1
|
Alshehri KA, Bahashwan AA, Fakieha AY, Alkhamisi HE, Albladi MM. Unmasking May-Thurner Syndrome: A Case Report of Massive Deep Vein Thrombosis. Cureus 2024; 16:e56979. [PMID: 38681360 PMCID: PMC11045298 DOI: 10.7759/cureus.56979] [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] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
Deep venous thrombosis is a significant medical condition that results in life-threatening complications such as pulmonary embolism. Various factors can contribute to the formation of deep venous thrombosis, including prolonged immobility, surgery, and specific health conditions. May-Thurner syndrome is an underrecognized cause of deep venous thrombosis due to the compression of the left common iliac vein by the right common iliac artery. It poses diagnostic challenges due to its varied clinical presentations. This report discusses a 42-year-old female with no notable medical history who presented with acute onset of left leg swelling, pain, and discoloration. Despite the absence of common risk factors for deep venous thrombosis, investigations revealed a massive left-sided deep venous thrombosis. Additional imaging studies revealed the diagnosis of May-Thurner syndrome, manifesting as significant compression of the left common iliac vein. The patient underwent anticoagulation therapy, catheter-directed thrombolysis, and stent placement, resulting in symptomatic improvement and no recurrence over a six-month follow-up period. This case underscores the necessity of considering anatomical variations like May-Thurner syndrome in patients with unexplained deep venous thrombosis, particularly without typical risk factors. It highlights the importance of a comprehensive diagnostic approach, including advanced imaging techniques, to uncover underlying causes of deep venous thrombosis.
Collapse
Affiliation(s)
- Khalid A Alshehri
- General Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | | | | | | | | |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Bahadur A, Mundhra R, Ravi AK, Gill P, Pathak A, Singhvi S, Shah K, Suresh G. May-Thurner Syndrome in a Case of Left Iliofemoral Vein Thrombosis With Contralateral Tubo-Ovarian Abscess in the Post-postpartum Period. Cureus 2023; 15:e49879. [PMID: 38174177 PMCID: PMC10761936 DOI: 10.7759/cureus.49879] [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] [Accepted: 12/02/2023] [Indexed: 01/05/2024] Open
Abstract
May-Thurner syndrome (MTS) is a rare, yet important, differential diagnosis in reproductive-age women with deep vein thrombosis (DVT). It is characterized by the compression of the left common iliac vein by the right common artery against the lumbar vertebra. The condition is complicated by recurrent DVT with pulmonary thromboembolism (PTE). Here is a case of multiparous women in early puerperium with right tubo-ovarian abscess and left lower limb DVT likely due to MTS. The diagnosis was further complicated by the presence of persistent thrombocytosis but a myeloproliferative neoplasm was ruled out by genetic mutation testing. She was given anticoagulants, and laparotomy was done for the excision of the tubo-ovarian mass in view of the persistent fever not responding to injectable antibiotics. PTE in the postoperative period was managed by anticoagulants followed by an inferior vena cava (IVC) filter for the risk of recurrent DVT and/or PTE in an MTS case.
Collapse
Affiliation(s)
- Anupama Bahadur
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Rajlaxmi Mundhra
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Anoosha K Ravi
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Poonam Gill
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Anjali Pathak
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Shreya Singhvi
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Komal Shah
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Gayatri Suresh
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| |
Collapse
|
4
|
Phillips-Smith BA, Jatana J, Carter E, Machani S, Wickel DJ. May-Thurner Syndrome: An Interesting Presentation of Recurrent, Unprovoked Deep Vein Thrombosis. Cureus 2023; 15:e43491. [PMID: 37719504 PMCID: PMC10499663 DOI: 10.7759/cureus.43491] [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] [Accepted: 08/13/2023] [Indexed: 09/19/2023] Open
Abstract
May-Thurner Syndrome (MTS) is a unique condition characterized by the compression of the left iliac vein by the right common iliac artery, which causes venous outflow obstruction and a high risk of venous sequelae. May-Thurner Syndrome is a condition that is primarily observed in females and is an uncommon cause of deep vein thrombosis (DVT). The more common presentation of DVT is in the lower left extremity, although there have been cases of right-sided formation. In this case report, we present a patient with unprovoked, recurrent, left-sided deep vein thrombosis in a 70-year-old woman. The aim of this case report is to highlight this uncommon condition and to suggest consideration of MTS in the setting of a patient with recurrent unprovoked DVTs of the same extremity.
