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What the Young Physician Should Know About May-Thurner Syndrome.

Donatella N, Marcello BU, Gaetano V, Massimo P, Massimo M, Giancarlo B - Transl Med UniSa (2014)

Bottom Line: Mainly, clinical symptoms and signs include, but are not limited to, pain, swelling, venous stasis ulcers, skin pigmentation changes and post-thrombotic syndrome.Correct treatment is not well established and is based on clinical presentation.The aim of this review is to present in a simple and didactic form all variable clinical presentations of MTS and to outline possible management within the current guidelines.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology D.I.B.I.M.E.F., "P. Giaccone" University Hospital, Palermo, Italy.

ABSTRACT
May-Thurner syndrome (MTS) is an anatomically variable condition resulting in compression of the left common iliac vein between the right common iliac artery and the underlying spine with subsequent development of a left deep vein thrombosis (DVT). Although this syndrome is rare, its true prevalence is likely underestimated. Mainly, clinical symptoms and signs include, but are not limited to, pain, swelling, venous stasis ulcers, skin pigmentation changes and post-thrombotic syndrome. Correct treatment is not well established and is based on clinical presentation. Staged thrombolysis with/without prophylactic retrievable inferior vena cava filter placement followed by angioplasty/stenting of the left iliac vein appears to be the best option in MTS patients with extensive DVT. The aim of this review is to present in a simple and didactic form all variable clinical presentations of MTS and to outline possible management within the current guidelines.

No MeSH data available.


Related in: MedlinePlus

drawing showing left common iliac vein compression by right common iliac artery (morphologic type I).
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f1-tm-12-19: drawing showing left common iliac vein compression by right common iliac artery (morphologic type I).

Mentions: May-Thurner Syndrome (MTS), otherwise known as iliac vein compression syndrome [1], is an anatomically variable condition of the left common iliac vein (LCIV) with outflow obstruction caused by the right common iliac artery compression against the lower lumbar vertebrae (Fig. 1). Right-sided MTS cases are definitively more rare but have also been reported [2,3] in the literature. The majority of patients with right-sided MTS are male which may be due to the shape of the male pelvis. Although numerous articles have described the left-sided and female predominance of MTS, no correlation has been found between right-sided MTS and male gender. Some Authors postulate that the conical shape of the male pelvis may predispose the right iliac vein to compression by the iliac artery. However Virchow was the first who described this condition in 1851 and noted that deep vein thrombosis (DVT) was five times more likely to occur in the left lower limb [4]. In 1906 Mcmurrich proposed a congenital aetiology for LCVI obstruction [5] while Ehrich and Krumbhaar postulated, instead, a degenerative change of a venous valve at or near the origin of the LCIV [6]. Compression of the left iliac vein with detailed anatomic description was later described by May and Thurner in 1958 [7]. Cockett and Thomas also reported this condition in 1965, illustrating the relation between iliac vein compression and post-thrombotic syndrome and for this reason it is also known as “Cockett syndrome” [1]. Compression of the left common iliac vein by the right common iliac artery is a frequent anatomic variant observed in 22–32% of cadavers [8]. Most MTS patients throughout the course of their lives have no symptoms and therefore no treatment is required. Some Authors have proposed using the term “May-Thurner anatomy” in patients without hemodynamic significance and reserve the term “May-Thurner syndrome” for cases with compromised venous flow [9].


What the Young Physician Should Know About May-Thurner Syndrome.

Donatella N, Marcello BU, Gaetano V, Massimo P, Massimo M, Giancarlo B - Transl Med UniSa (2014)

drawing showing left common iliac vein compression by right common iliac artery (morphologic type I).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4592040&req=5

f1-tm-12-19: drawing showing left common iliac vein compression by right common iliac artery (morphologic type I).
Mentions: May-Thurner Syndrome (MTS), otherwise known as iliac vein compression syndrome [1], is an anatomically variable condition of the left common iliac vein (LCIV) with outflow obstruction caused by the right common iliac artery compression against the lower lumbar vertebrae (Fig. 1). Right-sided MTS cases are definitively more rare but have also been reported [2,3] in the literature. The majority of patients with right-sided MTS are male which may be due to the shape of the male pelvis. Although numerous articles have described the left-sided and female predominance of MTS, no correlation has been found between right-sided MTS and male gender. Some Authors postulate that the conical shape of the male pelvis may predispose the right iliac vein to compression by the iliac artery. However Virchow was the first who described this condition in 1851 and noted that deep vein thrombosis (DVT) was five times more likely to occur in the left lower limb [4]. In 1906 Mcmurrich proposed a congenital aetiology for LCVI obstruction [5] while Ehrich and Krumbhaar postulated, instead, a degenerative change of a venous valve at or near the origin of the LCIV [6]. Compression of the left iliac vein with detailed anatomic description was later described by May and Thurner in 1958 [7]. Cockett and Thomas also reported this condition in 1965, illustrating the relation between iliac vein compression and post-thrombotic syndrome and for this reason it is also known as “Cockett syndrome” [1]. Compression of the left common iliac vein by the right common iliac artery is a frequent anatomic variant observed in 22–32% of cadavers [8]. Most MTS patients throughout the course of their lives have no symptoms and therefore no treatment is required. Some Authors have proposed using the term “May-Thurner anatomy” in patients without hemodynamic significance and reserve the term “May-Thurner syndrome” for cases with compromised venous flow [9].

Bottom Line: Mainly, clinical symptoms and signs include, but are not limited to, pain, swelling, venous stasis ulcers, skin pigmentation changes and post-thrombotic syndrome.Correct treatment is not well established and is based on clinical presentation.The aim of this review is to present in a simple and didactic form all variable clinical presentations of MTS and to outline possible management within the current guidelines.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology D.I.B.I.M.E.F., "P. Giaccone" University Hospital, Palermo, Italy.

ABSTRACT
May-Thurner syndrome (MTS) is an anatomically variable condition resulting in compression of the left common iliac vein between the right common iliac artery and the underlying spine with subsequent development of a left deep vein thrombosis (DVT). Although this syndrome is rare, its true prevalence is likely underestimated. Mainly, clinical symptoms and signs include, but are not limited to, pain, swelling, venous stasis ulcers, skin pigmentation changes and post-thrombotic syndrome. Correct treatment is not well established and is based on clinical presentation. Staged thrombolysis with/without prophylactic retrievable inferior vena cava filter placement followed by angioplasty/stenting of the left iliac vein appears to be the best option in MTS patients with extensive DVT. The aim of this review is to present in a simple and didactic form all variable clinical presentations of MTS and to outline possible management within the current guidelines.

No MeSH data available.


Related in: MedlinePlus