• Venous thromboembolism
• chronic thromboembolic pulmonary hypertension
• factor Xa inhibitor
• thoracic outlet syndrome

• Humans
• Female
• Male
• Factor Xa Inhibitors/adverse effects
• Factor Xa Inhibitors/therapeutic use
• Factor Xa Inhibitors/administration & dosage
• Adult
• Middle Aged
• Venous Thromboembolism/etiology
• Hypertension, Pulmonary/drug therapy
• Hypertension, Pulmonary/etiology
• Treatment Failure
• Pulmonary Embolism/drug therapy
• Pulmonary Embolism/complications
• Young Adult
• Risk Factors
• Thoracic Outlet Syndrome/complications
• Chronic Disease
• Rivaroxaban/adverse effects
• Rivaroxaban/administration & dosage
• Rivaroxaban/therapeutic use
• Fibrin Fibrinogen Degradation Products

• deep venous thrombosis (dvt)
• endovascular embolisation
• may-thurner's syndrome
• varicocele treatment
• vulvar varicosities

• catheter-directed thrombolysis
• deep vein thrombosis (dvt)
• hypercoagulability
• imaging to diagnose may-thurner syndrome
• may-thurner's syndrome
• thrombolysis

• May–Thurner syndrome
• conservative management
• spontaneous iliac vein injury

• Humans
• May-Thurner Syndrome/complications
• May-Thurner Syndrome/diagnostic imaging
• May-Thurner Syndrome/therapy
• Venous Thrombosis/diagnostic imaging
• Venous Thrombosis/etiology
• Venous Thrombosis/therapy
• Iliac Vein/diagnostic imaging
• Iliac Vein/surgery
• Thrombosis/complications
• Hematoma/diagnostic imaging
• Hematoma/etiology
• Hematoma/therapy
• Rupture, Spontaneous/complications

• May-Thurner syndrome
• balloon angioplasty
• iliac vein compression syndrome
• intravascular ultrasound
• venous stenting

• Humans
• Iliac Vein/diagnostic imaging
• Treatment Outcome
• May-Thurner Syndrome/therapy
• Ultrasonography
• Stents
• Ultrasonography, Interventional
• Retrospective Studies

• cardiac catheterization
• hematuria
• iliac vein

• Turner’s syndrome
• cholestatic
• estrogen replacement
• liver

• Compartment syndrome
• DVT
• Lidocaine
• Phlegmasia cerulea dolens

• assessment
• blood flow restriction
• kaatsu
• risk assessment
• risk factors

May-Thurner syndrome, which has been called by many names, including Cockett syndrome, iliocaval compression syndrome, and iliac vein compression syndrome, is an anatomic variation where there is extrinsic venous compression by the arterial system against the bony structure of the axial skeleton, most commonly right common iliac artery compressing the left iliac vein against the fifth lumbar vertebra. The persistent right common iliac pulsation results in endothelial irritation of the venous system and at the same time reduces venous return, hence satisfying two factors in Virchow's triad for the formation of venous thrombosis. Here we present a rare case of a patient who presented with multiple risk factors that could propagate the formation of deep vein thrombosis with the underlying anatomic variation of May-Thurner syndrome in the setting of dehydration, systemic infection, failure to thrive, and psychiatric decompensation. Treatment required fluid hydration, antibiotic therapy, and mechanical thrombectomy in conjunction with local infusion of thrombolytics. Subsequent stent placement was performed to prevent re-thrombosis and stenosis of the affected area with long-term oral anticoagulation.

Phlegmasia cerulea dolens (PCD) can present as leg pain accompanied by bluish discoloration. It is a limb-threatening emergency that needs to be promptly addressed with anticoagulation with consideration of thrombolytics. We present a case of PCD in an 83-year-old female without obvious risk factor for thrombosis, found to have May Thurner Syndrome (MTS) requiring a chemical and mechanical approach to prevent catastrophic outcomes.

