Spontaneous rupture of the left common iliac vein associated with May–Thurner syndrome: successful management with surgery and placement of an endovascular stent

Abstract

. We report a case of spontaneous rupture of the left common iliac vein diagnosed pre-operatively with CT and successfully treated with surgery and placement of a stent. A 60-year-old woman was referred to our emergency room because of a sudden left lower abdominal pain and swelling of the left lower extremity. CT revealed a huge retroperitoneal haematoma and extrinsic compression of the left common iliac vein with acute thrombosis of deep veins of the left lower extremity. Venous patch angioplasty was performed at the site of spontaneous rupture. After thrombectomy with use of a Forgaty catheter, a stent was placed at the occluded segment of the left common iliac vein under the C-arm fluroscopic guidance. Follow-up CT 10 days and 8 months after initial examination demonstrated a venous stent with preserved luminal patency and striking resolution of deep vein thrombosis of the left lower extremity. Spontaneous rupture of the iliac vein associated with May–Thurner syndrome is rarely reported [1–3]. This situation is life-threatening and must be diagnosed and treated correctly. In the past, the correct diagnosis was frequently not apparent pre-operatively and surgery was associated with substantial mortality and morbidity. Cho et al [4] reported successful conservative treatment of spontaneous rupture of the left common iliac vein. However, surgery or conservative treatment does not prevent the development of deep vein thrombosis and pulmonary embolism. Zieber et al [2] reported two cases, which were successfully managed by emergent endovascular repair with use of a covered stent. We report a case of spontaneous rupture of the left common iliac vein diagnosed pre-operatively with CT and successfully treated with surgery and placement of a stent.