Symptomatic ileofemoral DVT after onset of oral contraceptive use in women with previously undiagnosed May-Thurner Syndrome.
OBJECTIVE
May-Thurner syndrome is characterized by left common iliac obstruction secondary to compression of the left iliac vein by the right common iliac artery against the fifth-lumbar vertebra. This anatomic variant results in an increased incidence of left-sided deep venous thrombosis (DVT). Furthermore, while a preponderance of left-sided DVT has been demonstrated in women during pregnancy and oral contraceptive use, patients are not typically screened for this condition after developing a left-sided DVT. As anticoagulation alone is ineffective for DVT treatment in the setting of May-Thurner anatomy, more aggressive treatment is warranted. Failure to diagnosis this condition predisposes these women to the unnecessary risks of recurrent DVT and post-thrombotic syndrome.


METHODS
We present the occurrence of 7 adolescent patients with previously undiagnosed May-Thurner syndrome who presented with DVT after the initiation of oral contraceptive steroids (OCP) use. All 7 patients elected to proceed with mechanical thrombolysis/catheter based thrombolysis followed by endovascular stenting and were postoperatively treated with 6 months of warfarin.


RESULTS
Mean patient age was 18.3 +/- 3.3 years (range, 16-24 years). Mean time to presentation after initiation of OCP was 5 weeks (range, 2-10 weeks). Mean time to intervention was 16.8 days (range, 10-24 days). All patients were treated with mechanical thrombectomy. Our rate of intraoperative clot resolution was 100%. All 7 patients were treated with self expanding nitinol stents after angioplasty of the iliac vein stenosis with resolution of the stenotic segment. Primary stent patency is 100% (7/7). Mean follow-up time is 13 +/- 13.84 months (range, 6-42 months). There have been no long-term complications related to surgical treatment or anticoagulation. All 7 patients have experienced resolution of left leg swelling and pain and have no evidence of post-thrombotic syndrome or DVT recurrence to date.


CONCLUSIONS
Women on OCPs presenting with left-sided iliofemoral DVT should be screened for hypercoagulable disorders and underlying May-Thurner anatomy. Treatment of May-Thurner syndrome should include thrombolysis/thrombectomy and anticoagulation for current DVT in addition to angioplasty and stenting of the underlying obstruction.
Murphy
Erin H
EH
Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9157, USA.
Davis
Charles M
CM
Journeycake
Janna M
JM
DeMuth
R Patrick
RP
Arko
Frank R
FR
D000293:Adolescent; D017130:Angioplasty / Q000295:instrumentation; D000925:Anticoagulants / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects*; D005260:Female; D005268:Femoral Vein / Q000473:pathology / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000473:pathology; D007084:Iliac Vein / Q000473:pathology / Q000601:surgery; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D010690:Phlebography; D012189:Retrospective Studies; D015607:Stents; D013577:Syndrome; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000139:chemically induced / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
D000925:Anticoagulants; D003278:Contraceptives, Oral, Hormonal; D014859:Warfarin