May-Thurner syndrome in a 68-year-old woman after remote abdominal surgery

May-Thurner syndrome, also called iliac vein compression syndrome, is a rare cause of left iliac deep vein thrombosis, which arises from pulsatile compression of the left common iliac vein by the right common iliac artery. The resultant endothelial damage and intraluminal spur formation can lead to iliac deep vein thrombosis and sudden-onset left-lower-extremity edema and pain. Patients typically present with May-Thurner syndrome in their 2nd to 4th decades of life. In chronic form, the syndrome can be debilitating because of venous claudication and stasis ulcers. Surgical approaches and endovascular interventions have been effective in the acute phase of the disease, and intravenous stents can resolve the manifestations of chronic venous compression. Anticoagulation alone is ineffective, and a consensus regarding the usage and duration of antiplatelet and antithrombotic therapy has not been established. We present the case of a 68-year-old woman with a remote history of abdominal surgery who presented with left-lower-extremity edema and pain. Magnetic resonance venography of the pelvic veins yielded a definitive diagnosis of May-Thurner syndrome. Catheter-directed thrombolysis and intravenous stent placement resolved her symptoms, and she was discharged from the hospital on anticoagulative therapy. A year later, she had no residual pain or edema, and the affected veins were patent with normal phasic flow and normal responses to compression and augmentation.