May-Thurner syndrome needs to be ruled out in unexplained left-sided deep venous thrombosis: Three-tiered endovascular therapy is warranted

A 58-year-old gentleman presented with left sided deep venous thrombosis for 1 month. CT venography demonstrated thrombus extending from lower inferior vena cava upto left popliteal vein; right common iliac artery was compressing left common iliac vein suggestive of May-Thurner syndrome (MTS). CT Pulmonary angiography and echocardiography were essentially normal. He was successfully treated with three-tiered endovascular therapy inclusive of IVC filter, catheter-directed thrombolysis and left common iliac vein stenting. Hence MTS needs to be ruled out in left sided deep venous thrombosis and treated with the above principles. CT venography helps in establishing the diagnosis and planning of the treatment.