May-Thurner: diagnosis and endovascular management

Abstract

Common left iliac vein compression, otherwise known as May-Thurner (MT), is an anatomical risk factor for lower extremity deep vein thrombosis (DVT). MT refers to chronic compression of the left iliac vein against the lumbar spine by the overlying right common iliac artery. The compression may be asymptomatic. The syndrome is a clinical spectrum of physical findings and history plus the lesion. It is characterized by the varying degrees of venous hypertension. This can be non-thrombotic, combined with acute DVT or post-thrombotic. Traditionally, acute DVT was treated with standard anticoagulation and sometimes, thrombectomy. However these measures do not address the underlying culprit lesion of mechanical compression. Furthermore, if managed only with anticoagulation, patients with residual thrombus are at risk for developing recurrent DVT or post-thrombotic syndrome (PTS). Both retrospective and prospective studies have shown that endovascular management should be the preferred approach to dissolve proximal thrombus and to also treat the underlying compression with endovascular stent placement.

<p>Iliac vein compression: epidemiology, diagnosis and treatment</p>

“…Symptomatic ILVC can present with a variety of symptoms most commonly lower extremity swelling, claudication, hyperpigmentation, varicose veins and/or venous ulceration. Patients may report tighter shoes in the affected leg at the end of the day with more fatigue and swelling 5. The quality of life (QOL) in patients with ILVC is reduced, particularly in those who develop DVT with post-thrombotic syndrome (PTS).…”

Atypical May-Thurner syndrome caused by endovascular aortic aneurysm repair

“…However, several factors can limit the technical success of imaging of the inferior vena cava and iliac veins with ultrasound. 8 Axial imaging such as computed tomography or magnetic resonance imaging can be used to demonstrate narrowing of the iliac vein and to identify other potential causes of clinical symptoms. However, timing of these studies for optimal opacification of the venous system can be challenging.…”

A Rare Cause of May-Thurner Syndrome Postarterial Intervention

“…[8][9][10] Computed tomography venogram is the optimal noninvasive imaging modality for diagnosis but can also be used for posttreatment monitoring. 11,12 Choi et al reported 92.9% predictive accuracy of CT venogram for identifying venous occlusion within 6 months of catheter-directed thrombolysis. 11 IVUS has the added advantage of correlating age of thrombus, identifying collateral formation and measuring intravenous pressures in addition to ensuring accurate guidewire and stent placement during endovascular treatment.…”

“…11 IVUS has the added advantage of correlating age of thrombus, identifying collateral formation and measuring intravenous pressures in addition to ensuring accurate guidewire and stent placement during endovascular treatment. 10,12,13 Treatment options include endovascular or open surgical procedures. Anticoagulation with open thrombectomy has been proven ineffective with a high rate of recurrence.…”