SHM Converge Scientific Abstract ePoster Gallery-Unilateral Recurrent Deep Vein Thrombosis: A Case of May-Thurner Syndrome

Pdf Summary

A 73-year-old Caucasian woman with a remote history of hysterectomy and cesarean section presented with acute onset of painful, swollen, erythematous left leg edema extending to the groin. She had no history of prior clots, recent travel, or immobilization and was not taking medications. Duplex ultrasound showed extensive thrombosis from the left calf veins to the left common femoral vein. CT angiography of the chest showed no pulmonary embolism. She was started on enoxaparin and vascular surgery was consulted.<br /><br />She underwent percutaneous thrombectomy and venography with intravascular ultrasound, which revealed severe left common iliac vein stenosis consistent with May-Thurner syndrome. Catheter-directed thrombolysis was performed, followed by venography showing marked stenosis of the left common iliac vein extending proximally to the caval confluence and distally into the left external iliac vein. Self-expanding venous stents were placed in the left common iliac and external iliac veins, and she was started on rivaroxaban and clopidogrel.<br /><br />Three days later, she returned with recurrent symptoms and was found to have stent thrombosis. She underwent repeat catheter-directed thrombolysis and heparin infusion but developed significant blood loss anemia, with hemoglobin dropping from 12 g/dL to 6.9 g/dL, requiring transfusion. A second compressive lesion at the left common femoral vein was identified, and additional self-expanding stents were placed with balloon angioplasty.<br /><br />The case highlights that recurrent or persistent unilateral deep vein thrombosis should raise suspicion for May-Thurner syndrome, even in older patients. Diagnosis requires identifying the underlying anatomic venous compression, and treatment involves restoring venous patency with thrombolysis or thrombectomy, stenting, and anticoagulation/antiplatelet therapy to prevent recurrence.

Asset Subtitle

Vasanthan Muthusamy Kumarasamy

Meta Tag

Author List Akash Parashar, Arya Mariam Roy, Vasanthan Muthusamy Kumarasamy

Category Clinical Vignettes

Concept May-Thurner Syndrome

Concept Deep Vein Thrombosis

Concept Anticoagulation

Concept Intravascular Ultrasound

Concept Catheter-directed thrombolysis

Distinguished Non-Finalist

Presenter Organization University at Buffalo-Catholic Health System

Presenting Author Vasanthan Muthusamy Kumarasamy

Track Adult

Keywords

May-Thurner syndrome

deep vein thrombosis

left leg edema

iliac vein stenosis

catheter-directed thrombolysis

venous stenting

stent thrombosis

venography

intravascular ultrasound

anticoagulation

May-Thurner Syndrome

Deep Vein Thrombosis

Anticoagulation

Intravascular Ultrasound

Catheter-directed thrombolysis