• Case report
• Iliac vein
• Inferior mesenteric vein drainage
• May-Thurner
• Venous stent
• extremity deep vein thrombosis

• may-thurner syndrome
• postthrombotic syndrome
• venous thrombosis

• Aged
• Female
• Femoral Vein
• Humans
• Iliac Artery
• Iliac Vein/diagnostic imaging
• May-Thurner Syndrome/complications
• May-Thurner Syndrome/diagnostic imaging
• Venous Thrombosis/etiology

• May–Thurner syndrome
• anticoagulation
• complications
• diagnosis
• treatment

• any specific funding

• May–Thurner syndrome
• QFlow
• TRANCE MRI
• common iliac vein compression
• non-contrast venography

May–Thurner syndrome is an anatomical condition characterized by compression of the left common iliac vein by the right common iliac artery, causing venous outflow obstruction. It is an uncommon cause of deep vein thrombosis and is more prevalent among women. This paper highlights the importance of considering May–Thurner syndrome in young males without risk factors presenting with left lower limb pain, as endovascular treatment may be required.

A 23 year-old Caucasian male presented with a 1-week history of left lower limb pain, edema, and pallor. He was found to have an unprovoked deep vein thrombosis on Doppler ultrasound involving the left fibular, soleus, gastrocnemius, popliteal, femoral, common femoral, and external iliac veins. A heparin infusion was commenced as the initial treatment for deep vein thrombosis. Further investigation with computer tomography pulmonary angiogram and computer tomography venography of the abdomen and pelvis showed bilateral pulmonary emboli and left common iliac vein compression with left common, internal, and external iliac vein thrombosis. He was diagnosed with May–Thurner syndrome despite having no risk factors. A retrievable Cook Celect Platinum inferior vena cava filter was placed, and thrombus of the left common femoral, external, and common iliac veins was treated successfully with AngioJet thrombectomy, thrombolysis using 200,000 units of urokinase, angioplasty and stenting using two Cook Zilver Vena venous self-expanding stents. Therapeutic enoxaparin was commenced on discharge. His filter was removed after 10 weeks. Hematological follow-up 4 months later showed an overall negative thrombophilia screen, and anticoagulation was switched to apixaban. He has had no recurrent thrombosis.

Clinicians should have a low threshold to investigate for May-Thurner syndrome in patients with left lower limb venous thrombotic events regardless of risk factors, as endovascular treatment may be required to minimize the long-term sequelae of deep vein thrombosis. Duplex ultrasound can be used initially for diagnosis, and computer tomography venography used subsequently if the common iliac vein is not visualized on ultrasound. Endovascular treatment is preferred over anticoagulation alone, especially in otherwise fit patients presenting early, the aim being to reduce the chances of chronic venous hypertension in the lower limb.

• Case report
• Computer tomography venography
• Deep vein thrombosis
• Endovascular
• Left common iliac vein
• May–Thurner syndrome
• Risk factors
• Stent
• Ultrasound
• Venous hypertension

• Klippel-Trenaunay syndrome
• May-Thurner syndrome
• swelling
• venous disease

• Cognitive rehabilitation
• Occipital-temporal stroke
• Posterior cortical infarct
• Quadrantanopsia
• Topographical disorientation

• Adult
• Female
• Hemianopsia
• Humans
• Infarction
• Magnetic Resonance Imaging
• Memory Disorders
• Occipital Lobe/diagnostic imaging

• K23 MH097844 NIMH NIH HHS

May-Thurner syndrome, which is also known as iliac vein compression syndrome, is caused when an anatomical variant of the left common iliac vein with a lateral or anterior spur is compressed by the right iliac artery, resulting in thrombosis of the vein. It can present as left deep vein thrombosis which can lead to pulmonary embolism or chronic changes of venous insufficiency in the left lower limb. We report a 27-year-old female with pain abdomen, who was diagnosed to have May-Thurner syndrome.

• May-Thurner syndrome
• deep vein thrombosis
• leg swelling

Iliocaval venous compression syndrome (ICS) is the extrinsic compression of the common iliac vein by the overlying iliac artery against the vertebra. Chronic compression can lead to venous stenosis and stasis, which manifests as chronic venous disease and treatment resistance. Therefore, early recognition of ICS and prompt treatment are essential. Clinical presentations of ICS can be ambiguous and diagnosis requires a high index of suspicion with the relevant imaging studies. The initial imaging test is typically a Duplex ultrasound for vessel assessment and pelvic ultrasound to exclude a compressive mass, which is followed by computed tomography (CT) or magnetic resonance (MR) venography. CT and MRI can identify the anatomical causes for venous compression. In patients with high clinical suspicion for ICS, negative findings on CT and MR venography would still warrant further investigations. Definitive diagnosis can be established using catheter-based venography complemented with intravascular ultrasonography but the nature of their invasiveness limits its utility as a routine imaging modality. In this review paper, we will discuss the evidence, utility and limitations of the existing imaging modalities and endovascular intervention used in the management of ICS.

