PMC9479514_01
A 61-year-old lady presented with prior left lower limb deep vein thrombosis with CT confirmed May-Thurner's syndrome. Contrast-enhanced venous phase CT with compression of the left common iliac vein by the right common iliac artery against the lumbar vertebra (arrow).
JCIS-12-52-g001.jpg
PMC9479514_01_JCIS-12-52-g001.jpg
F1
A 61-year-old woman presented with a history of the left lower extremity deep vein thrombosis 4 years prior, with CT scan confirming thrombus involving the left external iliac vein and extrinsic compression of the left common iliac vein by the right common iliac artery against lumbar vertebra, suggestive of May-Thurner syndrome [Figure 1].
DSA from the venous access at the great saphenous vein showing diseased left common iliac and left external iliac veins (arrow) with venous collaterals seen.
JCIS-12-52-g002.jpg
PMC9479514_01_JCIS-12-52-g002.jpg
F2
Venous access was obtained through the left great saphenous vein with venogram confirming the venous stenosis at the left common iliac vein with venous collateral flow seen [Figure 2].
Post-procedure DSA shows technically successful stent deployment with substantial reduction in collaterals.
JCIS-12-52-g003.jpg
PMC9479514_01_JCIS-12-52-g003.jpg
F3
GOLD balloon (BD) sized 10 x 40 mm to treat the length of affected veins. Good angiographic flow through the stented veins was then confirmed on DSA with substantial reduction in collateral flow [Figure 3].
PMC9479514_02
41-year-old man with contrast enhanced CT findings compatible with May-Thurner Syndrome and thrombus from the left common iliac vein the upper portion of the left femoral vein. The venogram at the upper portion of the superficial femoral vein showing occlusive thrombus at the common femoral vein (arrow).
JCIS-12-52-g004.jpg
PMC9479514_02_JCIS-12-52-g004.jpg
F4
The left femoral venogram demonstrated occlusive thrombus involving the left common femoral vein [Figure 4].
Placement of three stents performed, ensuring overlap, followed by post-deployment balloon angioplasty to achieve desired diameter (arrow).
JCIS-12-52-g005.jpg
PMC9479514_02_JCIS-12-52-g005.jpg
F5
Then, three Venovo  venous stents (BD Medical) sized 18 x 80 mm, 16 x 120 mm, and 16 x 80 mm were deployed and subsequent further balloon angioplasty with an Atlas  balloon sized 14 x 40 mm [Figure 5].
Post-procedure venogram shows good flow through the stents with no substantial collateral flow.
JCIS-12-52-g006.jpg
PMC9479514_02_JCIS-12-52-g006.jpg
F6
Post-procedure venogram confirmed patent left common and external iliac veins and satisfactory stent deployment with good flow on angiography through the left external iliac and common iliac veins was achieved with reduction in flow through collaterals [Figure 6].
PMC9479514_03
An 85-year-old lady with CT findings compatible with May-Thurner syndrome and a left pelvic haematoma. Slow contrast extravasation to the known left pelvic haematoma is shown.
JCIS-12-52-g007.jpg
PMC9479514_03_JCIS-12-52-g007.jpg
F7
Endovascular mechanical thrombectomy was performed with 10Fr Aspirex  S catheter (BD Medical) from the left popliteal vein to the lower portion of the left common femoral vein, but slow extravasation of contrast was noted into the pelvis during procedure [Figure 7].
Post-procedure digital subtraction angiogram demonstrating no extravasation nor gross collateral flow.
JCIS-12-52-g008.jpg
PMC9479514_03_JCIS-12-52-g008.jpg
F8
Post-procedure venogram shows good angiographic result with stents placed over the left common iliac to superficial femoral veins, without angiographic evidence of further contrast extravasation nor gross collateral flow [Figure 8].