# Endovascular Management of Iliac Hematoma Associated with May–Thurner Syndrome Using Mechanical Thrombectomy and Bare-Metal Stenting: A Case Report

## TL;DR

A rare case of iliac hematoma linked to May-Thurner syndrome was successfully treated using endovascular techniques.

## Contribution

A novel endovascular treatment approach using mechanical thrombectomy and stenting for MTS-related hematoma is reported.

## Key findings

- Iliac hematoma associated with MTS can occur without clear evidence of vein rupture.
- Endovascular treatment with mechanical thrombectomy and stenting resolved thrombus and hematoma effectively.
- The treatment strategy restored venous outflow and maintained stent patency.

## Abstract

Background/Objectives: May–Thurner syndrome (MTS) is a common cause of iliofemoral deep vein thrombosis (DVT). Venous bleeding associated with MTS is extremely rare and has been reported mainly as spontaneous iliac vein rupture (SIVR) with retroperitoneal or iliac hematoma. Additionally, standardized treatment strategies have not yet been established. Herein, we report a case of an iliac hematoma associated with MTS that was successfully treated with endovascular mechanical thrombectomy and bare-metal stenting. Case Presentation: A 69-year-old man presented with acute swelling and pain in the left lower extremity. Computed tomography angiography demonstrated extensive iliofemoral DVT and an iliac hematoma adjacent to the left common iliac vessels, without definite evidence of iliac vein rupture. Initial conservative management with anticoagulation therapy was selected as the patient was hemodynamically stable and showed no active bleeding. However, follow-up imaging one week later revealed persistent DVT with interval enlargement of the hematoma. Pelvic arteriography excluded an arterial bleeding source. Endovascular treatment was performed, including mechanical thrombectomy using the AngioJet system and bare-metal stent placement to restore venous outflow. Follow-up imaging revealed complete thrombus resolution, hematoma regression, and sustained stent patency. Conclusions: Iliac hematomas associated with MTS may occur without definite radiological evidence of iliac vein rupture. In selected hemodynamically stable patients, an individualized endovascular strategy focused on venous outflow restoration using the AngioJet system and bare metal stents may be a feasible treatment option.