Advertisement

May-Thurner Syndrome

  • Soumya Khanna
  • Ajay K. Khanna
Chapter

Abstract

May-Thurner syndrome (MTS) is a rarely diagnosed condition in which there is extrinsic venous compression by the arterial system against bony structure in the iliocaval territory. The condition is mostly asymptomatic in cases where there is partial obstruction, but progression with symptoms related to chronic venous hypertension or venous occlusion can occur, with or without venous thrombosis. This condition should always be kept in mind if a young woman comes with lower extremity swelling or deep vein thrombosis.

References

  1. 1.
    Virchow R. Ueber die Erweiterung kleinerer Gefäfse. Arch Pathol Anat Physiol Klin Med. 1851;3:427.CrossRefGoogle Scholar
  2. 2.
    Shebel ND, Whalen CC. Diagnosis and management of iliac vein compression syndrome. J Vasc Nurs. 2005;23:10–7.; quiz 18–19.  https://doi.org/10.1016/j.jvn.2004.12.001.CrossRefPubMedGoogle Scholar
  3. 3.
    Brazeau NF, Harvey HB, Pinto EG, Deipolyi A, Hesketh RL, Oklu R. May-Thurner syndrome: diagnosis and management. Vasa. 2013;42:96–105.  https://doi.org/10.1024/0301-1526/a000252.CrossRefPubMedGoogle Scholar
  4. 4.
    Burke RM, Rayan SS, Kasirajan K, et al. Unusual case of right-sided May-Thurner syndrome and review of its management. Vascular. 2006;14:47.CrossRefGoogle Scholar
  5. 5.
    Moudgill N, Hager E, Gonsalves C, et al. May-Thurner syndrome: case report and review of the literature involving modern endovascular therapy. Vascular. 2009;17:330.CrossRefGoogle Scholar
  6. 6.
    May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957;8:419.CrossRefGoogle Scholar
  7. 7.
    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;53:1303.CrossRefGoogle Scholar
  8. 8.
    Hurst DR, Forauer AR, Bloom JR, Greenfield LJ, Wakefield TW, Williams DM. Diagnosis and endovascular treatment of iliocaval compression syndrome. J Vasc Surg. 2001;34:106–13.  https://doi.org/10.1067/mva.2001.114213.CrossRefPubMedGoogle Scholar
  9. 9.
    Ibrahim W, Al Safran Z, Hasan H, Zeid WA. Endovascular management of May-Thurner syndrome. Ann Vasc Dis. 2012;5:217–21.  https://doi.org/10.3400/avd.cr.12.00007.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Patel NH, Stookey KR, Ketcham DB, Cragg AH. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome. J Vasc Interv Radiol. 2000;11:1297–302.  https://doi.org/10.1016/S1051-0443(07)61304-9.CrossRefPubMedGoogle Scholar
  11. 11.
    Wolpert LM, Rahmani O, Stein B, Gallagher JJ, Drezner AD. Magnetic resonance venography in the diagnosis and management of May-Thurner syndrome. Vasc Endovasc Surg. 2002;36:51–7.  https://doi.org/10.1177/153857440203600109.CrossRefGoogle Scholar
  12. 12.
    Kibbe MR, Ujiki M, Goodwin AL, Eskandari M, Yao J, Matsumura J. Iliac vein compression in an asymptomatic patient population. J Vasc Surg. 2004;39:937–43.  https://doi.org/10.1016/j.jvs.2003.12.032.CrossRefPubMedGoogle Scholar
  13. 13.
    McDermott S, Oliveira G, Ergül E, Brazeau N, Wicky S, Oklu R. May-Thurner syndrome: can it be diagnosed by a single MR venography study? Diagn Interv Radiol. 2013;19:44–8.  https://doi.org/10.4261/1305-3825.DIR.5939-12.1.CrossRefPubMedGoogle Scholar
  14. 14.
    Liu Z, Gao N, Shen L, Yang J, Zhu Y, Li Z, Si Y. Endovascular treatment for symptomatic iliac vein compression syndrome: a prospective consecutive series of 48 patients. Ann Vasc Surg. 2014;28:695–704.  https://doi.org/10.1016/j.avsg.2013.05.019.CrossRefPubMedGoogle Scholar
  15. 15.
    Lensing AW, Prandoni P, Brandjes D, et al. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med. 1989;320:342.CrossRefGoogle Scholar
