1
|
Konopa J, Komorowska-Jagielska K, Łaski D, Chamienia A, Budyńko Ł, Dębska-Ślizień A. Kidney Transplant Loss Due to May-Thurner Syndrome: Case Report and Review of the Literature. Transplant Proc 2024; 56:972-975. [PMID: 38734519 DOI: 10.1016/j.transproceed.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND May-Thurner syndrome (MTS) is an extrinsic venous compression by the arterial system against bony structures in the iliocaval territory. The most common variant of MTS is due to compression of the left iliac vein between the overlying right common iliac artery and the fifth lumbar vertebrae. The prevalence of MTS is unknown; therefore, there are only a few publications about MTS in kidney transplant recipients. Risk factors that may progress from usually asymptomatic to symptomatic MTS are female sex, scoliosis, dehydration, coagulation disorders, and radiation. Clinical presentations include acute extremity pain and swelling, venous claudication, and chronic signs of venous insufficiency. METHODS We describe a 63-year-old man who underwent kidney transplantation (left iliac fossa). Four days after transplantation, a graftectomy was done due to graft rupture caused by renal vein thrombosis. After imaging studies, a diagnosis of MTS was established. The patient had no typical symptoms of MTS. However, an incidence of right lower limb thrombosis was observed, and due to vertebral discopathy, the patient underwent surgery with implantation of a vertebral implant. RESULT After a successful second transplantation on the right side, incidents of thrombosis were observed: superficial thrombosis of the upper limbs and massive deep vein thrombosis of the right lower limb. Thrombophilia was recognized, the graft function is stable, and anticoagulation therapy is being continued. CONCLUSION Asymptomatic MTS in the case of coincidence of other risk factors, such as coagulation disorders, history of vertebral operation, and additional pressure of the graft, can result in graft failure.
Collapse
Affiliation(s)
- Joanna Konopa
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Poland.
| | | | - Dariusz Łaski
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Poland
| | - Andrzej Chamienia
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Poland
| | - Łukasz Budyńko
- Department of Radiology, Medical University of Gdansk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Poland
| |
Collapse
|
2
|
Costa M, Ferreira G, Gomes D, Oliveira C, Domingues N. May-Thurner Syndrome: The Worst-Case Scenario. Cureus 2024; 16:e55742. [PMID: 38586812 PMCID: PMC10998721 DOI: 10.7759/cureus.55742] [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: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
May-Thurner syndrome (MTS) is caused by compression of the left common iliac vein by the right common iliac artery against the spinal column. It can range from asymptomatic or present with subtle and unspecific signs and symptoms and rarely exhibit severe complications such as pulmonary embolism (PE). The diagnosis is confirmed by typical imaging findings. Treatment may include conservative measures, anticoagulation, endovascular or even surgical options. We report the case of a 20-year-old female who presented with cardiac arrest caused by an acute massive PE. Further study showed partial thrombosis of the internal iliac veins resulting from MTS. She continued anticoagulation therapy with low-molecular-weight heparin and then switched to edoxaban with a good clinical outcome. She was also referred to Vascular Surgery to discuss the possibility of iliac vein stenting. Abdominopelvic vascular compression syndromes include a large spectrum of conditions, and they are rarely considered as an etiology for venous thromboembolism. The clinical presentation of PE varies with several triggering factors and atypical presentation is more common in nonmalignant causes. The combination of noninvasive and invasive imaging modalities might be beneficial to establish a definitive diagnosis. Nevertheless, invasive procedures are often restricted to doubtful cases or to guide endovascular procedures which is the current treatment of choice. There is little evidence using nonvitamin K oral anticoagulants, but there are some case reports detailing their successful use. This case aims to point out the need for a profound understanding of different causes of deep vein and pulmonary thromboembolism; common entities in our practice but with a variety of clinical presentations and potentially caused by rare underlying conditions. MTS can be the origin of serious and deadly complications, hence the importance of early recognition and treatment.
