insufficient data available in current literature. Further clinical research should more clearly address the role of antithrombotic therapy for preservation of long-term patency following venous stenting.