Unusual Case of Right-Sided May-Thurner Syndrome and Review of Its Management

Burke, Renee; Rayan, Sunil S.; Kasirajan, Karthikeshwar; Chaikof, Elliot L.; Milner, Ross

doi:10.2310/6670.2006.00012

Cited by 63 publications

(36 citation statements)

References 21 publications

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“…Variants of this syndrome have been described resulting in compression of the right iliac vein or distal vena cava by the aortic bifurcation as well. 3 Although May-Thurner syndrome is believed to be a contributing factor related to iliofemoral venous thrombosis, compression occurs in many asymptomatic patients as well. Kibbe et al 4 reviewed abdominal/pelvic computed tomography (CT) scans performed on patients with no lower extremity symptoms for the presence of iliocaval abnormalities.…”

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confidence: 99%

Incidence of and risk factors for iliocaval venous obstruction in patients with active or healed venous leg ulcers

Marston

Fish

Unger

et al. 2011

Journal of Vascular Surgery

105

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confidence: 99%

Incidence of and risk factors for iliocaval venous obstruction in patients with active or healed venous leg ulcers

Marston

Fish

Unger

et al. 2011

Journal of Vascular Surgery

105

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“…There was one case in our sample of compression of the vena cava by a retroperitoneal tumor mass, the etiology of which is currently under investigation. 4,11,26 When cases can be evaluated in advance in this manner, it enables better planning of the tactics and techniques that will be used when treatment is administered.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomograpy Venography diagnosis of iliocaval venous obstruction in advanced chronic venous insufficiency

et al. 2014

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Objective: Iliocaval obstruction is associated with venous hypertension symptoms and may predispose to deep venous thrombosis (DVT). Ultrasonography may fail to achieve noninvasive diagnosis of these obstructions. The possibility of using Computed Tomography Venography (CTV) for these diagnoses is under investigation. Methods: Patients with CVI graded at CEAP clinical classes 3 to 6 and previous treatment failure underwent evaluation with CTV. Percentage obstruction was rated by two independent examiners. Obstruction prevalence and its associations with risk factors and CEAP classification were analyzed. Results: A total of 112 limbs were prospectively evaluated. Mean patient age was 55.8 years and 75.4% were women. Obstructions involved the left lower limb in 71.8% of cases and 35.8% of patients reported a medical history of deep venous thrombosis. Overall, 57.1% of imaging studies demonstrated venous obstruction of at least 50% and 10.7% showed obstruction of >80%. The only risk factor that was found to be independently associated with a significantly higher incidence of >50% venous obstruction was a medical history of DVT (p=0.035) (Fisher' s exact test). There was a positive relationship between clinical classification (CEAP) and degree of venous obstruction in the limbs studied (Chi-square test for linear trend; p=0.011). Conclusion: Patients with advanced CVI are often affected by obstructions in the iliocaval venous territory and CTV is able to diagnose the degree of obstruction. There is a positive association between degree of obstruction and both previous history of DVT and severity of symptoms of CVI. ResumoObjetivo: A obstrução ilíaco-cava é associada a sintomas de hipertensão venosa e é um fator de risco para a trombose venosa profunda (TVP). A ultrassonografia pode falhar em seu diagnóstico. Não existe método de "sreening" bem estabelecido. A capacidade da Angiotomografia em realizar esse diagnóstico vem sendo investigada. Método: Pacientes portadores de IVC avançada e com falha no tratamento clínico foram submetidos à Angiotomografia. As imagens foram classificadas quanto ao grau de obstrução por dois investigadores independentes. Foram avaliados a prevalência e o grau de obstrução, e a sua relação com dados demográficos, fatores de risco e sintomas clínicos (CEAP). Resultados: Foram avaliados 112 membros. A idade média dos pacientes foi de 55,8 anos e 75,4% eram mulheres. A obstrução acometia o membro inferior esquerdo em 71,8% e havia história de TVP em 35,8% destes. Em 57,1% dos membros, havia obstrução > 50% e, em 10,7%, a obstrução era > 80%. A história de TVP foi o único fator demográfico com associação positiva com o grau de obstrução (p = 0,035) (teste Exato de Fisher). Houve associação positiva entre a classificação clínica (CEAP) e o grau de obstrução venosa (Teste Qui-quadrado para tendência linear; p=0,011). Conclusão: Pacientes portadores de IVC avançada são frequentemente acometidos por obstrução venosa ilíaco-cava e a Angiotomografia é capaz de identificar o grau dessa obstrução. Exi...

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“…9) In 1943, Ehrich and Krumbhaar performed anatomic dissections in 412 cadavers and found obstructive lesions in 23.8% of the left common iliac veins. Histologically, these lesions did not represent chronic recanalized clot; rather, they were composed of elastin and collagen, without inflammatory cellular infiltration or irregular arrangement of scar.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Management of May-Thurner Syndrome

Ibrahim

Safran

Hasan

et al. 2012

Annals of Vascular Diseases

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May-Thurner syndrome or iliac vein compression syndrome is associated with deep vein thrombosis (DVT) resulting from chronic compression of the left iliac vein against lumbar vertebrae by the overlying right common iliac artery. Historically, May-Thurner syndrome has been treated with anticoagulation therapy. However, this therapy can be problematic when given alone, because it prevents the propagation of the thrombus without eliminating the existing clot. Furthermore, it does not treat the underlying mechanical compression. Consequently, syndrome who was managed by anticoagulation therapy alone, there is a significant chance that the patient will develop recurrent deep vein thrombosis or post thrombotic syndrome or both. Recently, both retrospective and prospective studies have suggested that endovascular management should be front-line treatment; endovascular management actively treats both the mechanical compression with stent placement and the thrombus burden with chemical dissolution. We report our case of 53 years old male patient with May Thurner syndrome who managed by endovascular treatment.

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Unusual Case of Right-Sided May-Thurner Syndrome and Review of Its Management

Cited by 63 publications

References 21 publications

Incidence of and risk factors for iliocaval venous obstruction in patients with active or healed venous leg ulcers

Incidence of and risk factors for iliocaval venous obstruction in patients with active or healed venous leg ulcers

Computed Tomograpy Venography diagnosis of iliocaval venous obstruction in advanced chronic venous insufficiency

Endovascular Management of May-Thurner Syndrome

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