Collapse
Affiliation(s)
- Marta Costa
- Department of Internal Medicine, Unidade Local de Saúde Viseu Dão-Lafões, Viseu, PRT
| | - Gonçalo Ferreira
- Department of Cardiology, Unidade Local de Saúde Viseu Dão-Lafões, Viseu, PRT
| | - Dora Gomes
- Department of Internal Medicine, Unidade Local de Saúde Viseu Dão-Lafões, Viseu, PRT
| | - Catarina Oliveira
- Department of Internal Medicine, Unidade Local de Saúde Viseu Dão-Lafões, Viseu, PRT
| | - Nelson Domingues
- Department of Internal Medicine, Unidade Local de Saúde Viseu Dão-Lafões, viseu, PRT
| |
Collapse
|
3
|
Nowak S, Jakob A, Dalla Pozza R, Michel S, Haas NA, Pattathu J. Familiar Disposition of May-Thurner Syndrome-A Case Series. Life (Basel) 2024; 14:221. [PMID: 38398730 PMCID: PMC10890414 DOI: 10.3390/life14020221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
May-Thurner syndrome is a venous compression syndrome of the pelvic vessels that represents a relevant risk factor for thrombus formation. The standard procedure to secure a diagnosis is venography, followed by endovascular therapy as the preferred treatment choice if the patient is symptomatic. In our case series, there are three related patients with May-Thurner syndrome. A 16-year-old female was admitted with pulmonary embolism, dyspnoea and hip pain. The compression syndrome was diagnosed with interventional venography, and the patient received venous stent implantation. Due to her family history, we also suspected her mother to be affected by the syndrome and elucidated the diagnosis shortly afterwards by invasive venography. Subsequently, we examined the patient's 19-year-old brother, and magnetic resonance imaging confirmed May-Thurner syndrome. A similar case series has not been published before. In this case, the family relation indicates a possible hereditary aspect of May-Thurner syndrome. This hypothesis should be the subject of further research. In conclusion, it is essential to assess family history thoroughly when treating patients with May-Thurner syndrome.
Collapse
Affiliation(s)
| | | | | | | | | | - Joseph Pattathu
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig-Maximilians-University, 81377 Munich, Germany (N.A.H.)
| |
Collapse
|
4
|
Galea M, Brincat MR, Calleja-Agius J. A review of the pathophysiology and evidence-based management of varicoceles and pelvic congestion syndrome. HUM FERTIL 2023; 26:1597-1608. [PMID: 37190955 DOI: 10.1080/14647273.2023.2212846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 04/25/2023] [Indexed: 05/17/2023]
Abstract
Pelvic congestion syndrome (PCS) in females and varicoceles in males may be regarded as closely related conditions since the main pathophysiological cause for both processes is pelvic venous insufficiency. Varicoceles are more prevalent amongst sub-fertile males, with an approximate incidence of 15% in the general male population. PCS is commonly diagnosed amongst premenopausal multiparous women, representing one of the leading causes of chronic pelvic pain. Both conditions appear to be predominantly left-sided and are associated with oxidative stress and pro-inflammatory cascades with subsequent effects on fertility. Clinical examination and pelvic ultrasonography play an essential role in the assessment of varicoceles, PCS and chronic pelvic pain. Venography is generally considered as a gold-standard procedure for both conditions. There is still much debate on how these conditions should be managed. This review article provides a comparative analysis of the underlying pathophysiological mechanisms of both PCS and varicoceles, their impact on fertility, as well as their clinical management.
Collapse
Affiliation(s)
- Matteo Galea
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Mark R Brincat
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Department of Obstetrics and Gynaecology, Mater Dei Hospital, Msida, Malta
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| |
Collapse
|
5
|
Haq SH, Shah SR, Chandra J, Kannan P, Patel SM. Case Report: It's not always about the veins; intervention of bilateral May-Thurner Syndrome secondary to iliac aneurysm. Front Cardiovasc Med 2023; 10:1279981. [PMID: 38034392 PMCID: PMC10687451 DOI: 10.3389/fcvm.2023.1279981] [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: 08/19/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
May-Thurner Syndrome (MTS) remains evasive because of the insidiousness and variable etiologies by which it can manifest. In this study, we examine a unique presentation of MTS resulting from compression of both common iliac veins by a right common iliac artery aneurysm that required complex endovascular venous and arterial intervention.
