Conclusion
Femoral vein access for interventional procedures can be associated with serious complications in patients with May-Thurner syndrome regarding their complex abdominopelvic collateral vessels. The correct direction of the wire must be achieved with precision. Back pain with concomitant hematuria during the procedure can be a result of renal parenchymal perforation, which is life-threatening and mandates emergent treatment. We illustrated this rare complication can be treated with iliac venoplasty, nevertheless, open surgery should be considered in the case of resistant ongoing hematuria.
Data availability statement:  The data supporting this study’s findings are available from the corresponding author upon reasonable request.
Acknowledgments:  Our special thanks go to the Tehran Heart Center catheterization laboratory staff.
Conflict of Interest:  None
Funding Declaration:  The present report received no funding support.