Collapse
Affiliation(s)
| | - Jazmin Jatana
- Family Medicine, West Virginia University School of Medicine, Wheeling, USA
| | - Emma Carter
- Family Medicine, West Virginia University School of Medicine, Wheeling, USA
| | | | - Dean J Wickel
- Vascular Surgery, West Virginia University School of Medicine, Wheeling, USA
| |
Collapse
|
5
|
Guo Z, Du X, Zhang Y, Su C, Ran F, Lu Q. Diosmin Alleviates Venous Injury and Muscle Damage in a Mouse Model of Iliac Vein Stenosis. Front Cardiovasc Med 2022; 8:785554. [PMID: 35097005 PMCID: PMC8792538 DOI: 10.3389/fcvm.2021.785554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
Chronic venous disease (CVD) is a progressive inflammatory disease that increases in prevalence with age. Elucidating the underlying molecular mechanism of CVD development is essential for disease prevention and treatment. This study constructed a mouse model of iliac vein stenosis to explore the mechanism of the CVD disease progression, and diosmin was administered as a positive control (as recommended by clinical practice). The mouse model was established successfully with iliac vein stenosis, leading to the expansion of the intercellular space and venous leakage. Conversely, micronized diosmin showed a dose-dependent therapeutic effect for these manifestations. Concerning the mechanism, iliac vein stenosis caused an inflammatory response in veins, while diosmin suppressed this increase. Furthermore, RNA sequencing analysis indicated that diosmin significantly improved muscle function through actin filament organization and muscle contraction. These results indicated that the mouse model of iliac vein stenosis is a reliable model to study venous diseases. Furthermore, the dose-dependent therapeutic effect of diosmin on stenosis (without toxic side-effects) suggests greater protection against venous diseases at higher doses of diosmin.
Collapse
Affiliation(s)
- Zhiye Guo
- Key Laboratory of Cardiovascular and Cerebrovascular Medicine, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China
| | - Xiaolong Du
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yihua Zhang
- Key Laboratory of Cardiovascular and Cerebrovascular Medicine, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China
| | - Chunwan Su
- Key Laboratory of Cardiovascular and Cerebrovascular Medicine, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China
| | - Feng Ran
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Feng Ran
| | - Qiulun Lu
- Key Laboratory of Cardiovascular and Cerebrovascular Medicine, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China
- *Correspondence: Qiulun Lu
| |
Collapse
|
6
|
Poyyamoli S, Mehta P, Cherian M, Anand RR, Patil SB, Kalva S, Salazar G. May-Thurner syndrome. Cardiovasc Diagn Ther 2021; 11:1104-1111. [PMID: 34815961 DOI: 10.21037/cdt.2020.03.07] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/09/2020] [Indexed: 12/26/2022]
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). Variations are known where in the right lower limb can be affected. While most of the cases are asymptomatic, it can cause severe morbidity in symptomatic individuals, most commonly deep vein thrombosis and post thrombotic sequelae. In this article, we review the key clinical features, multimodality imaging findings and treatment options of this disorder. Our goal is to raise awareness of this under-diagnosed condition among clinicians in order to promote early detection and recognition to enhance positive and expedited outcomes.
