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      Deep vein thrombosis due to May-Thurner syndrome: a case report

      case-report

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          Abstract

          Background

          May-Thurner syndrome (MTS) or Cockett’s syndrome is a rare clinical syndrome, which refers to the compression of the left common iliac vein (LCIV) by right common iliac artery and vertebral body. Complications of MTS include deep vein thrombus formation and even life-threatening pulmonary embolism.

          Case presentation

          Here, we report the case of a 60-year-old female patient with a complaint of swelling in the left lower limb and pain for 5 days. Computed tomography angiography indicated MTS, and thrombus formation of left external iliac vein and femoral vein. The patient was diagnosed with deep venous thrombosis (DVT) and MTS. The patient underwent ascending venography from the lower extremity to inferior vena cava (IVC) and then to the pulmonary artery with IVC filter implantation, left iliac vein balloon plasty, and stent placement. The patient visited the hospital for the removal of IVC filter, 28 days after the operation. After the interventional therapy, the patient had no in-stent restenosis and had remission during the 2-year follow-up.

          Conclusions

          This case presents a successful management of MTS in presence of DVT. Although clinicians are rarely aware, the presence of unilateral lower limb swelling and thrombosis may be the manifestations of MTS.

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          Most cited references16

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          The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins.

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            May-Thurner syndrome: update and review.

            May-Thurner syndrome (MTS) is an anatomically variable condition of venous outflow obstruction caused by extrinsic compression. Although this syndrome is rare, its prevalence is likely underestimated. The pathology of this condition is secondary to a partial obstruction of the common iliac vein by an overlying common iliac artery with subsequent entrapment of the left common iliac vein. Regardless of the mechanism, this causes partial or complete impedance to the iliac vein outflow with subsequent possible obstruction and extensive ipsilateral deep vein thrombosis (DVT) of the ipsilateral extremity. Clinical presentations include, but are not limited to pain, swelling, venous stasis ulcers, and skin discoloration. With extensive DVT, postphlebetic syndrome, with all of its sequelae, may also develop. Treatment is based on the clinical presentation and includes staged thrombolysis with/without prophylactic retrievable inferior vena cava filter placement, followed by angioplasty/stenting of the left iliac vein in MTS patients with extensive DVT. This review highlights the variable presentations of MTS and outlines possible management within the current Society for Vascular Surgery consensus.
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              Iliac vein compression as risk factor for left- versus right-sided deep venous thrombosis: case-control study.

              To determine if compression of the left common iliac vein (LCIV) by the right common iliac artery is associated with left-sided deep venous thrombosis (DVT). This institutional review board-approved case-control study was performed in a cohort of 230 consecutive patients (94 men, 136 women; mean age, 57.5 years; range, 10-94 years) at one institution who had undergone contrast material-enhanced computed tomography of the pelvis prior to a diagnosis of unilateral DVT. Demographic data and information on risk factors were collected. Two board-certified radiologists determined iliac vein compression by using quantitative measures of percentage compression {[1 minus (LCIV diameter at point of maximal compression/distal right common iliac vein diameter)] times 100%}, as well as qualitative measures (none, mild, moderate, severe), with estimates of measurement variability. Logistic regression analysis was performed (independent variable, left vs right DVT; dependent variable, iliac vein compression). Cutpoints of relevant compression were evaluated by using splines. Means (with 95% confidence intervals [CIs]) and odds ratios (ORs) (and 95% CIs) of left DVT per 1% increase in percentage compression were calculated. Patients with right DVT were more likely than those with left DVT to have a history of pulmonary embolism. Overall, in all study patients, mean percentage compression was 36.6%, 66 (29.7%) of 222 had greater than 50% compression, and 16 (7.2%) had greater than 70% compression. At most levels of compression, increasing compression was not associated with left DVT (adjusted ORs, 1.00, 0.99, 1.02) but above 70%, LCIV compression may be associated with left DVT (adjusted ORs, 3.03, 0.91, 10.15). Increasing levels of percentage compression were not associated with left-sided DVT up to 70%; however, greater than 70% compression may be associated with left DVT. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12111580/-/DC1. ©RSNA, 2012.
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                Author and article information

                Contributors
                daxianghouzi@foxmail.com
                104059284@qq.com
                evil37ma@qq.com
                zhangjunbo@126.com
                271088875@qq.com
                panghg0820@163.com
                yinqian610@163.com
                hongyanTian417@163.com
                Journal
                BMC Cardiovasc Disord
                BMC Cardiovasc Disord
                BMC Cardiovascular Disorders
                BioMed Central (London )
                1471-2261
                19 May 2020
                19 May 2020
                2020
                : 20
                : 233
                Affiliations
                GRID grid.452438.c, Department of Peripheral Vascular Diseases, , the First Affiliated Hospital of Xi’an Jiaotong University, ; No. 277 Yanta Road, Xi’an, 710061 China
                Author information
                http://orcid.org/0000-0003-2939-1570
                Article
                1515
                10.1186/s12872-020-01515-z
                7236309
                32429980
                c098005c-1a87-4ffb-8f4c-dabfdf9f0db2
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 3 March 2020
                : 10 May 2020
                Funding
                Funded by: Fund for key research and development program project of Shaanxi province, China
                Award ID: 2017SF-254
                Award Recipient :
                Categories
                Case Report
                Custom metadata
                © The Author(s) 2020

                Cardiovascular Medicine
                may-thurner syndrome,iliac vein plasty,deep vein thrombosis,endovascular management,case report

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