The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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A Case of May-Thurner Syndrome with Systemic Lupus Erythematosus in Antiphospholipid Syndrome

항인지질 증후군을 동반한 전신홍반루푸스에서 진단된 May-Thurner 증후군

  • Kim, Ji-Hun (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Kang, Jong-Wan (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Bae, Gi-Bum (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lee, Jong-Min (Department of Radiology, Kyungpook National University School of Medicine) ;
  • Im, Churl-Hyun (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Nam, Eon-Jeong (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Kang, Young-Mo (Department of Internal Medicine, Kyungpook National University School of Medicine)
  • 김지훈 (경북대학교 의학전문대학원 내과학교실) ;
  • 강종완 (경북대학교 의학전문대학원 내과학교실) ;
  • 배기범 (경북대학교 의학전문대학원 내과학교실) ;
  • 이종민 (경북대학교 의학전문대학원영상의학교실) ;
  • 임철현 (경북대학교 의학전문대학원 내과학교실) ;
  • 남언정 (경북대학교 의학전문대학원 내과학교실) ;
  • 강영모 (경북대학교 의학전문대학원 내과학교실)
  • Published : 2012.06.01
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Abstract

May-Thurner syndrome, which refers to an iliofemoral venous thrombosis caused by chronic compression of the left common iliac vein by the right common iliac artery, usually manifests as left lower extremity pain and swelling. The syndrome is particularly evident in patients with health conditions including obesity, smoking, pregnancy, surgery, or prolonged immobility. Antiphospholipid syndrome consists of arterial or venous thrombosis and the association of lupus anticoagulant or anticardiolipin antibodies. Most common clinical manifestations include pregnancy loss and deep vein thrombosis. We experienced a rare case of May-Thurner syndrome concurrent with antiphospholipid syndrome, secondary to systemic lupus erythematosus. The patient was treated successfully by catheter-directed percutaneous thrombectomy, venous thrombolysis, and stent insertion, followed by oral anticoagulant therapy.

항인지질 증후군이 동반된 전신홍반루푸스 환자에서 May-Thurner 증후군이 진단된 예는 아직 세계적으로 보고가 없다. 본 증례와 같이 전신홍반루푸스를 가진 젊은 환자에서 좌측 하지에 심부정맥 혈전증이 발생한 경우 항인지질 증후군을 감별하여야 하며 동시에 May-Thurner 증후군도 감별진단에 포함시켜야 한다. 그리고 진단 이후의 적극적인 혈관중 재시술과 지속적인 항응고제 치료를 통해 재발을 방지하기 위한 전략이 필요할 것이다.

Keywords

References

  1. May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology 1957;8:419-427. https://doi.org/10.1177/000331975700800505
  2. Cockett FB, Thomas ML. The iliac compression syndrome. Br J Surg 1965;52:816-821. https://doi.org/10.1002/bjs.1800521028
  3. Ruiz-Irastorza G, Crowther M, Branch W, Khamashta MA. Antiphospholipid syndrome. Lancet 2010;376:1498-1509. https://doi.org/10.1016/S0140-6736(10)60709-X
  4. Raffini L, Raybagkar D, Cahill AM, Kaye R, Blumenstein M, Manno C. May-Thurner syndrome (iliac vein compression) and thrombosis in adolescents. Pediatr Blood Cancer 2006; 47:834-838. https://doi.org/10.1002/pbc.20728
  5. Sharma R, Joshi W. A case of May-Thurner syndrome with antiphospholipid antibody syndrome. Conn Med 2008;72: 527-530.
  6. Baron HC, Shams J, Wayne M. Iliac vein compression syndrome: a new method of treatment. Am Sung 2000;66: 653-655.
  7. Knipp BS, Ferguson E, Williams DM, et al. Factors associated with outcome after interventional treatment of symptomatic iliac vein compression syndrome. J Vasc Surg 2007;46: 743-749. https://doi.org/10.1016/j.jvs.2007.05.048
  8. Tektonidou MG, Laskari K, Panagiotakos DB, Moutsopoulos HM. Risk factors for thrombosis and primary thrombosis prevention in patients with systemic lupus erythematosus with or without antiphospholipid antibodies. Arthritis Rheum 2009;61:29-36.
  9. Danowski A, de Azevedo MN, de Souza Papi JA, Petri M. Determinants of risk for venous and arterial thrombosis in primary antiphospholipid syndrome and in antiphospholipid syndrome with systemic lupus erythematosus. J Rheumatol 2009;36:1195-1199. https://doi.org/10.3899/jrheum.081194
  10. Binkert CA, Schoch E, Stuckmann G, et al. Treatment of pelvic venous spur (May-Thurner syndrome) with selfexpanding metallic endoprostheses. Cardiovasc Intervent Radiol 1998;21:22-26. https://doi.org/10.1007/s002709900205
  11. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet 2000;355:1295-1302. https://doi.org/10.1016/S0140-6736(00)02110-3
  12. Collaborative overview of randomised trials of antiplatelet therapy: III: reduction in venous thrombosis and pulmonary embolism by antiplatelet prophylaxis among surgical and medical patients: Antiplatelet Trialists' Collaboration. BMJ 1994;308:235-246. https://doi.org/10.1136/bmj.308.6923.235