Collapse
Affiliation(s)
- Santhosh Poyyamoli
- Department of Diagnostic and Interventional Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Pankaj Mehta
- Department of Radiology, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Mathew Cherian
- Department of Diagnostic and Interventional Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Rinoy R Anand
- Department of Diagnostic and Interventional Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Santosh B Patil
- Department of Diagnostic and Interventional Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Sanjeeva Kalva
- Division of Interventional Radiology, Massachusetts General Hospital Boston, Harvard University, MA, USA
| | - Gloria Salazar
- Division of Interventional Radiology, Massachusetts General Hospital Boston, Harvard University, MA, USA
| |
Collapse
|
7
|
Sigua-Arce P, Mando R, Spencer L, Halalau A. Treatment of May-Thurner's Syndrome and Associated Complications: A Multicenter Experience. Int J Gen Med 2021; 14:4705-4710. [PMID: 34447265 PMCID: PMC8384425 DOI: 10.2147/ijgm.s325231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/02/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess the treatment options and associated complications in patients with May-Thurner's syndrome (MTS). METHODS We retrospectively reviewed the charts of patients diagnosed with MTS. Thorough review was completed and data relevant to methods of diagnosis, treatment, complications, hospital readmission, and mortality were extracted from patient charts. The patients were followed for two years after diagnosis. RESULTS Of the 47 patients identified as having "MTS", 32 (70%) were diagnosed formally with either magnetic resonance venography, computed tomography venography, or ultrasound. Two patients were excluded for insufficient availability of follow-up records. Mean age of the population included (N = 30) was 50.24 ±15.33 years and 83% (N = 25) had female gender. The majority (40%) of patients were treated with anticoagulation, thrombolysis, and stent placement, and 13.3% received a combination of anticoagulation, antiplatelet agent, thrombolysis, and stent placement. Overall, we found 28 patients (93%) who underwent endovascular stenting. However, 39.3% (11/28) had stent-related complications that included stent thrombosis, stenosis, and migration. One patient underwent open heart surgery for stent retrieval. Duration of anticoagulation therapy ranged from 6 months to lifelong. Two patients (6.7%) suffered major bleeds requiring transfusion. Fourteen patients (46.6%) developed post-thrombotic syndrome. Seven (23.3%) patients required MTS-related readmission within 30 days. No mortality was noted at two-year follow-up. CONCLUSION Although our study only included 30 patients, it was evident to us that there is no consensus in the management of MTS. Furthermore, endovascular stenting, which has a major role in the management of MTS, has complication rates that hover close to 40%. Further research is needed to help develop a standardized evidence-based approach in the management of MTS that ensures a decreased risk of immediate and long-term complications.
Collapse
Affiliation(s)
| | - Ramy Mando
- Department of Internal Medicine, Beaumont Health System, Royal Oak, MI, USA
| | - Lisa Spencer
- Oakland University William Beaumont School of Medicine, Rochester Hills, MI, USA
| | - Alexandra Halalau
- Department of Internal Medicine, Beaumont Health System, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester Hills, MI, USA
| |
Collapse
|
8
|
Phelps BJ, Boutin O, Patel U, King C. May-Thurner Syndrome and Patent Foramen Ovale: A Rare Etiology of Cryptogenic Stroke. Cureus 2019; 11:e5468. [PMID: 31641564 PMCID: PMC6802804 DOI: 10.7759/cureus.5468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Patients who present with stroke or transient ischemic attacks (TIA) in the setting of patent foramen ovale (PFO) mandate investigation of the lower extremities and pelvis in order to determine a possible source of thromboembolic disease. Imaging studies including Doppler ultrasound of the extremities may not be sufficient to diagnose the presence of anatomic variants that predispose patients to thrombus formation. May-Thurner syndrome (MTS) is characterized by extrinsic compression of the common iliac veins or inferior vena cava which leads to chronic physiologic changes within the vasculature. This condition increases risk of venous occlusion, diminution of venous flow, and most significantly, formation of thrombi. In this case report, we present a young Hispanic female diagnosed with ischemic cerebral vascular accident (CVA) secondary to thromboembolism in the setting of May-Thurner syndrome and a PFO, a rare etiology of cryptogenic CVA.
