May-Thurner syndrome: a review
DOI:
https://doi.org/10.18203/2320-6012.ijrms20240242Keywords:
MTS, Cockett syndrome, Iliac vein spur, Iliac vein compression, DVT, Recurrent thromboembolic diseaseAbstract
May-Thurner syndrome (MTS) is an underdiagnosed entity and level of suspicious should be raised during evaluation of deep vein thrombosis (DVT) of the left lower limb, especially in women between the third and fifth decades of life. To correctly identify MTS, high clinical suspicion, and imaging studies such as phlebography, magnetic resonance imaging (MRI), computed tomography (CT), and intravascular ultrasound are required. In correct clinical context, CT/MRI venography can be used to facilitate early diagnosis and treatment that includes pharmaco-mechanical thrombolysis with angioplasty and stenting, both of which minimize late morbidity from post-thrombotic syndrome.
Metrics
References
Cockett FB, Thomas ML. The iliac compression syndrome. Br J Surg. 1965;52(10):816-21.
Jiasheng X, Yujun L, Weimin Z. Mid-and long-term efficacy of endovascular-based procedures for Cockett syndrome. Scientific Rep. 2018;8:12145.
Esposito A, Charisis N, Kantarovsky A, Uhl JF, Labropoulos N. A Comprehensive review of the Pathophysiology and clinical Importance of iliac vein obstruction. Eur J Vasc Endovasc Surg. 2020;60(1):118-25.
May R, Thurner J. The Cause of the Predominantly Sinistral Occurrence of Thrombosis of the Pelvic Veins. Angiology. 1957;8(5):419-27.
Schrufer-Poland TL, Florio K, Grodzinsky A, Borsa JJ, Schmidt L. Management of May Thurner Syndrome in Pregnant Patients. J Cardiovasc Dev Dis. 2022;9(12):410.
Kalu S, Shah P, Natarajan A, Nwabundo N, Usman M, Nasir H. May-thurner syndrome: a case report and review of the literature. Case Rep Vasc Med. 2013;2013:740182.
Goto M, Miura SI, Yamamoto T, Fukuda Y, Kuwano T, Kimura I et al. Anticoagulant Therapy in a Pregnant Woman with May-Thurner Syndrome. Intern. Med. 2016;55(1):59-62.
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.
Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2005;111()18:2398-409.
Santhosh P, Pankaj M, Mathew C, Rinoy RA, Santosh BP, Sanjeeva K et al. May-Thurner syndrome. Cardiovasc Diagn Ther. 2021;11(5):1104-11.
Oguzkurt L, Ozkan U, Ulusan S, Zafer K, Fahri T. Compression of the left common iliac vein in asymptomatic subjects and patients with left iliofemoral deep vein thrombosis. J Vasc Interv Radiol. 2008;19(3):366-70.
Zander KD, Staat B, Galan H. May-Thurner Syndrome resulting in acute iliofemoral deep vein thrombosis in the postpartum period. Obstet Gynecol. 2008;111:565-9.
Murphy EH, Davis CM, Journeycake JM, DeMuth RP, Arko FR. Symptomatic ileofemoral DVT after onset of oral contraceptive use in women with previously undiagnosed May-Thurner Syndrome. J Vasc Surg. 2009;49(3):697-703.
Kim JY, Choi D, Guk Ko Y, Park S, Jang Y, Lee DY. Percutaneous Treatment of Deep Vein Thrombosis in May-Thurner Syndrome. Cardiovasc. Intervent Radiol. 2006;29(4):571-5.
Van Vuuren TMAJ, Kurstjens RLM, Wittens CHA, Van Laanen JHH, De Graaf R. Illusory Angiographic Signs of Significant Iliac Vein Compression in Healthy Volunteers. Eur J Vasc Endovasc Surg. 2018;56(6):874-9.
Casanegra AI, McBane RD, Bjarnason H. Intervention radiology for venous thrombosis: early thrombus removal using invasive methods. Br J Haematol. 2017;177(2):173-84.
