Electrophysiologic procedures with femoro-iliac vein catheterization may trigger massive DVT in patients with underlying May-Thurner Syndrome, particularly those with additional risk factors like obesity and oral contraceptive use.
Raises caution for femoral access in patients with May-Thurner risk factors; hypothesis-generating for targeted pre-procedure screening.
A 44-year-old woman, who was obese and on oral contraceptive medication, presented with recurrent palpitation to the emergency department. A 12-lead electrocardiography showed narrow QRS complex tachycardia with a short RP interval. On electrophysiology study, typical atrioventricular nodal reentrant tachycardia was confirmed by differential pacing maneuvers, and a radiofrequency slow pathway modification was demonstrated without complication. A week later, the patient complained of pelvic pain and leg swelling. Emergent computer tomography revealed massive deep vein thrombosis (DVT) underlying external iliac vein compression (May-Thurner Syndrome). The case suggests that electrophysiologic procedure with catheterization via the femoro-iliac vein may lead to DVT underlying May-Thurner Syndrome in obese patients on oral contraceptive medication.
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Ki‐Woon Kang (2015) studied this question.
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