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Review
. 2021 Oct;11(5):1104-1111.
doi: 10.21037/cdt.2020.03.07.

May-Thurner syndrome

Santhosh Poyyamoli  1 , Pankaj Mehta  2 , Mathew Cherian  1 , Rinoy R Anand  1 , Santosh B Patil  1 , Sanjeeva Kalva  3 , Gloria Salazar  3
Affiliations
Review

May-Thurner syndrome

Santhosh Poyyamoli et al. Cardiovasc Diagn Ther. 2021 Oct.

Abstract

May-Thurner syndrome (MTS) is a venous compression syndrome in which the left common iliac vein (LCIV) is compressed between the lower lumbar spine and the right common iliac artery (RCIA). Variations are known where in the right lower limb can be affected. While most of the cases are asymptomatic, it can cause severe morbidity in symptomatic individuals, most commonly deep vein thrombosis and post thrombotic sequelae. In this article, we review the key clinical features, multimodality imaging findings and treatment options of this disorder. Our goal is to raise awareness of this under-diagnosed condition among clinicians in order to promote early detection and recognition to enhance positive and expedited outcomes.

Keywords: Cockett syndrome; Compressive venous syndromes; May-Thurner syndrome (MTS).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/cdt.2020.03.07). The series “Compressive Vascular Syndromes” was commissioned by the editorial office without any funding or sponsorship. Dr. SK served as the unpaid Guest Editor of the series. Dr. SK reports personal fees from Elsevier, personal fees from Springer, personal fees from Koo Foundation, Taiwan, personal fees from Medtronic Inc, personal fees from Penumbra Inc, personal fees from US Vascular, other from Althea Health, personal fees from Dova Pharmaceuticasl, outside the submitted work. Dr. GS reports personal fees from Medtronic Vascular, outside the submitted work. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
A 51-year-old male with left leg swelling and prior history of recurrent left leg DVT. USG color Doppler showed normal respiratory variation in right common femoral vein (A) and diminished respiratory variation in left common femoral vein suggesting proximal obstructive lesion (B). Post contrast MR venogram (C,D) demonstrated compression of left common iliac vein (C, arrow) by right common iliac artery (C, arrowhead) and cross pelvic collaterals (arrow) (D). Axial MIP time-of-flight MR image (E) showed hemodynamically significant left common iliac vein compression (arrow) with non-visualized left internal iliac vein suggesting flow reversal in left internal iliac vein. Intravascular ultrasound (F) showed small caliber left common iliac vein at the site of crossing by right common iliac artery. Post stenting intravascular ultrasound (G) showed restoration of lumen of the left common iliac vein. Catheter venogram (H) showed significant narrowing of left common iliac vein with cross pelvic collaterals. Post deployment of VICI (Boston Scientific, USA) stent (I), there was restoration of lumen with absence of pelvic collaterals. Three months after stenting, axial (J) and coronal (K) reformatted images of MDCT venography showed widely patent stent (arrow) with normal lumen of the left common iliac vein. The patient’s symptoms of left leg swelling resolved at 3 months. DVT, deep venous thrombosis; USG, ultrasonography; MR, magnetic resonance; MIP, maximum intensity projection.
Figure 2
Figure 2
Axial (A) and coronal (B) reformatted images of MDCT venography of a 37 years old female with left lower limb swelling showing compression of left common iliac vein (arrow) by right common iliac artery (arrowhead) with thrombus in left common iliac vein. Suction thrombectomy was performed using Angiojet (Boston Scientific, USA). Catheter venogram (C) performed after suction thrombectomy showed proximal left common iliac vein stenosis. Balloon dilatation (D) was performed using 8mm balloon. Self- expanding stainless steel stent (Wallstent, Boston Scientific, USA) (E,F) was deployed with restoration of caliber and flow across left common iliac vein. MDCT, multi-detector computed tomography.
See this image and copyright information in PMC

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