Authors

• Ivana Jurin — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-2637-9691
• Jasmina Ćatić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-6582-4201
• Željko Đurašević — University Hospital Dubrava, Zagreb, Croatia
• Diana Rudan — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-9473-2517
• Sanda Sokol — University Hospital Dubrava, Zagreb, Croatia
• Tomić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-4551-9231
• Ana Zovko — University Hospital Dubrava, Zagreb, Croatia

Keywords

May-Thurner syndrome, left iliac vein, anticoagulation

DOI

Full Text

**Introduction:** May-Thurner syndrome is the condition of the left common iliac vein being compressed between the right common iliac artery and the associated vertebral body. This condition has been linked to spontaneous episodes of deep vein thrombosis (DVT) and it is three times more common in women, especially between 20 and 50 years of age. (1) **Case report:** A 82-year-old man with a history of arterial hypertension was hospitalized because of a painless swelling of the left leg which lasted 10 days before admission. In the physical status we measured the circumference of both legs and the difference between the right and left upper leg was 9 cm, and the left and right lower leg was 6 cm. The value of D-dimer was 14.87, while CRP was 7.8 and basal coagulogram as complete blood count was normal. Ultrasound Doppler venous imaging of left leg demonstrated no evidenced signs of deep venous thrombosis but all veins were significantlly dilated with low flow rates which suggested a possible proximal compression or partial thrombosis. MSCT in the arterial and venous phase was done and showed that the left common iliac vein was more horizontal than usual and it was compressed by right common illiac artery. MSCT also showed thrombosis of illiac vein with the propagation of thrombus to the inferior vena cava. The patient was treated with dalteparin, and was discharged with warfarin in therapy. **Conclusion:** We present a case of a patient with May-Thurner syndrome who had left-sided DVT in the absence of risk factors. The monitoring of these patients is important because of possible recurrent deep vein thrombosis with unsatisfactory effect of anticoagulant therapy and then other treatment options such as venous angioplasty and stenting should be considered. At four years of follow up there was no recurrence of deep vein thrombosis with still ongoing warfarin therapy.

Literature

1. May R, Thurner J. The cause of the predominately sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957;8:419–27. https://doi.org/10.1177/000331975700800505