• Iliocaval venous compression syndrome
• Duplex ultrasound
• Intravascular ultrasound
• Computed tomography venography
• Magnetic resonance venography
• Endovascular stent

• Risk factors
• Thromboembolism
• Thrombosis
• Vascular diseases

• deep vein thrombosis
• epidemiology
• iliac vein compression syndrome
• pulmonary embolism
• thrombophilia

• Humans
• Iliac Vein/diagnostic imaging
• May-Thurner Syndrome/diagnostic imaging
• May-Thurner Syndrome/epidemiology
• Prevalence
• Risk Factors
• Venous Thrombosis/diagnostic imaging
• Venous Thrombosis/epidemiology

• Cross-sectional anatomy
• Endovascular procedures
• Venous anatomy
• Venous insufficiency
• Venous thromboembolism

May-Thurner syndrome (MTS) is a venous outflow obstruction disorder characterized by compression of the left common iliac vein by an overriding right common iliac artery. MTS primarily affects young to middle-aged women, although many patients remain entirely asymptomatic. Anatomic variations of MTS, while uncommon, have been described. Treatment usually involves endovascular management, including thrombolysis and/or thrombectomy with or without inferior vena cava filter placement, followed by angioplasty and stenting of the left common iliac vein. We report a unique case of a 31-year-old woman who presented with MTS-related deep vein thrombosis accompanied by symptomatic abdominal and pelvic varicosities. The varicosities were treated successfully using multiple procedures, resulting in complete resolution of all symptoms. Our case discusses a treatment approach for an unusual presentation of MTS-related postthrombotic syndrome, and provides a brief literature review of MTS complications and management.

May–Thurner syndrome (MTS) is an anatomic variant where the overlying right common iliac artery compresses and chronically obstructs the left common iliac vein, leading to thrombosis. Interventions for symptomatic MTS include endovascular thrombectomy and stenting. Occluding venous thrombus can be fatal to transplanted allografts. No guidelines exist for patients with MTS after simultaneous kidney-pancreas transplant. A 57-year-old female with ESRD and diabetes mellitus underwent a kidney-pancreas transplant. Post-operative imaging revealed a compressed left CIV with an occlusive thrombus threatening the renal graft. Thrombectomy with stent placement was performed, maintaining patency of both allograft venous outflows. Post-intervention the patient has demonstrated preserved kidney and pancreas allograft function through 1 year of follow-up. Interventions for MTS in patients after transplant are challenging given the complex allograft vascular reconstruction. We present a case which demonstrates that angiographic interventions for MTS can be safely performed after simultaneous kidney-pancreas transplant.

• chronic thromboembolic pulmonary hypertension
• pulmonary thromboendarterectomy
• right ventricle function and dysfunction
• uterine fibroid
• venous thromboembolism

May-Thurner syndrome (MTS) is a rarely diagnosed vascular abnormality that typically presents in young adults. The anomaly arises from compression of the left common iliac vein between the right iliac artery anteriorly and the lumbar vertebral body posteriorly, resulting in lower extremity venous outflow obstruction and recurrent deep vein thromboses (DVTs). We report the case of a 24-year-old female with a long history of recurrent DVTs and pulmonary emboli (PE) despite full anticoagulation. A computed tomography (CT) scan revealed findings consistent with MTS, and a left common iliac vein stent was placed. However, the patient continued to have DVTs while trialing several anticoagulation therapies, including rivaroxaban, enoxaparin, and warfarin. Eventually, the patient developed arterial thrombi resulting in critical limb ischemia, necessitating a right below knee amputation (BKA). One month status-post BKA, the patient was admitted for severe BKA stump pain secondary to infection and necrosis. She underwent BKA revision, but continued to experience pain post-operatively and was found to have new right common iliac artery, external iliac artery, and common femoral artery thrombosis in the setting of continued inpatient anticoagulation therapy with enoxaparin and aspirin. The patient returned to the operating room for emergent Fogarty thrombectomy, however, this was complicated by rupture of the balloon catheter secondary to migration of the left common iliac vein stent into the right common iliac artery lumen. A stent was placed in the right common iliac artery to shift the rogue vein stent, but the patient continued to have poor distal circulation of the BKA stump and eventually underwent an above knee amputation. Dual anti-platelet therapy (DAPT) with aspirin and clopidogrel in combination with enoxaparin were used to prevent in-stent thrombosis and future formation of arterial and venous thrombi. After the initiation of DAPT and enoxaparin, her clinical course was free of any further thromboembolic events. Clinicians should consider MTS in the differential diagnosis of younger adults presenting with recurrent DVTs or other unprovoked thromboembolic events. A two-pronged strategy of DAPT and anticoagulation was employed for successful prevention of thrombotic events.

