Illusory Angiographic Signs of Significant Iliac Vein Compression in Healthy Volunteers

Abstract

This study demonstrates a remarkably high percentage of generally accepted signs of significant iliac vein obstruction (May-Thurner compression) on venography in healthy young subjects. Diagnosis of true iliac vein obstruction remains a major challenge, which mostly leans on improvement of clinical symptoms rather than imaging findings. Treating the patient rather than the image seems to be a valid principle all the more.

Re. “Illusory Angiographic Signs of Significant Iliac Vein Compression in Healthy Volunteers”

“…We should instead use the term "anatomical variation." 1 We agree that supine imaging may not encapsulate the entire problem of pelvic vein compression. Sadly, all modern imaging modalities are routinely performed in the supine position and we currently know of no acceptable alternatives.…”

“…I read with interest the article by Timme et al, 1 which raises concerns about the currently accepted diagnosis and management of May-Thurner syndrome (MTS). The authors show that left common iliac vein compression is common and that the accepted "pathological signs" of MTS, i.e., antero-posterior compression or venographic collaterals, may, in fact, represent normality.…”

How to Assess Illusory May–Thurner Syndrome by Ultrasound

“…We read with interest the excellent article by van Vuuren et al, 1 who described an impressive prevalence of angiographic signs usually indicative of MayeTurner syndrome (MTS) in healthy volunteers.…”

Go with the (Lymph) Flow?

“…If the non-thrombotic deep venous obstruction was the sole explanation, then release of the iliac vein compression should solve the problem and it often doesn't. Given the fact that a high incidence of iliac vein occlusion can be found in healthy volunteers, perhaps the fault is also with the lymphatics [5].…”