Ann Phlebology.  2022 Dec;20(2):104-107. 10.37923/phle.2022.20.2.104.

May-Thurner Syndrome with Coexisting Arteriovenous Fistula Treated Using an Endovascular Procedure

• Rim Tg

• KMID: 2549990
• DOI: http://doi.org/10.37923/phle.2022.20.2.104

Abstract

An 82-year-old female was referred from a local clinic due to left leg swelling despite 1 month of direct oral anticoagulant therapy for left iliac deep vein thrombosis. Enhanced computed tomography (CT) revealed a hypoplastic iliac vein with several iliac and popliteal arteriovenous fistulas (AVFs), without significant iliofemoral deep vein thrombosis. First, endovascular balloon angioplasty was performed for iliac vein hypoplasia related to a previous deep vein thrombosis. On postoperative day 4, CT angiography was performed due to persistent left leg edema with circumference discrepancy, which confirmed narrowing of the left common iliac vein with extrinsic compression between the right common iliac artery and vertebral body. Persistent left leg edema required an additional endovascular procedure; more specifically, placement of an iliac vein stent. After restoration of circumference equality in both the thigh and calf, the patient was discharged from hospital on antiplatelet and antithrombotic medications. Three months later, the patient visited again due to recurrent left leg edema, with a circumference discrepancy measuring ＞10 cm. Iliac vein balloon angioplasty was performed, as was additional stent placement for May-Thurner syndrome (MTS) and coil embolization of the iliac AVF. Endovascular embolization resulted in full recovery from MTS with coexisting iliac AVFs. MTS combined with ilio-iliac AVF(s) may be a neglected phenomenon, although it is not very rare. The present report reviews this disease category and raises awareness of possible disease mechanisms(s).

Keyword

May-Thurner’s syndrome; Iliac AVF; Endovascular; Co-existing fistula