A case report of May-Thurner syndrome presenting with anticoagulation-refractory iliofemoral deep vein thrombosis successfully treated by aspiration thrombectomy and iliac vein stenting.

Background: May-Thurner syndrome (MTS) is a common anatomical variant predisposing to left iliofemoral deep vein thrombosis (DVT). Endovascular therapy is increasingly recognized as an effective approach to restore venous outflow, yet the optimal thrombus removal strategy remains debated. Case summary: An 87-year-old woman presented with progressive swelling of the left leg and was diagnosed with extensive iliofemoral DVT secondary to MTS. Symptoms persisted despite one week of oral apixaban therapy, prompting endovascular evaluation. Intravascular ultrasound (IVUS) revealed significant compression of the left common iliac vein. Aspiration thrombectomy followed by balloon angioplasty and self-expanding stent implantation was performed in a single session without adjunctive thrombolytic infusion. Final venography demonstrated brisk venous flow from the popliteal vein to the inferior vena cava without residual stenosis. The patient's symptoms rapidly improved, and follow-up imaging showed sustained patency of the stented segment under long-term anticoagulation therapy. Discussion: This case emphasizes that single-session mechanical thrombectomy with stenting can achieve successful recanalization in anticoagulation-refractory May-Thurner syndrome.