Unintentional May-Thurner

Sd. After Iliac Artery PTASAmy L. Adams Sibley

Background

May-Thurner Sd. (MTS)

Iliac vein compression

● Usually of left iliac vein

by right iliac artery

● Causes swelling of the

left lower extremity (May

and Thurner 1957)

http://www.md-health.com/images/10408671/left-leg-swelling.jpg

Background

MTS caused from

vein compression

by aorto-iliac

aneurysms

(DaSilva-DeAbrau

et al. 2017)

DaSilva-DeAbreu A, Masha L, Peerbhai S. An Unusual Endovascular Therapeutic

Approach for a Rare Case of May-Thurner Syndrome. American Journal of Case

Reports. 2017;18:226-229.

Background

MTS after abdominal

hysterectomy and cystocele

(Frenando et al. 2013)

Fernando R, Koranne K, Schneider D, Fuentes F. May-Thurner

syndrome in a 68-year-old woman after remote abdominal

surgery. Texas Heart Institute Journal [serial online].

2013;40(1):82-87.

MTS creation of

occlusive thrombi

complicating renal

transplant (Campsen et

al. 2010)

Background

Campsen J, Bang T, Kam I, Gupta R. May-Thurner

Syndrome Complicating Left-Sided Renal Transplant.

Transplantation. 2010;89(7):904-6.

Background

MTS as unusual

complication from

bladder distension in

stroke patient (Im et

al. 2009)

Im S, Lim S, Chun H, Ko Y, Yang B, Kim H. Leg Edema With Deep Venous

Thrombosis-Like Symptoms as an Unusual Complication of Occult Bladder

Distension and Right May-Thurner Syndrome in a Stroke Patient: A Case Report.

Arch Phys Med Rehabil. 2009;90:886-90.

Background

Vein comprsession with

retroperitoneal hematoma

associated with iliac vein

rupture (Jiang et al. 2010)

Jiang J, Ding X, Zhang G, Su Q, Wand Z, Hu S. Spontaneous retroperitoneal hematoma

associated with iliac vein rupture. Journal of Vascular Surgery. 2010;52:1278-82.

Problem

To our knowledge, MTS has not been reported in the setting

of iliac percutaneous angioplasty and stenting (I-PAS).

Case Presentation

81 yo Male, EVAR (6/14/2012)

● Developed claudication symptoms

● CTA demonstrated stenosis of the

distal aortic aneurysmal neck

Required Iliac PTAS Kissing

● Complicated by LLE Swelling

● Venous Duplex Neg x DVT

Case Presentation

81 yo Male, EVAR (6/14/2012)

● Developed claudication symptoms

● CTA demonstrated stenosis of the

distal aortic aneurysmal neck

Required Iliac PTAS Kissing

● Complicated by LLE Swelling

● Venous Duplex Neg x DVT

Case Presentation

81 yo Male, EVAR (6/14/2012)

● Developed claudication symptoms

● CTA demonstrated stenosis of the

distal aortic aneurysmal neck

Required Iliac PTAS Kissing

● Complicated by LLE Swelling

● Venous Duplex Neg x DVT

Case Presentation

81 yo Male, EVAR (6/14/2012)

● Developed claudication symptoms

● CTA demonstrated stenosis of the

distal aortic aneurysmal neck

Required Iliac PTAS Kissing

● Complicated by LLE Swelling

● Venous Duplex Neg x DVT

Case Presentation

81 yo Male, EVAR (6/14/2012)

● Developed claudication symptoms

● CTA demonstrated stenosis of the

distal aortic aneurysmal neck

Required Iliac PTAS Kissing

● Complicated by LLE Swelling

● Venous Duplex Neg x DVT

Case Presentation

81 yo Male, EVAR (6/14/2012)

● Developed claudication symptoms

● CTA demonstrated stenosis of the

distal aortic aneurysmal neck

Required Iliac PTAS Kissing

● Complicated by LLE Swelling

● Venous Duplex Neg x DVT

Case Presentation

81 yo Male, EVAR (6/14/2012)

● Developed claudication symptoms

● CTA demonstrated stenosis of the

distal aortic aneurysmal neck

Required Iliac PTAS Kissing

● Complicated by LLE Swelling

● Venous Duplex Neg x DVT

Fernando R, Koranne K, Schneider D, Fuentes F. May-Thurner

syndrome in a 68-year-old woman after remote abdominal

surgery. Texas Heart Institute Journal [serial online].

2013;40(1):82-87.

Case Presentation

81 yo Male, EVAR (6/14/2012)

● Developed claudication symptoms

● CTA demonstrated stenosis of the

distal aortic aneurysmal neck

Required Iliac PTAS Kissing

● Complicated by LLE Swelling

● Venous Duplex Neg x DVT

Management

IVUS

● Demonstrating flat

pattern

IVUS

● Satisfactory result

Management

IVUS

● Demonstrating flat

pattern

IVUS

● Satisfactory result

Clinical Result

Fernando R, Koranne K, Schneider D, Fuentes F. May-Thurner syndrome in a 68-year-old woman after

remote abdominal surgery. Texas Heart Institute Journal [serial online]. 2013;40(1):82-87. Available from:

MEDLINE with Full Text, Ipswich, MA. Accessed August 29, 2017.

Conclusion

MTS may be an atypical complication of iliac PTAS and or aorto-iliac endografting.

High index of clinical suspicion is necessary in patients that develop unexplained

unilateral swelling following I-PAS.

There may be radiographic predictor factors to help anticipate this complication.

Questions?

Radiographic Predictor