May-Thurner Syndrome: Three Patients Treated with Catheter-Directed Thrombolysis and Stent Placement

Abstract

Compression of the proximal left iliac vein by the right common iliac artery (May-Thurner syndrome) is an unusual cause of iliofemoral thrombosis. Several different surgical approaches have been advocated to alleviate or bypass the compression, but few reports exist of successful treatment using interventional techniques. The authors report three cases of left common iliac vein thrombosis caused by May-Thurner syndrome in two women aged 51 and 36 years, and one man aged 56 years. The two women had long histories of left leg swelling, with recurrent episodes of left iliac venous thrombosis; the man had acute symptoms and no previous history of venous thrombosis or leg swelling. Venography in all patients demonstrated left iliac vein thrombosis associated with large pelvic venous collaterals. Catheter-directed thrombolysis was performed successfully, allowing visualization of the lesions treated with balloon venoplasty and stenting. All three patients were treated with warfarin following stent placement, and all have had improvement or resolution of their symptoms and patent left iliac and femoral veins by duplex scan at 8 to 12 months of follow-up. The authors conclude that (1) Catheter-directed thrombolysis of left iliac vein thrombosis may identify patients with May-Thurner syndrome, which may occur more commonly than previously reported; (2) May-Thurner syndrome may be effectively treated nonoperatively by balloon venoplasty and stenting of the stenotic segment; and (3) the role of warfarin and the long-term results of this treatment are currently unknown.