May-Thurner syndrome and iliac arteriovenous fistula in an elderly woman Nancy Huynh, BS, Lindsay Gates, MD, Leslie Scoutt, MD, Bauer Sumpio, MD, PhD,

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May-Thurner syndrome and iliac arteriovenous fistula in an elderly woman Nancy Huynh, BS, Lindsay Gates, MD, Leslie Scoutt, MD, Bauer Sumpio, MD, PhD, Timur Sarac, MD, Cassius Iyad Ochoa Chaar, MD, MS Journal of Vascular Surgery Cases and Innovative Techniques Volume 2, Issue 2, Pages 46-49 (June 2016) DOI: 10.1016/j.jvsc.2016.02.001 Copyright © 2016 The Authors Terms and Conditions

Fig 1 A, Preoperatively, the patient had severe left lower extremity edema, two areas of skin ulceration on the anterior calf, and cyanosis in the toes. B, Three months postoperatively, the patient's swelling has significantly reduced, the ulcers have healed, and the toes are no longer cyanotic. Journal of Vascular Surgery Cases and Innovative Techniques 2016 2, 46-49DOI: (10.1016/j.jvsc.2016.02.001) Copyright © 2016 The Authors Terms and Conditions

Fig 2 Venous duplex Doppler examination. Both the left common femoral vein (v) and artery (a) exhibit the same flow direction on color Doppler examination. There is complete reversal of flow toward the lower extremity in the vein as well as pulsatile waveforms (not shown) suggestive of an arteriovenous fistula (AVF). Journal of Vascular Surgery Cases and Innovative Techniques 2016 2, 46-49DOI: (10.1016/j.jvsc.2016.02.001) Copyright © 2016 The Authors Terms and Conditions

Fig 3 Angiography. A, Arteriogram obtained through right common femoral artery access (black arrow) and injection of contrast material at the aortic bifurcation. The left external iliac artery (a) and vein (v) were visualized concomitantly because of early retrograde filling of the vein from an arteriovenous fistula (AVF, white arrow) at the level of the left internal iliac artery. B, Venogram obtained through left common femoral vein access (arrow) after coil embolization of AVF (c) and stenting (s) of left common iliac vein (CIV) shows normal flow through the venous system. Journal of Vascular Surgery Cases and Innovative Techniques 2016 2, 46-49DOI: (10.1016/j.jvsc.2016.02.001) Copyright © 2016 The Authors Terms and Conditions