May-Thurner's syndrome (MTS) is an anatomical variant where the left common iliac vein (CIV) is compressed by the overlying right common iliac artery and the underlying lumbar vertebrae, leading to
stenosis in the left CIV. Endovascular intervention followed by anticoagulation currently constitute the mainstay of management of MTS associated with recurrent
deep vein thrombosis (DVT).
Warfarin appears to be the
anticoagulant of choice in most studies conducted in patients with MTS. There is little evidence of treatment using nonvitamin K oral
anticoagulants. This case report serves to describe a patient with MTS who was successfully treated with
catheter-directed
therapy followed by anticoagulation using
rivaroxaban. A 64-year-old women presented with left lower limb swelling. Her duplex ultrasound and computed tomography (CT) showed extensive DVT and underlying narrowing of the left CIV, respectively. She underwent
catheter-directed
therapy, involving
stent placement in the left CIV, and was subsequently started on
rivaroxaban. She developed partial
thrombosis of the external iliac vein at 5 months postprocedure and partial
stent thrombosis at 1 year postprocedure while on
rivaroxaban, requiring repeat stenting and continuation of anticoagulation. On follow-up, there was no recurrence of symptoms related to MTS, no
postthrombotic syndrome, and no clinically significant
bleeding as a side effect of
rivaroxaban. This case report shows that
rivaroxaban is a safe agent that can be successfully used in the treatment of MTS after stenting.