A 29 year-old woman non-smoker reported recent onset of left leg swelling followed by sudden dyspnea. She had recently undergone implantation of an ethynil estradiol vaginal ring. Acute pulmonary embolism and deep vein thrombosis (DVT) extending from the iliac to the tibioperoneal veins were confirmed by contrast CT and leg ultrasound, respectively. The lack of improvement in the clinical signs of DVT despite anticoagulation prompted CT venography (Video).
The patient was treated with catheter-directed thrombolysis followed by balloon angioplasty and placement of two stents (AbreTM, Medtronic®), which restored blood flow and resolved the leg swelling. Besides oral acenocumarol and baby aspirin, removal of the vaginal ring and daily use of compression stocking were recommended.
May-Thurner syndrome (MTS) is usually diagnosed in the second and third decades of life, being more common to women. It is an anatomical variant present since birth, and frequently involves the left common iliac vein, but transient risk factors are needed to precipitate DVT. Anticoagulation alone is not sufficient. In the absence of contraindications, patients with MTS and acute thrombosis should undergo catheter-directed thrombolysis followed by stent placement.
The following are the supplementary data related to this article.
Supplementary data to this article can be found online at https://doi.org/10.1016/j.mcpsp.2022.100336.
