Singh Gurdeep, Alshareef Sanad, Meka Murali
Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA.
Interventional Radiology, Cape Fear Valley Medical Center, Fayetteville, USA.
Cureus. 2020 Oct 25;12(10):e11160. doi: 10.7759/cureus.11160.
May-Thurner syndrome (MTS) is defined as extrinsic venous compression by the arteries of the iliocaval system. The most common manifestation of MTS is compression of the left common iliac vein by the right common iliac artery. May-Thurner syndrome is pathologically seen in 2%-5% of patients presenting with symptomatic deep vein thrombosis (DVT). As an anatomic variant, the prevalence is predicted to be much higher as most patients with MTS anatomy are asymptomatic and do not seek evaluation. Symptomatic clinical presentations can include left lower extremity pain, swelling, skin discoloration, ulceration, and venous claudication. Here we present a patient with symptomatic MTS. A 64-year-old female with no pertinent past medical history presented with complaint of worsening left lower extremity swelling and pain. Clinical picture was concerning for phlegmasia cerulea dolens and ultrasound was bypassed in favor of a CT scan of the lower extremities bilaterally. The CT showed occlusion of the deep veins of the left leg secondary to stenosis of the left common iliac vein just posterior to the right common iliac artery; a finding consistent with MTS. Interventional radiology performed a catheter-directed thrombolysis with stenting of the left common iliac and external iliac veins. The patient clinically improved and was discharged with anticoagulative therapy. May-Thurner syndrome is a condition that typically manifests due to external anatomic compression of the left common iliac vein. It is our belief that patients (with the appropriate risk factors) presenting with signs and symptoms consistent with proximal lower extremity DVT would benefit from further radiographic studies to fully evaluate for iliocaval venous stenosis and subsequent catheter-directed thrombolysis with endovascular stenting.
梅-图二氏综合征（MTS）定义为髂总静脉系统动脉对静脉的外在压迫。MTS最常见的表现是右髂总动脉压迫左髂总静脉。在有症状的深静脉血栓形成（DVT）患者中，病理检查发现梅-图二氏综合征的比例为2%-5%。作为一种解剖变异，预计患病率要高得多，因为大多数有MTS解剖结构的患者无症状，也不会寻求评估。有症状的临床表现可包括左下肢疼痛、肿胀、皮肤变色、溃疡和静脉性跛行。在此，我们报告一例有症状的MTS患者。一名64岁女性，无相关既往病史，主诉左下肢肿胀和疼痛加重。临床情况令人担忧为股青肿，因此未进行超声检查，而是选择了双侧下肢CT扫描。CT显示左腿深静脉闭塞，继发于右髂总动脉后方左髂总静脉狭窄；这一发现与MTS一致。介入放射科进行了导管定向溶栓，并对左髂总静脉和髂外静脉进行了支架置入。患者临床症状改善，出院时接受抗凝治疗。梅-图二氏综合征是一种通常由于左髂总静脉外部解剖压迫而出现的病症。我们认为，出现与近端下肢DVT一致的体征和症状的患者（具有适当的风险因素），将受益于进一步的影像学检查，以全面评估髂总静脉狭窄情况，并随后进行导管定向溶栓和血管内支架置入。
