Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2015; 3(3): 318-321
Published online Mar 16, 2015. doi: 10.12998/wjcc.v3.i3.318
May-Thurner syndrome: High output cardiac failure as a result of iatrogenic iliac fistula
Shantanu Singh, Shivank Singh, Juthika Jyothimallika, Teresa J Lynch
Shantanu Singh, Teresa J Lynch, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61635, United States
Shivank Singh, Department of Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Juthika Jyothimallika, Division of Pulmonology, Duke LP, MP 27536, United States
Author contributions: All authors contributed to this work.
Ethics approval: The study was reviewed and approved by the University of Illinois, College of Medicine at Peoria Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: There are no conflicts of interest for any of the authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shantanu Singh, MD, Resident, Internal Medicine, Department of Medicine, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Ave, Peoria, IL 61635, United States. shantanu512@gmail.com
Telephone: +1-309-6808630
Received: July 7, 2014
Peer-review started: July 8, 2014
First decision: September 30, 2014
Revised: December 11, 2014
Accepted: December 29, 2014
Article in press: December 31, 2014
Published online: March 16, 2015
Processing time: 249 Days and 4.2 Hours
Abstract

May-Thurner syndrome (MTS) also termed iliocaval compression or Cockett-Thomas syndrome is a common, although rarely diagnosed, condition in which the patient has an anatomical variant wherein the right common iliac artery overlies and compresses the left common iliac vein against the fifth lumbar spine resulting in increased risk of iliofemoral deep venous thrombosis. This variant has been shown to be present in over 23% of the population but most go undetected. We present a patient with MTS who developed high output cardiac failure due to an iatrogenic iliac fistula. The patient underwent an extensive workup for a left to right shunt including MRI and arterial duplex in the vascular lab. He was ultimately found to have a 2.1 cm left common iliac artery aneurysm and history of common iliac stent. We took the patient to the operating room for aortogram with placement of an endovascular plug of the left internal iliac artery and aorto-bi-iliac stent graft placement with CO2 and IV contrast. Subsequently the patient underwent successful stent placement in the area that was compressed followed by 6 mo of anticoagulation with warfarin. The flow from the fistula decreased significantly.

Keywords: May-Thurner syndrome; Cardiac failure; Echocardiogram; Cockett-Thomas syndrome; Iliocaval compression

Core tip: To our knowledge, we describe the first case of high output cardiac failure due to iatrogenic iliac fistula and its management in the setting of May-Thurner syndrome (MTS). In our case, an iatrogenic iliac fistula resulted because of prior stent placement in left iliac vein to prevent deep venous thrombosis (DVT) secondary to MTS. We favored aorto-bi-iliac stent graft placement to prevent the fistula from leaking. In our case, the prior vascular stent placement was a clue to search for the fistula. It is important to note that stent placement to prevent DVT in MTS may result in iatrogenic fistula formation.