Evolving Concepts in the Diagnosis and Management of May–Thurner Syndrome

Abstract

May–Thurner syndrome is a common cause of left lower extremity venous thrombosis resulting from repetitive and dynamic compression of the left common iliac vein by the right common iliac artery, commonly seen in young to middle-aged women. The diagnosis requires high clinical suspicion. Computed tomography venography and magnetic resonance venography depict the extent of venous thrombosis and iliac venous compression in patients with underlying thrombotic and nonthrombotic pathologies, respectively. Contrast venography allows detection of acute and chronic thrombus, associated venous obstruction, and collaterals but is of limited value to evaluate the early venous wall abnormalities. Endovascular ultrasound is highly useful to detect early mural changes and accurately quantify venous narrowing. Endovascular intervention with balloon dilatation and stenting with or without pharmacomechanical thrombectomy followed by long-term anticoagulation is the preferred treatment with excellent technical and clinical outcomes. This review focuses on the current understanding of the pathology, clinical presentation, and endovascular management of May–Thurner syndrome.

Curious case of acute unilateral deep vein thrombosis: May-thurner syndrome

“…[ 2 ] It has been noted that the prevalence of MTA is higher as compared to MTS itself. [ 3 ] The exact threshold at which compression triggers symptomatic DVT is still unknown. [ 4 ] However, one study had reported that the DVT was more likely when the vein compression was >70%.…”

May Thurner syndrome: Sixty years later

“…These recent studies suggests that MTS has a congenital substratum, but the Arterial pulsations over the iliocaval segment it is an important factor causing the endothelial vein lesions to evolve whether or no to originate symptoms. 34,35…”

Identificação pela ultrassonografia vascular da compressão da veia ilíaca comum esquerda em mulheres assintomáticas: ortostatismo pode influenciar o diagnóstico?

“…A compressão da VICE pela AICD afeta principalmente mulheres jovens e adultas de meia idade, estando presente em 22% da população 6,7 . Essa compressão pode ser sintomática ou assintomática mesmo nos casos nos quais a redução do diâmetro da VICE é superior a 70% 8 . As complicações decorrentes da compressão da VICE estão relacionadas ao risco de trombose venosa iliofemoral esquerda ou a quadros de hipertensão venosa crônica pélvica responsável pelo aparecimento de varizes pélvicas ou de membros inferiores [9][10][11][12] .…”