May-Thurner syndrome (MTS), also known as the
iliac vein compression syndrome, is an anatomic anomaly in which the compression of the left common iliac vein by an overlying right common iliac artery leads to blood stasis, which predisposes to
deep venous thrombosis (DVT) in the iliofemoral venous system. We present a case of a female with a history of DVT and currently on
warfarin with a therapeutic international normalized ratio (INR), admitted with left leg swelling, redness, and
intractable pain. Venous Doppler scan confirmed a massive DVT from the level of the left common femoral vein to the popliteal vein. The clot recurred after an unsuccessful trial of
argatroban, in-line pharmacokinetic thrombolysis with local
catheter-based
alteplase infusion, and interventional radiology (IR)-guided mechanical
thrombectomy. Subsequently, the patient was diagnosed as MTS with overlying left common iliac vein compression, as evident on venous Doppler ultrasound. She was managed successfully by venous
stent placement and ongoing systemic anticoagulation with
fondaparinux.