Endovascular management of extensive iliocaval thrombosis secondary to synchronous uterine myoma compression and May-Thurner syndrome

This report presents a 42-year-old African American woman with bilateral lower extremity pain, swelling, and paresthesias. Imaging demonstrated a large fibroid uterus with a mass effect in proximity to an iliocaval venous thrombosis. Mechanical thrombectomy was performed with recurrent infrarenal vena cava and bilateral iliac thrombosis, prompting hysterectomy. A subsequent intravascular ultrasound examination demonstrated relief of the external caval compression, but with left iliac vein compression by the right common iliac artery. The patient was managed successfully with mechanical thrombectomy and venous stenting. This case highlights the benefit of a multidisciplinary approach to complex iliocaval thrombosis from both an obstructive uterine myoma and May-Thurner syndrome.