Collapse
Affiliation(s)
| | - Otto Boutin
- Critical Care, Palmetto General Hospital, Hialeah, USA
| | - Urvesh Patel
- Internal Medicine, Palmetto General Hospital, Hialeah, USA
| | - Christopher King
- Critical Care and Internal Medicine, Palmetto General Hospital, Hialeah, USA
| |
Collapse
|
9
|
Bhadra R, Somasundaram M, Iltchev DV, Ravakhah K. Acute bilateral pulmonary embolism in a 21-year-old: is May-Thurner syndrome in our differential? BMJ Case Rep 2019; 12:12/4/e227046. [PMID: 30940666 DOI: 10.1136/bcr-2018-227046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
May-Thurner syndrome (MTS) is a clinical condition where the left common iliac vein gets compressed by the overlying right common iliac artery anterior to the fifth lumbar vertebra and the sacral promontory. It results in vessel wall injury and predisposition to thrombosis. We present a case of a 21-year-old African-American man with no significant past medical history who came to the emergency department with left lower limb swelling associated with shortness of breath, and was eventually diagnosed to have extensive left lower extremity deep vein thrombosis (DVT) along with acute bilateral extensive pulmonary embolism (PE) as a consequence to MTS. MTS should be considered in the differential when young patients present with unprovoked or recurrent left-sided DVT. Diagnosis of this anatomical variant is critical as it may need long-term anticoagulation and consideration of pharmaco-mechanical intervention such as mechanical thrombectomy and venoplasty with or without stenting.
Collapse
Affiliation(s)
- Rajarshi Bhadra
- Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio, USA
| | - Meyappan Somasundaram
- Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio, USA
| | - Daniel V Iltchev
- Department of Pulmonary and Critical Care Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio, USA
| | - Keyvan Ravakhah
- Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio, USA
| |
Collapse
|
10
|
Goetz RL, Yoo JJH, Hsu J, Vakiti A, Hardy DM, Tariq K. May-Thurner Syndrome: A Rare and Under-Appreciated Cause of Venous Thrombosis in a 18-Year-Old Healthy Female. J Hematol 2018; 7:112-115. [PMID: 32300423 PMCID: PMC7155831 DOI: 10.14740/jh381w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/23/2018] [Indexed: 12/17/2022] Open
Abstract
May-Thurner syndrome (MTS) is a rarely diagnosed vascular abnormality that typically presents in young adults. The anomaly arises from compression of the left common iliac vein between the right iliac artery anteriorly and the lumbar vertebral body posteriorly, resulting in lower extremity venous outflow obstruction and recurrent deep vein thromboses (DVTs). We report the case of a 24-year-old female with a long history of recurrent DVTs and pulmonary emboli (PE) despite full anticoagulation. A computed tomography (CT) scan revealed findings consistent with MTS, and a left common iliac vein stent was placed. However, the patient continued to have DVTs while trialing several anticoagulation therapies, including rivaroxaban, enoxaparin, and warfarin. Eventually, the patient developed arterial thrombi resulting in critical limb ischemia, necessitating a right below knee amputation (BKA). One month status-post BKA, the patient was admitted for severe BKA stump pain secondary to infection and necrosis. She underwent BKA revision, but continued to experience pain post-operatively and was found to have new right common iliac artery, external iliac artery, and common femoral artery thrombosis in the setting of continued inpatient anticoagulation therapy with enoxaparin and aspirin. The patient returned to the operating room for emergent Fogarty thrombectomy, however, this was complicated by rupture of the balloon catheter secondary to migration of the left common iliac vein stent into the right common iliac artery lumen. A stent was placed in the right common iliac artery to shift the rogue vein stent, but the patient continued to have poor distal circulation of the BKA stump and eventually underwent an above knee amputation. Dual anti-platelet therapy (DAPT) with aspirin and clopidogrel in combination with enoxaparin were used to prevent in-stent thrombosis and future formation of arterial and venous thrombi. After the initiation of DAPT and enoxaparin, her clinical course was free of any further thromboembolic events. Clinicians should consider MTS in the differential diagnosis of younger adults presenting with recurrent DVTs or other unprovoked thromboembolic events. A two-pronged strategy of DAPT and anticoagulation was employed for successful prevention of thrombotic events.