  16. 16.
    Labropoulos N, Borge M, Pierce K, Pappas PJ. Criteria for defining significant central vein stenosis with duplex ultrasound. J Vasc Surg. 2007;46:101.CrossRefGoogle Scholar
  17. 17.
    Lamba R, Tanner DT, Sekhon S, McGahan JP, Corwin MT, Lall CG. Multidetector CT of vascular compression syndromes in the abdomen and pelvis. Radiographics. 2014;34:93–115.  https://doi.org/10.1148/rg.341125010.CrossRefPubMedGoogle Scholar
  18. 18.
    Chung JW, Yoon CJ, Jung SI, Kim HC, Lee W, Kim YI, Jae HJ, Park JH. Acute iliofemoral deep vein thrombosis: evaluation of underlying anatomic abnormalities by spiral CT venography. J Vasc Interv Radiol. 2004;15:249–56.  https://doi.org/10.1097/01.RVI.0000109402.52762.8D.CrossRefPubMedGoogle Scholar
  19. 19.
    Oguzkurt L, Tercan F, Pourbagher MA, Kizilkilic O, Turkoz R, Boyvat F. Computed tomography findings in 10 cases of iliac vein compression (May-Thurner) syndrome. Eur J Radiol. 2005;55:421–5.  https://doi.org/10.1016/j.ejrad.2004.11.002.CrossRefPubMedGoogle Scholar
  20. 20.
    Gurel K, Gurel S, Karavas E, Buharalıoglu Y, Daglar B. Direct contrast-enhanced MR venography in the diagnosis of May-Thurner syndrome. Eur J Radiol. 2011;80:533–6.  https://doi.org/10.1016/j.ejrad.2010.04.033.CrossRefPubMedGoogle Scholar
  21. 21.
    Meissner MH, Gloviczki P, Comerota AJ, 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;55:1449.CrossRefGoogle Scholar
  22. 22.
    Birn J, Vedantham S. May-Thurner syndrome and other obstructive iliac vein lesions: meaning, myth, and mystery. Vasc Med. 2015;20:74.CrossRefGoogle Scholar
  23. 23.
    DeRubertis BG, Lew W, Jabori S, et al. Importance of intravascular ultrasound imaging during percutaneous treatment of May-Thurner syndrome. J Vasc Surg. 2012;56:580.CrossRefGoogle Scholar
  24. 24.
    Mickley V, Schwagierek R, Rilinger N, et al. Left iliac venous thrombosis caused by venous spur: treatment with thrombectomy and stent implantation. J Vasc Surg. 1998;28:492.CrossRefGoogle Scholar
  25. 25.
    Gloviczki P, Lawrence PF. Iliac vein stenting and contralateral deep vein thrombosis. J Vasc Surg Venous Lymphat Disord. 2017;5:5.CrossRefGoogle Scholar
  26. 26.
    Jaff MR, McMurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123:1788.CrossRefGoogle Scholar
  27. 27.
    Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141:e419S.CrossRefGoogle Scholar
  28. 28.
    Hartung O, Benmiloud F, Barthelemy P, et al. Late results of surgical venous thrombectomy with iliocaval stenting. J Vasc Surg. 2008;47:381.CrossRefGoogle Scholar
  29. 29.
    Palma EC, Esperon R. Vein transplants and grafts in the surgical treatment of the postphlebitic syndrome. J Cardiovasc Surg (Torino). 1960;1:94.Google Scholar
  30. 30.
    Dale WA, Harris J. Cross-over vein grafts for iliac and femoral venous occlusion. J Cardiovasc Surg (Torino). 1969;10:458.Google Scholar
  31. 31.
    Binkert CA, Schoch E, Stuckmann G, et al. Treatment of pelvic venous spur (May-Thurner syndrome) with self-expanding metallic endoprostheses. Cardiovasc Intervent Radiol. 1998;21:22.CrossRefGoogle Scholar
  32. 32.
    O’Sullivan GJ, Semba CP, Bittner CA, et al. Endovascular management of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 2000;11:823.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Soumya Khanna
    • 1
  • Ajay K. Khanna
    • 2
  1. 1.Institute of Medical Sciences, Banaras Hindu UniversityVaranasiIndia
  2. 2.Department of General SurgeryInstitute of Medical Sciences, Banaras Hindu UniversityVaranasiIndia

Personalised recommendations