• Dual anti-platelet therapy
• May-Thurner syndrome
• Thrombosis

May-Thurner syndrome (MTS) is a medical condition where the left iliac vein is compressed by the right iliac artery, which in turn predisposes patients to deep venous thrombosis (DVT). We present a case of a 67-year-old female who had pain and swelling of the left leg. Ultrasound of the deep veins of the leg revealed DVT of the distal external iliac vein. She was treated with catheter-directed thrombolysis and stent placement. Finally, she was discharged on long-term anticoagulation with warfarin. The purpose of presenting this case is to highlight the clinical presentation, diagnosis, and treatment of MTS.

• anticoagulation
• may thurner syndrome
• stent

Venous aneurysms often present as painful masses. They can present either in the deep or superficial venous system. Deep venous system aneurysms have a greater risk of thromboembolism. Though rare, there have been case reports of superficial aneurysms and thrombus causing significant morbidity such as pulmonary embolism. We present a case of an anomalous greater saphenous vein connection with an aneurysm and thrombus resulting in a pulmonary embolism. This is the only reported case of an anomalous greater saphenous vein connection with aneurysm and thrombus, which eventually led to a pulmonary embolism. Recognition of the morbidity and mortality associated with superficial venous aneurysms can help prevent catastrophic outcomes such as pulmonary embolism. Surgical intervention on large symptomatic superficial venous aneurysms may be the optimal treatment in preventing unwanted complications compared to anticoagulation alone.

Isolated pelvic deep vein thromboses (DVT) are rare and difficult to diagnose, but they are more common in pregnant women and carry an increased risk of embolization. Pulmonary embolism is the most common non-obstetric cause of death in pregnancy. Compression ultrasound is the first-line imaging test for suspected lower extremity DVT, but it cannot usually aid in directly visualizing or easily diagnosing isolated pelvic DVT. Nonetheless, point-of-care ultrasound (POCUS) may provide valuable clues to help rule in pelvic DVT and expedite initiation of anticoagulant therapy. Such findings include increased venous diameter, increased resistance to compression, visible venous reflux, and blunted phasicity. This case presents an example of how these findings on POCUS led the emergency physician to make the difficult diagnosis of pelvic DVT at the bedside within seconds.

A 38-year-old woman with a history of recurrent deep venous thromboses (DVTs) on chronic anticoagulation presented with acute left leg swelling. The patient was diagnosed with an acute left lower extremity (LLE) DVT in the setting of May-Thurner syndrome for which treatment with unfractionated heparin was started. Her hospital course was complicated by a new diagnosis of heparin-induced thrombocytopenia (HIT), with an incidental discovery of a large tricuspid valve mobile mass on a transthoracic echocardiogram (TTE). Subsequent imaging confirmed multiple right atrial thrombi along with LLE venous stent thrombosis and a new right LE acute DVT. Anticoagulation with argatroban for HIT thrombosis was started. She underwent a right atrial percutaneous thrombectomy and bilateral lower extremity thrombectomy with directed angioplasty and stent placement. This presentation is a rare manifestation of HIT with extensive intracardiac and deep venous thrombi, with successful staged interventions.

• Acute Disease
• Female
• Femoral Vein
• Humans
• Iliac Vein
• May-Thurner Syndrome/complications
• May-Thurner Syndrome/nursing
• Middle Aged
• Nursing Diagnosis
• Treatment Outcome
• Venous Thrombosis/complications
• Venous Thrombosis/nursing

• Computed tomography
• Deep vein thrombosis
• Iliac vein compression syndrome
• May–Thurner syndrome

• Diagnosis, Differential
• Humans
• May-Thurner Syndrome/diagnostic imaging
• May-Thurner Syndrome/physiopathology
• May-Thurner Syndrome/therapy
• Multidetector Computed Tomography

• anticoagulation
• dvt
• femoral
• iliofemoral
• pulmonary embolism
• venogram
• young female