Symptomatic DVT after Onset of OCP use in Patients with Previously Undiagnosed May-Thurner Syndrome

OBJECTIVES:
May-Thurner syndrome is characterized by the occurrence of left common iliac obstruction secondary to compression of the left iliac vein by the right common iliac artery against the fifth-lumbar vertebra. This anatomic variant results in an increased incidence of left-sided deep venous thrombosis (DVT). Furthermore, while a preponderance of left-sided DVT has been demonstrated in women during pregnancy and during oral contraceptive use, patients are not typically screened for this condition after developing a left-sided DVT. As anticoagulation alone is ineffective for DVT treatment in the setting of May-Thurner anatomy, more aggressive treatment is warranted. Failure to diagnosis this condition predisposes these women to the unnecessary risks of recurrent DVT and post-thrombotic syndrome.
METHODS:
We present the occurrence of four adolescent patients with previously undiagnosed May-Thurner syndrome who presented with DVT after the initiation of oral contraceptive steroids (OCP’s) use. All four females elected to proceed with mechanical thrombolysis/catheter based thrombolysis followed by endovascular stenting and were post-operatively treated with 6 months of warfarin.
RESULTS:
Our rate of intraoperative clot resolution was 100%. Thus far, there have been no noted complications related to their surgical treatment or anticoagulation. All four patients have experienced resolution of left leg swelling and pain and have no evidence of post-thrombotic syndrome or DVT recurrence to date.
CONCLUSIONS:
Women presenting with left DVT should be further evaluated for May-Thurner anatomy. Patients with May-Thurner anatomy should not be placed on oral contraceptives without treatment of their underlying condition. Treatment should consist of angioplasty and stenting in addition to thrombolysis and/or anticoagulation for current DVT in order to prevent thrombus recurrence and prevent symptoms of post-thrombotic syndrome.