a unique case of may-thurner syndrome - jacc: cardiovascular interventions · 2016-11-10 · images...

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IMAGES IN INTERVENTION

A Unique Case of May-Thurner SyndromeExtrinsic Compression of the Common Iliac Vein AfterIliac Artery Stenting

Paul L. Hermany, MD,a Apurva O. Badheka, MBBS,b Carlos I. Mena-Hurtado, MD,a Robert R. Attaran, MBBSa

FIGURE 2 Left Iliac Venogram Demonstrating Area of

Interest at Level of Overlying Iliac Artery Stent

common iliac artery stenting. Examination revealedpalpable pedal pulses, small varicose veins, andperipheral edema most notably in the left leg.A venous duplex ultrasound ruled out lower extrem-ity deep vein thrombosis.

FIGURE 1 Simultaneous Aorto-Iliac Arterial Angiogram andIliac Venogram

Yellow arrow indicates overlying iliac artery stent.

From the aDepartment of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; and bThe

Everett Clinic, Everett, Washington. Dr. Mena has a consulting relationship with and has received honoraria fromMedtronic, Bard,

and Cook Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to

disclose.

Manuscript received November 12, 2015; accepted November 19, 2015.

FIGURE 3 Intravascular Ultrasound of the Mid Left Common

Iliac Vein

FIGURE 4 Intravascular Ultrasound of the Proximal Left

Common Iliac Vein Demonstrating Luminal NarrowingFIGURE 6 Deployed Stent in Left Common Iliac Vein Covering

Region of Compression By Right Iliac Artery Stent

Yellow arrow indicates right iliac artery stent now intersected

beneath by left iliac vein stent.

FIGURE 5 Intravascular Ultrasound of the Proximal Left

Common Iliac Vein Demonstrating Luminal Narrowing

Hermany et al. J A C C : C A R D I O V A S C U L A R I N T E R V E N T I O N S V O L . 9 , N O . 5 , 2 0 1 6

May-Thurner Syndrome After Iliac Arterial Stenting M A R C H 1 4 , 2 0 1 6 : e 3 9 – 4 1

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J A C C : C A R D I O V A S C U L A R I N T E R V E N T I O N S V O L . 9 , N O . 5 , 2 0 1 6 Hermany et al.M A R C H 1 4 , 2 0 1 6 : e 3 9 – 4 1 May-Thurner Syndrome After Iliac Arterial Stenting

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The patient underwent invasive aorto-iliac angi-ography and bilateral iliac venography (Figures 1and 2). Iliac artery stents were patent. Intravascularultrasound (Volcano, San Diego, California) revealedextrinsic compression of the proximal left commoniliac vein (Figures 3 to 5). A 14 � 60 mm Wallstent(Boston Scientific, Marlborough, Massachusetts) wasdeployed within the vein at the level of com-pression (Figure 6). Repeat intravascular ultrasounddemonstrated improved luminal gain. At 2-week and6-month follow-up visits, she reported completeresolution of her presenting symptoms and signifi-cant improvement in her lower extremity edema.

Iliac vein compression as a consequence of arterialintervention is a rare and likely under-reported entity(1,2). These images demonstrate venous outflowobstruction due to extrinsic compression from pre-vious arterial stenting, which responded dramaticallyto subsequent venous stenting.

REPRINT REQUESTS AND CORRESPONDENCE: Dr.Robert R. Attaran, Department of CardiovascularMedicine, Yale University School of Medicine, 15 YorkStreet, P.O. Box 208017, New Haven, Connecticut,06520-8017. E-mail: Robert.attaran@yale.edu.

RE F E RENCE S

1. Pandit AS, Hayes M, Guiney-Borgelt A, et al.Iatrogenic May-Thurner syndrome after EVAR. AnnVasc Surg 2014;28:739.

2. Rosen E,GrobenL, George J. Rare case of bilateralcommon iliac vein compression by arterial stents andcalcification. Vasc Dis Management 2012;9:E186.

KEY WORDS iliac stent, May-Thurner,venous compression