51 year old female with chronic pelvic complaints not diagnosed for many years. She was referred after her doctor saw a presentation I gave about venous disease in females. Workup of her pelvic pain using trans-vaginal and trans-abdominal ultrasound demonstrated an incompetent left internal iliac vein. CT venography was obtained confirming severe compression of the left common iliac vein by the right common iliac artery. This is the most common variant of iliac vein compression syndrome and is know as May Thurner Syndrome. The patient underwent embolization of the pelvic varicosities and stenting and venoplasty of the left common iliac vein with marked improvement in symptoms.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.
87 year old with severe left leg claudication limiting ability to walk more than 100 feet
30 year old female, on oral contraceptives, with severe left leg swelling after a long car ride. Ultrasound showed left iliofemoral DVT.