Treatment of May-Thurner syndrome with catheter-directed thrombolysis and stent placement, complicated by heparin-induced thrombocytopenia

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.