Radaideh Q, Patel N, Shammas NW. Iliac Vein Compression: Epidemiology, Diagnosis and Treatment. Vasc Health Risk Manag. 2019;15:115-22.
Zucker EJ, Ganguli S, Ghoshhajra BB, Gupta R, Prabhakar AM. Imaging of Venous Compression Syndromes. Cardiovasc Diagn. 2016;6(6):519-32.
Neglén P, Raju S. Intravascular ultrasound scan evaluation of the obstructed vein. J Vasc Surg. 2002;35(4):694-700.
Hai-Lei L, Kristine JSK, Yiu CC, Wubulikasimu W, Stephen WC. Prevalence and predictors of radiological left common iliac vein compression in asymptomatic patients. J Vascular Surg. 2024;12(1):101661.
Mangla A, Hamad H. May-Thurner Syndrome. StatPearls. Treasure Island (FL): StatPearls Publishing. 2022.
Vedantham S, Goldhaber SZ, Julian JA, Kahn SR, Jaff MR, Cohen DJ et al. Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis. N Engl J Med. 2017;377(23):2240-52.
Behzadi AH, Khilnani NM, Zhang W, Amanda JB, Srikanth RB, Robert JM et al. Pelvic cardiovascular magnetic resonance venography: venous changes with patient position and hydration status. J Cardiovasc Magn Reson. 2019;21(1):3.
Meissner MH, Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL et al. Early Thrombus Removal Strategies for Acute Deep Venous Thrombosis: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2012;55(5):1449-62.
Wong PC, Chan YC, Law Y, Cheng SWK. Percutaneous Mechanical Thrombectomy in the Treatment of Acute Iliofemoral Deep Vein Thrombosis: A Systematic Review. Hong Kong Med J. 2019;25(1):48-57.
Kaltenmeier CT, Erben Y, Indes J, Lee A, Dardik A, Sarac T et al. Systematic review of May-Thurner syndrome with emphasis on gender differences. J. Vasc. Surg. Venous. Lymphat. Disord. 2018;6(3):399-407.
Akintayo A, Patrick K, Josephine P-A, Hadiseh K, Katelyn N. May-Thurner syndrome: A case of extensive unprovoked left lower extremity deep vein thrombosis (DVT). Radiol Case Rep. 2024;19(2):680-83.
Birn J, Vedantham S. May-Thurner syndrome and other obstructive iliac vein lesions: meaning, myth, and mystery. Vasc Med. 2015;20(1):74-83.
Marston W, Fish D, Unger J, Keagy B. Incidence of and risk factors for iliocaval venous obstruction in patients with active or healed venous leg ulcers. J Vasc Surg. 2011;53(5):1303-8.
Oteros Fernández R, Bravo Rodríguez F, Delgado Acosta F, González Barrios I. May-Thurner syndrome and surgery for scoliosis. Radiología. 2008;50(3):245-7.
Brinegar KN, Sheth RA, Khademhosseini A, Bautista J, Oklu R. Iliac vein compression syndrome: clinical, imaging, and pathologic findings. World J Radiol. 2015;7(11):375-81.
Brazeau NF, Harvey HB, Pinto EG, Amy D, Richard LH, Rahmi O. May-Thurner syndrome: diagnosis and management. Vasa. 2013;42(2):96-105.
Desai J, Desai Z, Shah J, Hai O, Mignatti A, Zeltser R et al. Deep vein thrombosis of the left leg: a case of May-Thurner Syndrome. Eur J Case Rep Int Med. 2018;5(4):000829.
Comerota AJ, Kearon C, Gu CS, Julian JA, Goldhaber SZ, Kahn SR et al. Endovascular thrombus removal for acute iliofemoral deep vein thrombosis. Circulation. 2019;139(9):1162-73.
Kang JM, Park KH, Ahn S, Cho S, Han A, Lee T et al. Rivaroxaban after thrombolysis in acute iliofemoral venous thrombosis: a randomized, open-labeled, multicenter trial. Sci Rep. 2019;9(1):20356.