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A 20-year-old man presented with a 2-month history of persistent painless edema of the left thigh. He had no prior illness in the past. Physical examination revealed a swollen left thigh, which was 7 cm larger in maximal circumference than the opposite. The pulses were intact of bilateral lower extremities. No varicose veins were noted. Contrast-enhanced computed tomography of the abdominopelvic and lower limbs demonstrated the left common iliac vein (Figure 1A) compressed by the right common iliac artery (Figure 1A) at the aortoiliac bifurcation to the right inguinal region. No pelvic mass or lymphadenopathy was found. The clinical history and imaging findings were diagnostic for May-Thurner syndrome. Typically, this crossing over was considered to be anatomically normal, whereas in some patients, the compression of the vein between the vertebral body posteriorly and the chronic pulsatile force from the artery anteriorly may contribute to extensive intimal hypertrophy of the vein and thus to interfere with venous return.1,2 Surgical interventions aim at relieving the extrinsic compressions or direct repairing the vein.1,3 The patient underwent percutaneous transluminal angioplasty with endovascular tandem stent (18 × 90 mm) implantation (Figure 1B) across the stenotic segment of the left common iliac vein. Postoperative period was uneventful and he had clinical improvement. At 8-month follow-up on outpatient department, there have been no recurrences.
Conflict of interest: None declared.