Collapse
Affiliation(s)
- Syed H. Haq
- Department of Internal Medicine, BonSecours Mercy Health—St. Rita’s Medical Center, Lima, OH, United States
| | - Sidra R. Shah
- Department of Internal Medicine, BonSecours Mercy Health—St. Rita’s Medical Center, Lima, OH, United States
| | - Jaya Chandra
- Department of Internal Medicine, BonSecours Mercy Health—St. Rita’s Medical Center, Lima, OH, United States
| | - Pavithra Kannan
- Department of Internal Medicine, OhioHealth Riverside, Columbus, OH, United States
| | - Sandeep M. Patel
- Structural Heart & Intervention Center, BonSecours Mercy Health—St. Rita’s Medical Center, Lima, OH, United States
| |
Collapse
|
6
|
Nadal Bosch J, Moya M, Serna S, Sanchez R, Malcolm J. A Case Report on May-Thurner Syndrome: Beyond the Usual Suspects. Cureus 2023; 15:e48837. [PMID: 38106805 PMCID: PMC10722346 DOI: 10.7759/cureus.48837] [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: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
May-Thurner syndrome (MTS), also known as iliocaval venous compression syndrome, is a vascular condition characterized by extrinsic venous compression within the iliocaval territory. While traditionally considered a condition predominantly affecting women, this case report presents an atypical presentation in a middle-aged male patient. The patient initially presented with left lower extremity pain and swelling, which was attributed to deep venous thrombosis (DVT) in the left calf and femoral vein. Despite anticoagulation therapy, his symptoms persisted, leading to further diagnostic evaluation and the identification of MTS. This report highlights the clinical presentation, diagnostic challenges, and successful management of MTS in a male patient. Endovascular interventions, including balloon dilation and stent placement, were employed to address refractory stenosis and thrombus burden. The case emphasizes the importance of considering MTS as a potential diagnosis in patients with unexplained lower limb symptoms, irrespective of traditional risk factors or gender. Early identification and appropriate interventions can lead to symptom relief, obstruction resolution, and improved long-term outcomes for patients with MTS. This case underscores the need for heightened clinician awareness regarding MTS and its potential impact on patient care.
Collapse
Affiliation(s)
- Jorge Nadal Bosch
- Diagnostic Radiology, Doctors Hospital at Renaissance, Edinburg, USA
| | - Mario Moya
- Radiology, Doctors Hospital at Renaissance, Edinburg, USA
| | - Samuel Serna
- Radiology, Doctors Hospital at Renaissance, Edinburg, USA
| | | | - Javier Malcolm
- Medical Information, Doctors Hospital at Renaissance, Edinburg, USA
| |
Collapse
|
7
|
Jenab Y, Tofighi S, Navid H, Riazi H, Samimi S. Hematuria during the right heart catheterization procedure: Renal perforation as a very rare complication. Clin Case Rep 2023; 11:e7014. [PMID: 36852127 PMCID: PMC9958245 DOI: 10.1002/ccr3.7014] [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: 12/14/2022] [Revised: 01/24/2023] [Accepted: 02/13/2023] [Indexed: 02/27/2023] Open
Abstract
The occurrence of hematuria during a right heart catheterization can be a sign of renal perforation, a rare but life-threatening complication that could be developed due to the misdirection of wire into the abdominopelvic venous plexus. We showed this complication could be managed with venoplasty of the common iliac vein.
Collapse
Affiliation(s)
- Yaser Jenab
- Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Saeed Tofighi
- Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Hossein Navid
- Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Homan Riazi
- Academic Educational Hospital of Duisburg‐Essen UniversityDuisburgGermany
| | - Sahar Samimi
- Tehran Heart CenterTehran University of Medical SciencesTehranIran
| |
Collapse
|
8
|
Yue L, Fu HY, Sun HL. Acute deep venous thrombosis induced by May-Thurner syndrome after spondylolisthesis surgery: A case report and review of literature. World J Clin Cases 2021; 9:7490-7497. [PMID: 34616817 PMCID: PMC8464458 DOI: 10.12998/wjcc.v9.i25.7490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/04/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Deep venous thrombosis (DVT) is a serious complication of lumbar spine surgery. Current guidelines recommend pharmacomechanical prophylaxis for patients at high risk of DVT after spine surgery. May-Thurner syndrome (MTS), a venous anatomical variation that may require invasive intervention, is an often overlooked cause of DVT. To date, no case reports of symptomatic MTS caused by isthmic spondylolisthesis or subsequent acute DVT after posterior lumbar surgery have been published.
CASE SUMMARY We here present a case of a patient who developed acute DVT 4 h after spondylolisthesis surgery, and MTS was only considered after surgery, during a review of a gynecological enhanced computed tomography image taken before the procedure.
CONCLUSION In conclusion, clinicians should consider MTS in the presence of a dangerous triad: spondylolisthesis, elevated D-dimer levels, and sonographically indicated unilateral deep vein dilation. Consultation with a vascular surgeon is also essential to MTS management.
Collapse
Affiliation(s)
- Lei Yue
- Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
| | - Hao-Yong Fu
- Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
| | - Hao-Lin Sun
- Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
| |
Collapse
|
9
|
Bush RL. Treatment strategies for various venous disorders. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:411-412. [PMID: 33890757 DOI: 10.23736/s0021-9509.21.11930-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ruth L Bush
- University of Houston College of Medicine, Houston, TX, USA - .,Central Texas VA Health Care System, Temple, TX, USA -
| |
Collapse
|