Abstract
BACKGROUND: May-Thurner syndrome (MTS) is a rare cause of left lower extremity venous disorders, including deep vein thrombosis (DVT). Classic MTS is caused by compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA). We report a case of a left lower extremity DVT caused by a rare variant of the classic MTS wherein the LCIV is compressed by the left common iliac artery (LCIA) instead of the RCIA. CASE DESCRIPTION: A 77-year-old female presented with left lower extremity swelling for two days. Computed tomography (CT) venogram demonstrated extensive ileo-femoral DVT from the LCIV to the peroneal vein, raising suspicion of MTS. She was found to have an unusual variant of MTS wherein the LCIV was compressed by the LCIA instead of the RCIA. She was started on full-dose anticoagulation with heparin and subsequently underwent mechanical thrombectomy followed by endoluminal stenting of the LCIV and external iliac vein (EIV) with restoration of venous flow post-stenting as confirmed by venogram. The patient was discharged home with oral anticoagulation to be continued for 6 months and instructions for follow-up duplex ultrasound to ensure stent patency. CONCLUSIONS: MTS should be considered as an underlying etiology of left lower extremity DVT, especially in females and the atypical variants of MTS should be considered while formulating a management plan.