Successful Endovascular Treatment of Iliac Vein Compression (May-Thurner) Syndrome in a Pediatric Patient Levent Oguzkurt, 1 Fahri Tercan, 1 Mesut Sener 2 1 Department of Radiology, Baskent University, Adana Teaching and Medical Research Center, Adana, Turkey 2 Department of Anesthesiology and Reanimation, Baskent University, Adana Teaching and Medical Research Center, Adana, Turkey Abstract A 10-year-old boy presented to our clinic with left lower extremity swelling present for 1 year with deterioration of symptoms during the prior month. Laboratory investigation for deep vein thrombosis was negative. Venography and computed tomography scan of the pelvis showed compression of the left common iliac vein by the right common iliac artery. A diagnosis of iliac vein compression syndrome was made. After venography, endovascular treatment was planned. The stenosis did not respond to balloon dilatation and a 12 mm Wallstent was placed with successful outcome. The pa- tientÕs symptoms improved but did not resolve completely, prob- ably due to a chronically occluded left superficial femoral vein that did not respond to endovascular recanalization. To the best of our knowledge, this is the first case of successful endovascular treat- ment of iliac vein compression syndrome with stent placement in a pediatric patient. Key words: Iliac vein compression—Iliac veins—May-Thurner syndrome—Venous thrombosis Iliac vein compression syndrome (IVCS) or May-Thurner syn- drome is the result of narrowing of the left common iliac vein between the right common iliac artery and the lumbar vertebrae [1]. It has been shown that the syndrome results in intrinsic stenosis with spur formation in the left common iliac vein by continuous repetitive trauma of the pulsating force of the artery. In some pa- tients this intrinsic stenosis results in the development of deep vein thrombosis. Symptoms of the syndrome include left lower extremity swelling, varicosities, discoloration, and formation of ulcers on the foot due to venous stasis. Catheter-directed endovascular treatment has been shown to be very effective in the treatment of IVCS, but endovascular treatment of the compression in children has not been reported to date [2, 3]. We report a child with IVCS who had successful endovascular treatment of symptomatic compression with endovascular stent placement. Case Report A 10-year-old boy presented to our clinic with left lower extremity swelling of 1 yearÕs duration. The patient had been diagnosed with deep vein thrombosis and treated with anticoagulation therapy. The lower extremity swelling improved in the first month after treatment but did not resolve completely. The swelling began to increase in the month prior to his pre- sentation. On admission, he had increased swelling of the whole left lower extremity at rest and pain on walking. He had had purple discoloration around the ankle during the prior month, which had not been present before. The patient had had a soft tissue tumor in his left thigh for which he had had two operations at 1 year old and a year later because of recurrence. The pathology and the operation report could not be obtained; however, the family explained that the tumor had been benign. The pa- tient did not have a known history of leg swelling after his operations until the prior year. On admission, a search for deep vein thrombosis included investigation of protein C and S levels, prothrombin time, and antithrombin III levels, test results of which were in the normal ranges. Color Doppler sonography of the left lower extremity revealed patent crural and popliteal veins and an occluded left femoral vein in the proximal part of the left thigh. Acute thrombus was not observed. The left common iliac vein had a suspected narrowing at its origin but was patent. There were collateral veins around the left iliac vein. Informed consent was obtained from the patient and his parents for venography examination and for possible revascularization. The plan was to attempt recanalization of the occluded femoral vein, if possible, and stenting of the iliac vein if it were causing a hemodynamically significant stenosis. The patent left popliteal vein was punctured with a 20G plastic cannula under ultrasound guidance, and venography was performed. Venography showed long-segment occlusion of the proximal part of the left superficial femoral vein with collaterals (Fig. 1). The left common iliac vein had severe stenosis, and this finding was consistent with iliac vein compression. Because iliac vein compression may require stenting for definitive treatment, the patient was taken for computed tomography (CT) venography of the pelvis to clarify the external compression of the vein. Direct CT venography was obtained by injecting contrast through the left popliteal vein from the plastic cannula using a slow infusion of 30 ml of nonionic contrast material (Ultravist, Schering, Berlin, Germany) and a 10- sec delay while the patient was lying supine. CT was obtained using 80 kV and 95 mAs. CT parameters were 2.5 mm beam collimation and 3 mm slice thickness with 3 mm table feed. CT images in the transverse plane con- firmed the presence of severe compression (Fig. 2). The advantages and disadvantages of placing a stent in a 10-year-old child were explained to the patient and his parents. The patient was placed prone on a table in the angiography suite the next day. The left popliteal vein was punctured under ultrasound guidance and a 5 Fr vascular sheath (Cordis Europa, Roden, The Netherlands) was introduced. Correspondence to: L. Oguzkurt, M.D., Baskent Universitesi, Adana Hastanesi, Radyoloji Bolumu, Dadaloglu Mah. 39 Sok No: 6, Yuregir, Adana 01250, Turkey; email: loguzkurt@yahoo.com ª Springer Science+Business Media, Inc. 2006 Published Online: 30 June 2005 CardioVascular and Interventional Radiology Cardiovasc Intervent Radiol (2006) 29:446–449 DOI: 10.1007/s00270-004-0247-6