A Curious Presentation of May-Thurner Syndrome With Isolated Iliofemoral Deep Vein Thrombosis.

Abstract

May-Thurner syndrome, which has been called by many names, including Cockett syndrome, iliocaval compression syndrome, and iliac vein compression syndrome, is an anatomic variation where there is extrinsic venous compression by the arterial system against the bony structure of the axial skeleton, most commonly right common iliac artery compressing the left iliac vein against the fifth lumbar vertebra. The persistent right common iliac pulsation results in endothelial irritation of the venous system and at the same time reduces venous return, hence satisfying two factors in Virchow's triad for the formation of venous thrombosis. Here we present a rare case of a patient who presented with multiple risk factors that could propagate the formation of deep vein thrombosis with the underlying anatomic variation of May-Thurner syndrome in the setting of dehydration, systemic infection, failure to thrive, and psychiatric decompensation. Treatment required fluid hydration, antibiotic therapy, and mechanical thrombectomy in conjunction with local infusion of thrombolytics. Subsequent stent placement was performed to prevent re-thrombosis and stenosis of the affected area with long-term oral anticoagulation.