Collapse
Affiliation(s)
- Ryan L Goetz
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - James Jae-Hyung Yoo
- Department of Medicine at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Joyce Hsu
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Anusha Vakiti
- Department of Internal Medicine, Medstar Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, USA
| | - David M Hardy
- Department of Vascular Surgery at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Khurram Tariq
- Georgia Cancer Center, Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| |
Collapse
|
11
|
Extensive Intracardiac and Deep Venous Thromboses in a Young Woman with Heparin-Induced Thrombocytopenia and May-Thurner Syndrome. Case Rep Hematol 2017; 2017:8530476. [PMID: 28465848 PMCID: PMC5390556 DOI: 10.1155/2017/8530476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/08/2017] [Accepted: 03/19/2017] [Indexed: 12/13/2022] Open
Abstract
A 38-year-old woman with a history of recurrent deep venous thromboses (DVTs) on chronic anticoagulation presented with acute left leg swelling. The patient was diagnosed with an acute left lower extremity (LLE) DVT in the setting of May-Thurner syndrome for which treatment with unfractionated heparin was started. Her hospital course was complicated by a new diagnosis of heparin-induced thrombocytopenia (HIT), with an incidental discovery of a large tricuspid valve mobile mass on a transthoracic echocardiogram (TTE). Subsequent imaging confirmed multiple right atrial thrombi along with LLE venous stent thrombosis and a new right LE acute DVT. Anticoagulation with argatroban for HIT thrombosis was started. She underwent a right atrial percutaneous thrombectomy and bilateral lower extremity thrombectomy with directed angioplasty and stent placement. This presentation is a rare manifestation of HIT with extensive intracardiac and deep venous thrombi, with successful staged interventions.
Collapse
|
12
|
Alkhater M, Jockenhöfer F, Stoffels I, Dissemond J. May-Thurner syndrome: an often overlooked cause for refractory venous leg ulcers. Int Wound J 2017; 14:578-582. [PMID: 28251803 DOI: 10.1111/iwj.12724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/25/2017] [Indexed: 11/28/2022] Open
Abstract
We report a 53-year-old female patient presenting with a refractory venous leg ulcer and unremarkable findings in the doppler Ultrasound venous mapping of the leg veins. Further comprehensive diagnostics demonstrated an underlying May-Thurner syndrome. After resolution of the primary mechanical obstruction, rapid wound healing in the following 3 weeks was documented. Iliac vein compression syndrome, commonly known as May-Thurner syndrome, is a distinguishable anatomical variant that results from an external compression over the left iliac vein exerted by the overriding adjacent right common iliac artery. It is mostly seen among young, healthy female patients and can easily be under-diagnosed. Lower extremities duplex ultrasonography remains the gold standard in diagnosing venous insufficiency, but it should not solely depend on it. Instead, clinicians should consider other possibilities, assessing the patency within the truncal veins, which in turn might contribute to the venous insufficiency along the lower limbs. An active early diagnostic approach can prevent significant overall morbidity and help patients to ease back into their daily-life activities. Therefore, it is recommended that all patients with suspected venous insufficiency and normal lower limbs duplex findings should undergo further evaluation of the truncal venous system pattern. May-Thurner syndrome, along with other causes of iliac veins compression, should be considered in the differential diagnosis in unclear persistent cases of unilateral venous symptoms.
Collapse
Affiliation(s)
- Maryam Alkhater
- Department of Dermatology, Venerology and Allergology, University Hospital of Essen, Essen, Germany
| | - Finja Jockenhöfer
- Department of Dermatology, Venerology and Allergology, University Hospital of Essen, Essen, Germany
| | - Ingo Stoffels
- Department of Dermatology, Venerology and Allergology, University Hospital of Essen, Essen, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital of Essen, Essen, Germany
| |
Collapse
|