May-Thurner is correct. A self expandable stent was placed | Figure 1

May-Thurner Case Overview

May-Thurner is correct. A self expandable stent was placed in the left common iliac vein and venogram demonstrates patency without retrograde flow. CT abdomen and pelvis demonstrates patent left internal iliac vein with self expanding stent in place. 1 year later patient had recurrence of symptoms and CT showed mural thrombus with in-stent stenosis (image 3). Initial venogram on image 4 demonstrated in-stent stenosis with mural thickening. Angioplasty was performed and post procedure venogram film is shown on image 5.

Similar Cases

38 year old pregnant female presents with acute LLE DVT diagnosed by MRI. Due to the extreme pain, risk of PE and for prevention of post-thrombotic syndrome, she was treated with balloon venoplasty, AngioJet thrombectomy and overnight catheter directed lytics infusion. A self expanding stent was then deployed across the narrowing. Repeat venoplasty was performed within the stent. IVUS post intervention demonstrates that at the IVC bifurcation, the right common iliac artery (red arrowhead) no longer compresses the open left common iliac vein (yellow arrowhead). (Courtesy Feraz N Rahman MD)

49 yo female referred to IR with bilateral extremity pain and swelling for several months. Pmhx: NKDA, No medications, No relevant pelvic or other surgical history. Physical: BP 111/76 RR 14, BMI 22, BSA 1.5 RRR, Equal breath sounds, no abd pain. Bilateral non pitting edema with tenderness and varicosities. Pain improved with elevation. Figure 1, 2 and 3 demonstrate #venogram obtained via left popliteal v. access in prone position. Figure 1 green arrow shows nonopacification of the #IVC. Figure 2 arrow demonstrates collaterals entering right common iliac v. , delayed flow into IVC is demonstrated. What is the #angiographic diagnosis? Figure 4 and 5 demonstrate placement of A 14F self expandable wall #stent (Red) placed in the left common iliac vein and venogram demonstrates patency without retrograde flow. Which of these best describes anatomical relationship in #May-Thurner’s Syndrome? A: Right common iliac artery crosses over the right common iliac vein. B: Right common iliac #artery crosses over the left common iliac vein. C: Left common iliac artery crosses over the right common iliac vein. D: Left common iliac artery crosses over the left common iliac #vein. What is a possible late complication of venous stenting? What is demonstrated by CT at 1.5 year follow up?

Acute iliofemoral #DVT in patient with pancreatic #cancer, with May Thurner as evidence from the significant stenosis across the left common iliac vein. Access was obtained with patient prone through the left popliteal vein followed by pulse tPA, angioplasty and finally smart stents from the level of the left common iliac vein to just above the femoral head. Completion venogram demonstrates resolution of collateral vessels and improved flow from the popliteal to the heart.

1. Pancreatitis > splenic vein stenosis, pancreatic masses, trauma, TB, pregnancy, retroperitoneal fibrosis, lymphoma, iatrogenic, splenic and left gastric pseudoaneurysms, wandering spleen.
2. Endoscopic therapy, splenectomy, splenic vein stenting, and splenic artery embolization. Procedure: A standard transjugular liver biopsy obtained and the portal system was accessed via the conventional TIPS route. Pressure measurements and venograms were performed in the right hepatic, portal and splenic veins. The portosystemic gradient was normal, but main portal vein venogram revealed a moderately stenotic lesion with high pressure gradient which was treated with balloon-angioplasty. Repeat main portal vein venogram showed significant improvement in preferential flow into the liver relative to previous portosystemic collaterals. Next, a splenic vein venogram demonstrated a long segment stenosis at the portosystemic confluence thought to be from radiation therapy. The stenotic lesion was balloon-angioplastied and stented with bare-metal uncovered stents. Repeat splenic vein venogram after angioplasty/stenting showed significant improvement in preferential flow into the liver relative to previous portosystemic collaterals. Pressure measurements across the treated portal and splenic vein lesions were normal, and GI bleeding was resolved without recurrence.