May-Thurner Syndrome: A Case Report and Review of the Literature

Abstract

May-Thurner syndrome (MTS) has been recognized as a clinical entity for almost six decades. The true incidence rate of MTS is unknown and perhaps ranges from 22 to 32% according to the autopsy studies in the early twentieth century. However, MTS related deep venous thrombosis (DVT) accounts for only 2%-3% of all lower limb DVTS. In MTS, the left common iliac vein is compressed against the fifth lumbar vertebrae by the right common iliac artery, as it crosses in front of the vein. Chronic pulsation of the artery is thought to cause elastin, collagen deposition, and intimal fibrosis leading to formation of venous spur and venous thrombosis. MTS can present as acute or chronic DVT leading to pulmonary embolism (PE), chronic leg pain, chronic ulcers, or skin pigmentation changes. In this case report we have described an interesting case of a 28-year-old Caucasian female who presented for evaluation of shortness of breath (SOB) associated with cough for one week. SOB was found to be secondary to massive bilateral pulmonary embolism resulting from extensive MTS related DVT of the left lower extremity. Patient underwent pharmacomechanical treatment with local thrombolysis, thrombectomy, and venoplasty along with stent placement that extended to inferior vena caval junction. Subsequently patient was discharged on coumadin. MTS should be considered in differentials when faced with a case of unilateral DVT particularly in younger age group.

A case report of May–Thurner Syndrome associated with a large intra abdominal cyst

“…However, due to the advancement in surgical technology, less invasive techniques such as endovascular repair became widely accepted [1]. Following thrombolysis and cyst removal, we deployed an endovascular stent into the left CIV.…”

“…May-Thurner Syndrome (MTS) is an anatomical variant of the venous system in which the left common iliac vein (CIV) is compressed by the overlying right common iliac artery (CIA) leading to (via an unknown mechanism) vessel wall injury and predisposition to thrombosis [1][2].…”

Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

“…10 This chronic compression leads to intimal hyperplasia, caused by deposition of elastin and collagen, which creates the potential for venous stasis and subsequent thrombosis. 11 Furthermore, a recent case-control study suggested that compression greater than 70% is required in order to be an associated factor for left sided DVTs. 12 Although MTS has been shown to be present in about 20% of the population, it is thought to account for only 2% to 3% of all lower extremity DVTs.…”

“…24,25 It is suggested that the anatomical defect should be repaired with the use of stents and balloon venoplasty. 11 Patients with a high clot burden should also undergo inferior vena cava filter placement. 25 …”

May-Thurner Syndrome, the Role of Endovascular Intervention with Review of Published Treatment and Follow up Strategies

“…From autopsy studies, MTS accounts for 2-3% of lower limb deep vein thrombosis [2]. However; it is often underreported and miss-diagnosed in accident and emergency, resulting in long-term complication (post thrombotic syndrome) with its detrimental effect [3].…”