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Management of May-Thurner Syndrome with Extensive Left Lower Limb Deep Vein Thrombosis
Patient Details
Name: Mrs. Gopamma
Age/Sex: 58-year-old Female
Presenting Complaint: Progressive swelling of the left lower limb
Background
May-Thurner Syndrome (MTS) where the right common iliac artery compresses the left common iliac vein, leads to increased risk of left-sided deep vein thrombosis (DVT).
In untreated cases, extensive DVT can cause severe morbidity and life-threatening complications.
Timely recognition and advanced intervention are essential to prevent long-term sequelae like post-thrombotic syndrome.
Clinical Challenge
The case posed significant challenges:
- Risk of Pulmonary Embolism: Extensive thrombus burden with potential embolization.
- Risk of Post-thrombotic Syndrome: Chronic venous insufficiency, pain, and ulceration.
- Anatomical Complexity: Compression of the left iliac vein due to May-Thurner syndrome.
Diagnostic Workup
- Doppler Ultrasound of Left Lower Limb: Detected extensive thrombosis in the iliofemoral system.
- CT Venogram: Confirmed May-Thurner Syndrome with significant compression at the iliac vein crossover, demonstrating extensive thrombus formation in the left iliofemoral venous segment.
Intervention
The patient underwent a multimodality endovascular approach by our team of Dr. Md.Fahd Chand Chaudhary, Endovascular & Onco Interventional Radiologist and Dr. P. Ravi Kiran, Sr.General Physician & Medical Director at Onus Robotic Hospitals.
- Thrombectomy via Angioplasty – Mechanical removal of the clot to restore venous flow.
- Catheter-Directed Thrombolysis – Administration of Alteplase directly into the thrombus to achieve localized clot dissolution.
- Stenting at the Iliac Vein Crossover – Placement of a venous stent to correct the anatomic compression caused by May-Thurner Syndrome, ensuring long-term patency.
- Inferior Vena Cava (IVC) Filter Placement – To prevent embolic complications.
Outcome
- The procedure was uneventful.
- Immediate restoration of venous flow was achieved.
- The patient had significant reduction in swelling and discomfort.
- No peri-procedural complications were noted.
- The patient was discharged on anticoagulation therapy with instructions for follow-up.
Discussion
This case highlights the importance of early diagnosis and advanced intervention in the management of May-Thurner Syndrome. Standard anticoagulation alone is often insufficient in extensive iliofemoral DVT. Catheter-directed thrombolysis with stenting not only clears the thrombus but also addresses the underlying anatomical abnormality, thereby reducing the risk of recurrence and post-thrombotic complications.
Key Takeaways
- Technology: Advanced endovascular techniques enabled safe and effective management of a complex vascular condition.
- Expertise: Accurate diagnosis and timely execution of multimodal therapy.
- Teamwork: Successful outcome achieved through the coordinated efforts of vascular interventionists, radiologists, and critical care specialists.
- Hard Work: Prompt decision-making and diligent procedural care ensured life-saving results.
Conclusion
The case of Mrs. Gopamma demonstrates how a combination of technology, expertise, teamwork, and dedication can transform outcomes in life-threatening vascular emergencies. By addressing both the acute thrombotic event and the underlying anatomical cause, this intervention prevented potentially fatal pulmonary embolism and long-term disability, showcasing the strength of comprehensive interventional care.
