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A: CT scan shows compression and thrombosis of left common iliac vein by right common iliac artery. Permeable flow can be seen in the right common iliac vein; B: venogram revealing thrombosis of the left iliofemoral venous system and the presence venous collateral flow from the left common femoral vein to the right hypogastric vein; C-D: pharmacomechanical thrombolysis. The thrombus was removed with an Arrow Trerotola PTD device and angioplasty. No stent was placed in this case. Subsequently, normal flow was restored Case 3 In 2009, a 45-year-old female, who had undergone surgical treatment for a meningioma in 2008, presented with a 48-hour history of pain and increased edema in the left inguinal area. She associated also mild dyspnea. She had been taking OCPs for one month.. A venous Doppler ultrasound confirmed the clinical suspicion of extensive DVT, which continued up to the deep femoral vein. In addition, pulmonary arteries CT angiography verified the presence of a PE. Thrombophilia screening revealed the patient was heterozygous for FVL. Despite the substantial PTS and the persistent thrombus observed during the Doppler ultrasound follow-up examination, OAT with
Source publication
Introduction: May-Thurner syndrome (MTS) is an entity caused by the compression of the left iliac vein that predispose to acute deep vein thrombosis (DVT) of left lower limb. While standar management is anticoagulant therapy, a review of the literature reveals that new endovascular therapies can offer more optimal outcome than anticoagulation alone...
Context in source publication
Context 1
... 7 F over the wire percutaneous thrombectomy Arrow- Trerotola device (Arrow, Reading, PA, USA) with simultaneous infusion of 300 000 units of urokinase was used to obtain the fragmentation and lysis of the iliac vein thrombus. Finally a PTA with a 12 mm catheter balloon was done to treat the iliac vein stenosis ( Figure 1 and Figure 2). ...
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Deep venous thrombosis is a frequent, multifactorial disease and a leading cause of morbidity and mortality. Most of the time deep venous thrombosis is triggered by the interaction between acquired risk factors, such as hip fracture, pregnancy, and immobility, and hereditary risk factors such as thrombophilias. The mechanisms underlying deep venous...
Citations
... The main objective of MTS treatment is to resolve the extrinsic mechanical compression of the iliac vein. Initially, the non-invasive treatment was based on thrombolytic therapy and anticoagulation; however, this does not resolve or prevent hyperplasia of the vessel wall and does not eliminate the existing membranes and synechiae [1,9] . Berguer et al. were the first to describe treatment with catheter-guided thrombectomy and subsequent stenting in these patients. ...
... Berguer et al. were the first to describe treatment with catheter-guided thrombectomy and subsequent stenting in these patients. It is known that when compression of the left common iliac vein is > 70%, the risk of recurrence and postthrombotic syndrome is very high [9] . ...
We present the case of a 12-year-old girl with a history of vascular anomalies in the lower pelvic limbs and back, who developed unilateral deep vein thrombosis of the left lower limb after her pubertal development, she was diagnosed with May-Thurner syndrome with an abnormal venous drainage of the pelvic structures through the superior hemorrhoidal veins to the inferior mesenteric vein towards the porta system, this being a chronic manifestation. This kind of behavior has not been documented in the reviewed medical literature. Secondarily, balloon angioplasty was performed without breaking the stenotic ring. As a second attempt, it was decided to place the venous stent, with satisfactory resolution of the symptoms. There are controversies about the indications for the use of anticoagulants and antiplatelet agents, or the indications to place a venous stent in children. We must consider an approach to for effective therapeutic treatment in these cases is to control bleeding, the main goal being trying to avoid ulcerations in the lower limb due to venous insufficiency with irreversible affectation of the valvular system.
