Corbin, Dina

El-Haddad, Boutros

Biodiversity Informatics

A CASE OF DVT REVISITED Dina Corbin, MD; Boutros El-Haddad, MD Introduction • May-Thurner Syndrome is an uncommon condition characterized by the compression of the left common iliac vein by the right common iliac artery against the fifth lumber vertebra.   • Chronic compression results in intimal hyperplasia leading to stenosis and increased incidence of DVT and the risk increases in young women on oral contraceptives.   • The prevalence in patients undergoing evaluation for venous disorders is 2-5%, mostly in women between second and fourth decades.   Presentation • A 32 year-old woman on oral contraceptives presented with DVT of the left popliteal vein.  Anticoagulation was started  and she was discharged on warfarin.  • Days later, while INR was therapeutic.  A repeat ultrasound showed DVT extension to the femoral vein.  Venogram showed left popliteal, femoral, and left common iliac vein thrombosis. • Thrombolytic was given. Repeat venogram showed almost complete resolution of the thrombus.  She went home on warfarin. • Two weeks later, and while INR was therapeutic, a Doppler ultrasound showed popliteal DVT.  Hypercoagulable workup was negative as well as work up for malignancy. An IVC filter was placed.  • Angioplasty and stenting of the left common iliac vein was done.   The patient was kept on low-dose aspirin and discharged on warfarin.  The six-month follow-up venogram was negative for DVT. Discussion • Diagnosis of May-Thurner Syndrome is usually made by venography and/or intravenous ultrasound.  • Screening prior to prescribing oral contraceptives is not routinely recommended.    • Anticoagulation therapy alone is not very effective. • Treatment includes catheter-directed thrombolysis and mechanical thrombectomy with endovascular stent placement. • We recommend screening in young patients with DVT who failed anticoagulation and have negative       hypercoagulable work-up.  References 1. Murphy EH, et al.  Symptomatic ileofemoral DVT after onset of oral contraceptive use in women with previously undiagnosed May-Thurner Syndrome.  J Vasc Surg 2009; 49:697-703.  2. Jeon UB, et al.  May-Thurner syndrome complicated by acute iliofemoral vein thrombosis: helical CT venography for  evaluation of long-term stent patency and changes in the iliac vein. AJR Am J Roentgenol 2010,195:751-757. 3. Loukas M, et al.  A case of May-Thurner syndrome. Case report. Folia Morphol 2008; 67(3):214-217.  A  CT scan (left) and venogram (right) showing compressed left common iliac vein (black arrow). 

A Case of DVT Revisited

The University of Kansas: Journals@KU

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https://journals.ku.edu/kjm/article/download/11347/10754

A Case of DVT Revisited

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Biodiversity Informatics

The University of Kansas: Journals@KU