SHM Converge Scientific Abstract ePoster Gallery-Persistent Deep Vein Thrombosis on Apixaban Unmasks Atypical May-Thurner Syndrome After Lumbar Fusion

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This case describes a 73-year-old woman with Charcot-Marie-Tooth disease who developed persistent left lower extremity swelling after T11-pelvis spinal fusion complicated by surgical site infection. She was initially diagnosed with a distal left peroneal DVT and treated with apixaban, but her unilateral swelling and erythema worsened despite antibiotics and anticoagulation, raising concern for cellulitis.<br /><br />Further evaluation showed persistent DVT on venous duplex. CT imaging revealed an unusual vascular abnormality: thrombosis of the right common iliac artery and compression of the left common iliac vein between this thrombosed artery anteriorly and a posterior postoperative osteophyte complex. Interventional radiology concluded that this created an atypical form of May-Thurner syndrome (MTS), in which postoperative spinal changes and adjacent arterial thrombosis produced dual compression of the left common iliac vein. There was no clear proximal iliofemoral venous thrombosis.<br /><br />Her symptoms eventually improved, and repeat duplex showed resolution of the distal DVT. She was referred for outpatient venography to determine whether stenting would be needed.<br /><br />The report emphasizes that MTS is often underrecognized and may be triggered or worsened by spinal pathology, osteophytes, surgical hardware, or post-surgical anatomic changes. It also notes that this is believed to be the first reported case in which prior spinal fusion combined with right common iliac artery thrombosis contributed to left iliac vein compression. The authors highlight the importance of considering MTS in patients with persistent unilateral leg swelling after lumbar spine surgery, since early recognition can prevent recurrent thrombosis, pulmonary embolism, diagnostic delay, and long-term venous complications.

Asset Subtitle

Linh N. Vo

Meta Tag

Author List Conan Liu, Linh N. Vo

Category Clinical Vignettes

Concept May-Thurner Syndrome

Concept Unilateral Leg Swelling

Concept Deep Vein Thrombosis

Concept Vascular Imaging

Concept Recurrent Thrombosis

Distinguished Non-Finalist

Presenter Organization University of California, Davis School of Medicine

Presenting Author Linh N. Vo

Track Adult

Keywords

May-Thurner syndrome

iliac vein compression

spinal fusion

unilateral leg swelling

deep vein thrombosis

Charcot-Marie-Tooth disease

osteophyte

iliac artery thrombosis

postoperative complication

venous duplex

May-Thurner Syndrome

Unilateral Leg Swelling

Deep Vein Thrombosis

Vascular Imaging

Recurrent Thrombosis