D. Seidensticker et al., Treatment of May-Thurner syndrome with catheter-directed thrombolysis and stent placement, complicated by heparin-induced thrombocytopenia, CARDIOV SUR, 6(6), 1998, pp. 607-613
May-Thurner syndrome is an uncommon process in which the right common iliac
artery compresses the left common iliac vein, resulting in left iliofemora
l deep vein thrombosis and severe leg edema. We report the case of a 41-yea
r-old female who presented with severe left leg edema present for 1 day. On
e week earlier she had experienced acute shortness of breath and pleuritic
chest pain. Duplex ultrasound revealed a left iliofemoral deep vein thrombo
sis, A computed tomography (CT) scan performed for abdominal pain revealed
thrombosis of the entire left common and external iliac veins. A ventilatio
n-perfusion scan diagnosed a pulmonary embolism. The patient was treated wi
th systemic intravenous heparin and catheter-directed thrombolysis of the i
liofemoral deep vein thrombosis. Complete thrombolysis and iliofemoral vein
patency was achieved over 5 days. A persistent stenosis in the left common
iliac vein consistent with May-Thurner syndrome was alleviated with percut
aneous balloon angioplasty and placement of a Wallstent, Heparin therapy wa
s terminated at the time of stenting because of suspected heparin-induced t
hrombocytopenia. The patient was started on a continuous infusion of 10% de
xtran 40, and warfarin therapy was initiated. Heparin-induced antibodies we
re confirmed by a C-14 serotonin release assay. The endovascular reconstruc
tion remains patent 4 months later. Heparin-induced thrombocytopenia compli
cating endovascular reconstruction of the iliofemoral venous system in a pa
tient with May-Thurner Syndrome is an uncommon occurrence. This case and a
review of the literature are discussed. (C) 1998 The International Society
for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights r
eserved.