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Akinleye A, Kwaah P, Poku-Adusei J, Kavandi H, Norman K. May-Thurner syndrome: A case of extensive unprovoked left lower extremity deep vein thrombosis (DVT). Radiol Case Rep 2024; 19:680-683. [PMID: 38044907 PMCID: PMC10687697 DOI: 10.1016/j.radcr.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023] Open
Abstract
May-Thurner syndrome (MTS) also known as iliac vein compression syndrome, is a congenital anatomical variant, that results from the extrinsic compression of the left common iliac vein by the right iliac artery with resultant formation of left venous thrombosis. We report a case of a young man with recurrent unprovoked left lower extremity DVT in the setting of May Thurner syndrome who required endovascular intervention and was discharged on oral anticoagulation.
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Affiliation(s)
- Akintayo Akinleye
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT, USA
| | - Patrick Kwaah
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT, USA
| | | | - Hadiseh Kavandi
- Department of Radiology, University of Maryland, Baltimore, MD, USA
| | - Katelyn Norman
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT, USA
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Al-Otaibi M, Vaidy A, Vaidya A, Zlotshewer B, Oliveros E, Zhao H, Lakhter V, Auger WR, Forfia PR, Bashir R. May-Thurner Anatomy in Patients With Chronic Thromboembolic Pulmonary Hypertension: An Important Clinical Association. JACC Cardiovasc Interv 2021; 14:1940-1946. [PMID: 34503745 DOI: 10.1016/j.jcin.2021.06.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/01/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the incidence of May-Thurner anatomy (MTA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and identify its predictors. BACKGROUND MTA is an anatomical variant characterized by compression of left common iliac vein by the overlying right iliac artery. Over time, this leads to venous intimal scarring, blood flow stasis, and the development of deep vein thrombosis (DVT). DVT is a known risk factor for the development of CTEPH. The prevalence of this anatomical variation in patients with CTEPH is unknown. METHODS A retrospective chart review was conducted in patients referred to Temple University Hospital's cardiac catheterization laboratory for the evaluation of CTEPH between January 2016 and June 2020. Among these patients, those who underwent invasive venography were evaluated for the presence of angiographic MTA. Multivariate regression was used to identify factors associated with presence of MTA. RESULTS A total of 193 patients with CTEPH were referred for pulmonary angiography, of whom 148 patients underwent invasive venography. MTA was identified in 44 patients (29.7%). Factors associated with the presence of MTA were lower extremity DVT (odds ratio: 3.5; 95% confidence interval: 1.58-7.8; P = 0.002), and left lower extremity post-thrombotic syndrome (odds ratio: 2.0; 95% confidence interval: 0.98-4.1; P = 0.05). Patients with MTA were more likely to undergo pulmonary thromboendarterectomy than patients without MTA (79.5% vs 58.7%; P = 0.015). CONCLUSIONS MTA is very common in patients with CTEPH. History of lower extremity DVT and or left lower extremity post-thrombotic syndrome was associated with the presence of MTA.
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Affiliation(s)
- Mohamad Al-Otaibi
- Department of Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Anika Vaidy
- Division of Cardiovascular Disease, Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Anjali Vaidya
- Division of Cardiovascular Disease, Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Brooke Zlotshewer
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Estefania Oliveros
- Division of Cardiovascular Disease, Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Huaqing Zhao
- Department of Clinical Sciences, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Vladimir Lakhter
- Division of Cardiovascular Disease, Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - William R Auger
- Division of Cardiovascular Disease, Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Paul R Forfia
- Division of Cardiovascular Disease, Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Riyaz Bashir
- Division of Cardiovascular Disease, Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
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Hng JZK, Su S, Atkinson N. May-Thurner syndrome, a diagnosis to consider in young males with no risk factors: a case report and review of the literature. J Med Case Rep 2021; 15:141. [PMID: 33736685 PMCID: PMC7977182 DOI: 10.1186/s13256-021-02730-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/10/2021] [Indexed: 12/31/2022] Open
Abstract
Background May–Thurner syndrome is an anatomical condition characterized by compression of the left common iliac vein by the right common iliac artery, causing venous outflow obstruction. It is an uncommon cause of deep vein thrombosis and is more prevalent among women. This paper highlights the importance of considering May–Thurner syndrome in young males without risk factors presenting with left lower limb pain, as endovascular treatment may be required. Case presentation A 23 year-old Caucasian male presented with a 1-week history of left lower limb pain, edema, and pallor. He was found to have an unprovoked deep vein thrombosis on Doppler ultrasound involving the left fibular, soleus, gastrocnemius, popliteal, femoral, common femoral, and external iliac veins. A heparin infusion was commenced as the initial treatment for deep vein thrombosis. Further investigation with computer tomography pulmonary angiogram and computer tomography venography of the abdomen and pelvis showed bilateral pulmonary emboli and left common iliac vein compression with left common, internal, and external iliac vein thrombosis. He was diagnosed with May–Thurner syndrome despite having no risk factors. A retrievable Cook Celect Platinum inferior vena cava filter was placed, and thrombus of the left common femoral, external, and common iliac veins was treated successfully with AngioJet thrombectomy, thrombolysis using 200,000 units of urokinase, angioplasty and stenting using two Cook Zilver Vena venous self-expanding stents. Therapeutic enoxaparin was commenced on discharge. His filter was removed after 10 weeks. Hematological follow-up 4 months later showed an overall negative thrombophilia screen, and anticoagulation was switched to apixaban. He has had no recurrent thrombosis. Conclusions Clinicians should have a low threshold to investigate for May-Thurner syndrome in patients with left lower limb venous thrombotic events regardless of risk factors, as endovascular treatment may be required to minimize the long-term sequelae of deep vein thrombosis. Duplex ultrasound can be used initially for diagnosis, and computer tomography venography used subsequently if the common iliac vein is not visualized on ultrasound. Endovascular treatment is preferred over anticoagulation alone, especially in otherwise fit patients presenting early, the aim being to reduce the chances of chronic venous hypertension in the lower limb.
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Affiliation(s)
- Joel Zhen Khang Hng
- Department of Vascular Surgery, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia.
| | - Shu Su
- Department of Radiology, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Noel Atkinson
- Department of Vascular Surgery, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
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