Case of the Day – Dr. Ashchi

Do you have swollen leg(s)? Are you familiar with May-Thurner Syndrome?

We present to you a great case of May-Thurner Syndrome also known as Iliac Vein Compression Syndrome. It’s usually due to the right common iliac artery compressing the left common iliac vein resulting in Thrombus (clot) formation and/or Stenosis (blockage of the vein).

Once this occurs, the patient develops swelling in the leg, heaviness, tiredness, and fatigue in the leg. More advanced cases can result in chronic venous insufficiency (leaking in veins) and ulcers. Diagnosis is mainly by excellent history and physical exam. To verify the diagnosis, we have a few modalities with different sensitivity and specificity which is IVUS (Intravascular Ultrasound). Other modalities that are less sensitive and more specific are CAT Scan Venography, MRI Venography or a simple ultrasound of the pelvic veins and arteries.

Treatment is involved with a minimally invasive procedure by placing IV or catheters in the common femoral veins and performing venography and IVUS. If the patient has compression, stenosis, or total occlusion, then we perform angioplasty and stenting. There are several stents available in the market, however, the best of which is the Vici Stent by Boston Scientific. Our patient in this case received Vici Stent and angioplasty by Atlas Balloon. One video shows before and one shows after an intervention. The left common iliac vein as well as the left external iliac vein are now widely patent. The collaterals that were seen from left to right before interventions have disappeared.

The patient was sent home on Aspirin and Eliquis and already started having improvement in her symptoms. We are blessed and lucky to be living during this era of cutting edge technology.

I want to thank the Ashchi Heart & Vascular Center Cath Lab team and my partners for their professionalism and dedication.

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