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Current Management of Venous Diseases pp 463–477Cite as

May-Thurner Syndrome: Diagnosis and Management

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Abstract

Compression of the left common iliac vein by the overlying right common iliac artery has become an increasingly common finding in the era of advanced imaging modalities, albeit with a benign course in most individuals. However, patients with significant vein compression are at risk of developing May-Thurner syndrome, defined as unilateral left leg swelling or acute iliofemoral deep venous thrombosis in conjunction with this venous compression. The development of symptoms is likely due to a combination of venous outflow obstruction and chronic intraluminal damage to the affected vein. Although identifiable by less invasive imaging, pathologic compression of the left iliac vein is best identified by venography with intravascular ultrasound, which has become the gold standard for diagnosis and is useful in guiding therapy. Iliocaval stenting has become the standard treatment for this condition and is associated with excellent patency rates and clinical outcomes.

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References

  1. May R, Thurner J. The cause of the predominately sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957;8:419–27.

    Article  CAS  PubMed  Google Scholar 

  2. Virchow R. Uber die Erweiterung kleiner Gefasse. Arch Pathol Anat. 1851;3:427–62.

    Article  Google Scholar 

  3. McMurrich JP. The occurrence of congenital adhesions in the common iliac veins and their relation to thrombosis of the femoral and iliac veins. Am J Med Sci. 1908;135:342–6.

    Article  Google Scholar 

  4. Cockett FB, Thomas ML, Negus D. Iliac vein compression –its relation to iliofemoral thrombosis and the post-thrombotic syndrome. Br Med J. 1967;2:14–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kibbe MR, Ujiki M, Goodwin AL, Eskandari M, Yao J, Matsumura J. Iliac vein compression in an asymptomatic patient population. J Vasc Surg. 2004;39(5):937–43.

    Article  PubMed  Google Scholar 

  6. Fraser DG, Moody AR, Martel A, Morgan PS. Re-evaluation of iliac compression syndrome using magnetic resonance imaging in patients with acute deep venous thromboses. J Vasc Surg. 2004;40(4):604–11.

    Article  PubMed  Google Scholar 

  7. Raju S, Neglen P. High prevalence of nonthrombotic iliac vein lesions in chronic venous disease: a permissive role in pathogenicity. J Vasc Surg. 2006;44(1):136–43; discussion 144. PubMed PMID: 16828437.

    Article  PubMed  Google Scholar 

  8. Raju S, Darcey R. Unexpected major role for venous stenting in deep reflux disease. J Vasc Surg. 2010;51(2):401–8; discussion 408.

    Article  PubMed  Google Scholar 

  9. Birn J, Vedantham S. May–Thurner syndrome and other obstructive iliac vein lesions: meaning, myth, and mystery. Vasc Med. 2015;20:74–83.

    Article  PubMed  Google Scholar 

  10. Lee KH, Han H, Kee KJ, Yoon CS, Kim SH, Won JY. Mechanical thrombectomy of acute iliofemoral deep vein thrombosis with use of an arrow-Trerotola percutaneous thrombectomy device. J Vasc Interv Radiol. 2006;17(3):487–95.

    Article  PubMed  Google Scholar 

  11. Mousa AY, AbuRahma AF. May-Thurner syndrome: update and review. Ann Vasc Surg. 2013;27(7):984–95.

    Article  PubMed  Google Scholar 

  12. Neglen P, Hollis KC, Oliver J, Raju S. Stenting of the venous outflow in chronic venous disease: long term stent-related outcome, clinical and hemodynamic result. J Vasc Surg. 2007;46(5):979–90.

    Article  PubMed  Google Scholar 

  13. Neglen P, Raju S. Balloon dilation and stenting of chronic iliac vein obstruction: technical aspects and early clinical outcomes. J Endovasc Ther. 2000;7(2):79–91.

    Article  CAS  PubMed  Google Scholar 

  14. Baron HC, Shams J, Wayne M. Illiac vein compression syndrome: a new method of treatment. Am Surg. 2000;66(7):653–5.

    CAS  PubMed  Google Scholar 

  15. Titus JM, Moise MA, Bena J, Lyden SP. Iliofemoral stenting for venous occlusive disease. J Vasc Surg. 2011;53(3):706–12.

