Massive deep vein thrombosis and pulmonary embolism in the course of May-Thurner syndrome – new hybrid venous stent implantation after successful direct thrombolysis complicated with late extraperitoneal bleeding

We present a case of a 37-year-old patient with progressing deep vein thrombosis of the left lower limb, affecting the femoral and iliac veins, and also the distal part of the inferior vena cava, which was accompanied by pulmonary embolism. Endovascular treatment consisted of implantation of a retrievable vena cava filter and catheter-directed thrombolysis of the veins of the lower extremity. Thrombolytic treatment that lasted 72 h resulted in almost complete restoration of patency of thrombosed veins. Still, since intravascular ultrasound revealed a compression of the left iliac vein (May-Thurner syndrome) the treatment was completed by implantation of the new-generation hybrid venous stent: Sinus-Obliquus (Optimed, Ettlingen, Germany). After 3 weeks the caval filter was removed and the patient returned to normal everyday activity.