Doctor Le Quang Thang, from the Emergency Department at Tam Anh General Hospital TP HCM, reported that an acute blood clot completely obstructed the patient's common iliac, external iliac, and upper femoral veins. The clot extended from the pelvic region to nearly the entire venous system of the left lower limb. The soft tissues of the entire leg were also swollen.

CT scans further revealed the left common iliac vein was severely compressed between the spine and the right common iliac artery, narrowing the vessel lumen at this point to just about 1,6 mm. Doctors diagnosed the patient with extensive deep vein thrombosis (DVT) stemming from May-Thurner syndrome. Ms. Hoa had a history of endometriosis causing menorrhagia and had an intrauterine device (IUD) inserted at another hospital about two weeks prior.

According to Doctor Thang, May-Thurner vascular syndrome, affecting about 2-5% of the population, causes severe compression of the left common iliac vein between the right common iliac artery and the spine. This compression impedes blood flow from the left leg back to the heart, damaging the endothelium and leading to clot formation. May-Thurner syndrome is primarily congenital, but it can be exacerbated by factors such as pregnancy, pelvic surgery, prolonged immobility, and gynecological conditions like endometriosis. The syndrome is common in women aged 20-50, postpartum women, individuals with sedentary lifestyles, or those with a predisposition to blood clotting.

The blood clot (circled in red) completely obstructed Ms. Hoa's left iliofemoral vein. *Tam Anh General Hospital*

Emergency department doctors held an urgent consultation with the Thoracic-Vascular Surgery and Obstetrics-Gynecology teams. The patient required blood clot management, facing a risk of bleeding due to prolonged uterine bleeding associated with endometriosis.

Following a comprehensive assessment, the team developed a sequential treatment plan. First, the patient underwent a hysterectomy to address the cause of prolonged uterine bleeding. Once her health stabilized, Ms. Hoa proceeded with surgery to manage the lower limb blood clot and relieve the venous obstruction.

With the assistance of a digital subtraction angiography (DSA) system, Doctor Nguyen Anh Dung, Head of the Thoracic-Vascular Surgery Department at the Thoracic-Vascular Surgery Center, inserted a catheter to access the blood clot. Thrombolytic medication was delivered, combined with aspiration of the entire obstructing blood clot, to re-establish blood flow. Subsequently, the team placed a stent in the affected area. The stent expanded against the vessel wall, creating a protective layer that facilitates blood flow to the leg and prevents re-obstruction.

Doctor Dung (center) and his team removed the blood clot and placed a stent to restore blood flow to the patient's leg. *Tam Anh General Hospital*

Post-intervention angiography images showed optimal stent expansion and good blood flow. The patient recovered quickly, resumed normal eating and daily activities, and was able to walk and be discharged after one day.

According to Doctor Dung, symptoms of deep vein thrombosis can include swelling, pain, tenderness, warmth, or discoloration in one leg. The severity depends on the location and extent of the obstructed vessel. Women of reproductive age, especially those with a history of gynecological conditions like endometriosis, should not dismiss symptoms such as aching pain, one-sided leg swelling, or stiffness. They should avoid self-medicating with painkillers or massages at home. Patients need to seek medical examination at a healthcare facility. In cases of leg swelling and pain accompanied by sudden shortness of breath, chest pain, rapid heartbeat, dizziness, or fainting, immediate emergency care is required.

Bao Anh - Nhu Ngoc

* The patient's name has been changed.