    Article  PubMed  Google Scholar 

  16. Hager ES, You T, Tahara R, Dillavou E. Outcomes of endovascular intervention for May-Thurner syndrome. J Vasc Surg Venous Lymphat Disord. 2013;1(3):270–5.

    Article  PubMed  Google Scholar 

  17. Ahmed O, Ng J, Patel M, Ward T. Endovascular stent placement for May-Thurner syndrome in the absence of acute deep vein thrombosis. J Vasc Interv Radiol. 2016;27(2):167–73.

    Article  PubMed  Google Scholar 

  18. Lin PH, Zhou W, Dardik A, Mussa F. Catherer-directed thrombolysis versus pharmacomechanical thrombectomy for the treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg. 2006;192(6):782–8.

    Article  PubMed  Google Scholar 

  19. Xue GH, Hunag XZ, Ye M, Liang M. Catheter-directed thrombolysis and stenting in the treatment of iliac vein compression syndrome with acute iliofemoral deep vein thrombosis: outcome and follow-up. Ann Vasc Surg. 2014;28(4):957–63.

    Article  PubMed  Google Scholar 

  20. Park JY, Ahn JH, Jeon YS, Cho SG. Iliac vein stenting as a durable option for residual stenosis after catheter-directed thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May-Thurner syndrome. Phlebology. 2014;29(7):461–70.

    Article  PubMed  Google Scholar 

  21. Zhu QH, Zhou CY, Chen Y, Wang J. Percutaneous manual aspiration thrombectomy followed by stenting for iliac vein compression syndrome with secondary acute isolated iliofemoral deep vein thrombosis: a prospective study of single-session endovascular protocol. Eur J Vasc Endovasc Surg. 2014;47(1):68–74.

    Article  CAS  PubMed  Google Scholar 

  22. Liu Z, Gao N, Shen L, Yang J. Endovascular treatment for symptomatic iliac vein syndrome: a prospective consecutive series of 48 patients. Ann Vasc Surg. 2014;28(3):695–704.

    Article  PubMed  Google Scholar 

  23. Igari K, Kudo T, Toyofuku T, Jibiki M. Surgical thrombectomy and simultaneous stenting for deep venous thrombosis caused by iliac vein compression syndrome (May-Thurner syndrome). Ann Thorac Cardiovasc Surg. 2014;20(6):995–1000.

    Article  PubMed  Google Scholar 

  24. Goldman RE, Arendt VA, Kothary N, Kuo WT. Endovascular management of May-Thurner syndrome in adolescents: a single-center experience. J Vasc Interv Radiol. 2016.

    Google Scholar 

  25. DeStephano CC, Werner EF, Holly BP, Lessne ML. Diagnosis and management of iliac vein thrombosis in pregnancy resulting from May-Thurner syndrome. J Perinatol. 2014;34(7):566–8.

    Article  CAS  PubMed  Google Scholar 

  26. Bloom AL, Farkas A, Kalish Y, Elchalal U. Pharmacomechanical catheter-directed thrombolysis for pregnancy related iliofemoral deep vein thrombosis. J Vasc Interv Radiol. 2015;26(7):992–1000.

    Article  PubMed  Google Scholar 

  27. Herrera S, Comerota AJ, Thakur S, Sunderji S. Managing iliofemoral deep venous thrombosis of pregnancy with a strategy of thrombus removal is safe and avoids post thrombotic morbidity. J Vasc Surg. 2014;59(2):456–64.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Division of Vascular and Endovascular Surgery, UCLA Medical Center, 200 Medical Plaza, Suite 526, Los Angeles, CA, 90095, USA

    Brian DeRubertis MD & Rhusheet Patel MD

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  1. Brian DeRubertis MD
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  2. Rhusheet Patel MD
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Correspondence to Brian DeRubertis MD .

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Editors and Affiliations

  1. Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA

    Cassius Iyad Ochoa Chaar

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DeRubertis, B., Patel, R. (2018). May-Thurner Syndrome: Diagnosis and Management. In: Chaar, C. (eds) Current Management of Venous Diseases . Springer, Cham. https://doi.org/10.1007/978-3-319-65226-9_35

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  • DOI: https://doi.org/10.1007/978-3-319-65226-9_35

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-65225-2

  • Online ISBN: 978-3-319-65226-9

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