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May Thurner syndromeClinical History: 50 year old presented with increased swelling of the left leg. The patient has a history of factor V Leiden. Left common femoral vein and left external iliac vein were patent, but there was thrombosis at the level of the left common femoral vein with no runoff into the vena cava. Thrombolysis followed by angioplasty and stenting was done. Post procedure venogram showed excellent runoff into the vena cava with decompression of collaterals and no evidence of obstruction. Findings: Figure 1 - 4: Complete occlusion of the left common iliac vein near the origin with multiple collaterals. These findings are consistent with May-Thurner syndrome. This was successfully thrombolysed with angiojet and later stented and dilated with good results. Diagnosis: May Thurner syndrome Discussion: May-Thurner syndrome is deep vein thrombosis of the iliofemoral vein due to compression of the left common iliac vein by overlying right common iliac artery. Variously termed May-Thurner syndrome, iliac vein compression syndrome, Cockett syndrome, or iliocaval compression syndrome, this condition is caused by compression of the left common iliac vein by the right common iliac artery. In contrast to the right common iliac vein, which ascends almost vertically to the inferior vena cava, the left common iliac vein takes a more transverse course. Along this course, it underlies the right common iliac artery, which may compress it against the lumbar spine. The overlying artery appears to induce a partial obstruction of the vein in two ways: by its anatomic orientation with subsequent physical entrapment of the left common iliac vein and by extensive intimal hypertrophy of the vein resulting from the chronic pulsatile force of the right common iliac artery4. This condition has been estimated to occur in 2%–5% of patients who undergo evaluation for lower extremity venous disorders. May-Thurner syndrome is a progressive disease with substantial long-term disabling complications. Treatment options include vein-patch angioplasty with excision of intraluminal bands, division of the right common iliac artery and relocation behind the left common iliac vein or inferior vena cava, and contralateral saphenous vein graft bypass to the ipsilateral common femoral vein. Endovascular treatment options include thrombolysis, angioplasty and stenting. References / Suggested Reading:
Tue, 09/22/2009 - 08:13
#2
 
Excellent Case
Preangiography diagnostic images were necessary to document to show how the entity was diagnosed.
Wed, 03/04/2009 - 06:34
#3
very Good Case, Dr. Sharma. I would like to know from you, about the other imaging modalities(Doppler , CT / MR imaging)used in this patient prior to angiography. |
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The course covers topics that are a must for any practicing radiologist. The lecture format is audio-visual supplemented with audiovisual response system to make it more interactive. Recent comments
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Ultrasound with color Doppler was performed on this patient and the diagnosis was made based on that. This case only focusses on the angiography part of the management.
Shweta Bhatt, MD
Assistant Professor Department of Radiology
Assistant Director of Ultrasound
University of Rochester, Rochester, NY