Abstract Number: PB2233
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » Thrombophilia
Background: May-Thurner syndrome (MTS), also known as Cockett´s syndrome or iliac vein compression syndrome, is a rare cause of iliofemoral deep venous thrombosis (DVT). An anatomic anomaly produces chronic compression of the left common iliac vein by the overlying right common iliac artery when it passes between the right common iliac artery and the spine. Prolonged compression on the vein potentiates thrombus formation by impairing the intima and by leading to the development of membranes within the lumen that may decrease and/or block venous flow.
Aims: Presentation of 4 cases of MTS.
Methods: Collection of clinical data in SClínico® application.
Results: Patient 1 is a 54-year-old male with signs of DVT. Computed tomography scan (CT-scan) confirmed MTS. Despite ongoing anticoagulation with rivaroxaban, he developed a post-thrombotic syndrome and is waiting for endovascular treatment. Patient 2, a 15-year-old female, initiated oral contraceptive 1 month before presenting with left DVT complicated with bilateral pulmonary thromboembolism. CT-scan confirmed MTS. She remains asymptomatic and hypocoagulated with warfarin (Time in Therapeutic Range >80%). Patient 3, a 19-year-old obese female, maintained leg pain after 6-month anticoagulation for DVT despite absence of DVT signs in duplex ultrasound. Magnetic resonance imaging (MRI) confirmed MTS. Rivaroxaban was restarted and she’s currently asymptomatic. Patient 4, a 30-year-old female, presents acute pain and left leg swelling in her puerperium. Her workup revealed left-sided acute DVT secondary to MTS, confirmed by MRI.
Conclusions: MTS may be underdiagnosed, therefore all clinicians treating DVT should be aware of it. Anticoagulation, clinical follow-up and non-invasive imaging play critical roles in the diagnosis and prevention of relapse and complications associated with MTS. Despite none of our patients underwent stenting, guidelines nowadays recommend venous stenting to relieve symptoms and prevent relapse. Patient 4 emphasizes that DVT during puerperium should not only be attributed to hypercoagulability secondary to pregnancy.
To cite this abstract in AMA style:
Lopes S, Pombal R, Vieira L, Ferreira D, Cruz Gomes H, Figueiredo M. Is May-Thurner Syndrome a Forgotten Cause of Deep Vein Thrombosis? [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/is-may-thurner-syndrome-a-forgotten-cause-of-deep-vein-thrombosis/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/is-may-thurner-syndrome-a-forgotten-cause-of-deep-vein-thrombosis/