May-Thurner Syndrome: An Underdiagnosed Cause of Deep Venous Thrombosis
AAPA ePoster library. Villegas S. 05/17/17; 180566; 254
Sara Villegas
Sara Villegas
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Abstract
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Introduction: May-Thurner Syndrome (MTS), also known as iliac vein compression syndrome, is caused by a common anatomical variant where the right common iliac artery (RCIA) overlies the left common iliac vein (LCIV) causing it to compress against the underlying vertebrae and obstruct venous flow. It was first described by R. May and J. Thurner in 1957. It is thought to be present in greater than 20% of the general population and to be responsible for 2-3% of all deep venous thrombosis (DVT). However, this is likely an underestimate of the true prevalence as it believed to be underdiagnosed. Patients with May-Thurner Syndrome most commonly present with signs and symptoms of extensive or recurring DVT formation in the left lower extremity without coagulopathies, risk factors, or other common causes. Currently, the standard treatment for MTS includes catheter directed thrombolysis, anticoagulation therapy, and stent placement to prevent recurrent DVTs and future pulmonary embolisms. Case Description: A 44 year old male presented with pain, swelling and the inability to bear weight on the left lower extremity for two weeks. Symptoms began several days after a dog bite of the same leg. He denied any history of coagulopathies, contributing family history, or other DVT risk factors. The physical exam demonstrated edema and diminished dorsalis pedis and posterior tibialis pulses of the left lower extremity. The left calf was tender to palpation without erythema. The patient was afebrile and lung sounds were clear throughout. Doppler ultrasound confirmed extensive DVT formation in left common iliac, common femoral, popliteal and saphenous veins. Outcome: The patient's treatment included ultrasound guided vascular access and initiation of tissue plasminogen activator (tPA) for thrombolysis for 24 hours in the intensive care unit. The following day, the patient returned to the operating room for mechanical thrombolytic therapy and visualization of the anatomy with intravascular ultrasound (IVUS). IVUS confirmed May-Thurner Syndrome as the diagnosis and the underlying cause of the venous compromise. After the diagnosis was confirmed, venous angioplasty and stenting of the LCIV were performed. Lastly, an inferior vena cava filter was placed and the patient was started on apixaban indefinitely for long-term anticoagulation therapy. Conclusion: Currently, treatment of MTS focuses on thrombolysis of the DVT followed by correction of the underlying anatomica...
Introduction: May-Thurner Syndrome (MTS), also known as iliac vein compression syndrome, is caused by a common anatomical variant where the right common iliac artery (RCIA) overlies the left common iliac vein (LCIV) causing it to compress against the underlying vertebrae and obstruct venous flow. It was first described by R. May and J. Thurner in 1957. It is thought to be present in greater than 20% of the general population and to be responsible for 2-3% of all deep venous thrombosis (DVT). However, this is likely an underestimate of the true prevalence as it believed to be underdiagnosed. Patients with May-Thurner Syndrome most commonly present with signs and symptoms of extensive or recurring DVT formation in the left lower extremity without coagulopathies, risk factors, or other common causes. Currently, the standard treatment for MTS includes catheter directed thrombolysis, anticoagulation therapy, and stent placement to prevent recurrent DVTs and future pulmonary embolisms. Case Description: A 44 year old male presented with pain, swelling and the inability to bear weight on the left lower extremity for two weeks. Symptoms began several days after a dog bite of the same leg. He denied any history of coagulopathies, contributing family history, or other DVT risk factors. The physical exam demonstrated edema and diminished dorsalis pedis and posterior tibialis pulses of the left lower extremity. The left calf was tender to palpation without erythema. The patient was afebrile and lung sounds were clear throughout. Doppler ultrasound confirmed extensive DVT formation in left common iliac, common femoral, popliteal and saphenous veins. Outcome: The patient's treatment included ultrasound guided vascular access and initiation of tissue plasminogen activator (tPA) for thrombolysis for 24 hours in the intensive care unit. The following day, the patient returned to the operating room for mechanical thrombolytic therapy and visualization of the anatomy with intravascular ultrasound (IVUS). IVUS confirmed May-Thurner Syndrome as the diagnosis and the underlying cause of the venous compromise. After the diagnosis was confirmed, venous angioplasty and stenting of the LCIV were performed. Lastly, an inferior vena cava filter was placed and the patient was started on apixaban indefinitely for long-term anticoagulation therapy. Conclusion: Currently, treatment of MTS focuses on thrombolysis of the DVT followed by correction of the underlying anatomica...
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