Location
Suwanee, GA
Start Date
15-5-2018 1:00 PM
Description
May–Thurner Syndrome (MTS) is a condition defined by an anatomical variant that results in the compression of the left common iliac vein by the right common iliac artery. This case report describes MTS in a Hispanic female with folate deficiency. 44-year-old Nicaraguan female who is a lifelong nonsmoker without any past medical history presented with left leg pain and swelling for seven days. The patient stated that her whole left leg was edematous without erythema. No recent travel, trauma, surgery or immobilization of the lower extremity. Initial vitals on presentation were unremarkable. Physical exam revealed a tender swollen of left leg from ankle to the thigh. CBC showed WBC 16.2, hemoglobin 8.9, MCV 66, and platelets 295. BMP was normal. D-dimer was 6589. PT/INR 1.1 and 11.5. PTT 21.8. Doppler ultrasound of left lower extremity showed extensive DVT. CT of abd/pelvis with contrast showed May-Thurner lesion. Venogram was performed and a 5-French infusion catheter was placed with tPA infusion. Angioplasty and two overlapping 14 mm Bard Luminexx 60 mm Nitinol self-expanding stents were successfully positioned. The incidence of MTS is in the 30%, but DVT associated from MTS is around 2% with over 60% of patients having a hypercoagulable state. In our patient, thrombophilia work-up was negative. However, the patient had a folate deficiency which is an independent risk factor for venous thrombosis.
Embargo Period
8-14-2018
Folate Deficiency in May-Thurner Syndrome
Suwanee, GA
May–Thurner Syndrome (MTS) is a condition defined by an anatomical variant that results in the compression of the left common iliac vein by the right common iliac artery. This case report describes MTS in a Hispanic female with folate deficiency. 44-year-old Nicaraguan female who is a lifelong nonsmoker without any past medical history presented with left leg pain and swelling for seven days. The patient stated that her whole left leg was edematous without erythema. No recent travel, trauma, surgery or immobilization of the lower extremity. Initial vitals on presentation were unremarkable. Physical exam revealed a tender swollen of left leg from ankle to the thigh. CBC showed WBC 16.2, hemoglobin 8.9, MCV 66, and platelets 295. BMP was normal. D-dimer was 6589. PT/INR 1.1 and 11.5. PTT 21.8. Doppler ultrasound of left lower extremity showed extensive DVT. CT of abd/pelvis with contrast showed May-Thurner lesion. Venogram was performed and a 5-French infusion catheter was placed with tPA infusion. Angioplasty and two overlapping 14 mm Bard Luminexx 60 mm Nitinol self-expanding stents were successfully positioned. The incidence of MTS is in the 30%, but DVT associated from MTS is around 2% with over 60% of patients having a hypercoagulable state. In our patient, thrombophilia work-up was negative. However, the patient had a folate deficiency which is an independent risk factor for venous thrombosis.
Comments
Honorable mention for Excellence in Research - Residents/Fellows award