May-Thurner syndrome – Are we aware enough?

Abstract

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

The Number of Pregnancies and Deliveries and Their Association with Selected Morphological and Hemodynamic Parameters of the Pelvic and Abdominal Venous System

“…Dysfunction of pelvic veins may apply to nulliparous women as well. However, in their case, instead of pregnancy, the impairment of the LRV/LOV axis may result from the presence of various clinically relevant venous abnormalities [27]. In fact, one-fourth of the patients in the P0 subgroup revealed the features of PVI, including reflux in ovarian veins, which in all analyzed cases was due to the presence of various abnormalities, involving mainly the LRV/LOV axis or iliac veins.…”

Acute deep venous thrombosis induced by May-Thurner syndrome after spondylolisthesis surgery: A case report and review of literature

“…Despite its superior accuracy in diagnosing MTS, the use of contrast venography is usually limited in disease screening by its invasive nature. Although CT, magnetic resonance venography, and intravascular ultrasound (IVUS) have also been proven to be effective, they cannot be used for routine preoperative examinations in practice[ 23 ]. Doppler ultrasound is convenient and is useful in the detection of lower limb DVT but not MTS because of technological challenges.…”

Deep Venous Aberration

“…It ranges from 2-5% as per a few studies [ 5 , 6 ] Autopsy studies suggest a prevalence between 14-32% [ 5 ], radiology studies looking at the left lower extremity DVT alone suggest a prevalence from 22% to 76% [ 5 ]. A recent case series and extensive discussion by Katalin Mako et al [ 7 ] shows how it is often underestimated and needs a high index of suspicion for diagnosis.…”

“…It is important to remember that the gold standard for investigation, a venogram or an intravenous ultrasound is not routinely performed to clinch the diagnosis. It is important to diagnose and treat this condition to avoid complications of pulmonary embolism (PE) [ 7 , 16 ] and post-thrombotic syndrome [ 2 , 7 ]. Our patient had the risk factor of malignancy and this likely diverted attention away from MTS.…”