MAY-THURNER SYNDROME: A CASE REPORT AFTER TWO YEARS OF ENDOVASCULAR TREATMENT

  • Tony R. Soares Department of Vascular Surgery, Hospital Santa Maria, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal http://orcid.org/0000-0002-9344-6858
  • José Tiago 3Vascular Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
  • Viviana Manuel Department of Vascular Surgery, Hospital Santa Maria, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal
  • Pedro Amorim Department of Vascular Surgery, Hospital Santa Maria, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal; University of Lisbon, Lisbon, Portugal
  • João Leitão Department of Vascular Surgery, Hospital Santa Maria, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal; University of Lisbon, Lisbon, Portugal
  • Carlos Martins Department of Vascular Surgery, Hospital Santa Maria, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal
  • Luís Mendes Pedro Department of Vascular Surgery, Hospital Santa Maria, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal; University of Lisbon, Lisbon, Portugal
Keywords: Deep vein thrombosis, DVT, iliac veins, May–Thurner syndrome, Cockett syndrome, iliac vein compression syndrome, venous stenting

Abstract

Previously considered a rare clinical condition, the development of more sophisticated imaging methods and endovascular intervention for deep venous thrombosis (DVT) led to a more frequent identification of May-Thurner Syndrome.

We present a 68 years-old woman with history of chronic pain and edema in the left lower limb and a CT-scan finding of left common iliac vein compression. Phlebography confirmed a stenosis in the confluence of the left common iliac vein with the inferior vena cava and a dilated left ovarian vein as well as voluminous collaterals in the pelvic fossa to the contralateral iliac vessels. These aspects are suggestive of May-Thurner Syndrome. The lesion was treated by venous angioplasty and stenting of the left common iliac vein. The recovery was uneventful, the patient remained on antiplatelet therapy and anticoagulation and had a notorious clinical improvement.

May-Thurner Syndrome should be suspected in patients with chronic symptoms of venous insufficiency or as an underlying cause of acute proximal DVT in the left lower limb.

Downloads

Download data is not yet available.

References

1. Fazel R, Froehlich JB, Williams DM, Saint S, Nallamothu BK. A Sinister Development. N Engl J Med. 2007;357(1):53–59. doi:10.1056/NEJMcps061337

2. Kibbe MR, Ujiki M, Goodwin a. L, et al. Iliac vein compression in an asymptomatic patient population. J Vasc Surg. 2004;39(5):937–943. doi:10.1016/j.jvs.2003.12.032

3. Bozkaya H, Cinar C, Ertugay S, et al. Endovascular Treatment of Iliac Vein Compression (May-Thurner) Syndrome: Angioplasty and Stenting with or without Manual Aspiration Thrombectomy and Catheter-Directed Thrombolysis. Ann Vasc Dis. 2015;8(1):21–28. doi:10.3400/avd.oa.14-00110

4. May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957;8(5):419–427. doi:10.1177/000331975700800505

5. Wolpert LM, Rahmani O, Stein B, Gallagher JJ, Drezner a D. Magnetic resonance venography in the diagnosis and management of May-Thurner syndrome. Vasc Endovascular Surg. 2002;36(1):51–57. doi:10.1177/153857440203600109

6. Chung JW, Yoon CJ, Jung S Il, et al. Acute Iliofemoral Deep Vein Thrombosis: Evaluation of Underlying Anatomic Abnormalities by Spiral CT Venography. J Vasc Interv Radiol. 2004;15(3):249–256. doi:10.1097/01.RVI.0000109402.52762.8D

7. Mickley V, Schwagierek R, Rilinger N, Gorich J, Sunder-Plassmann L. Left iliac venous thrombosis caused by venous spur: Treatment with thrombectomy and stent implantation. J Vasc Surg. 1998;28(3):492–497. doi:10.1016/S0741-5214(98)70135-1

8. O’Sullivan GJ, Semba CP, Bittner C a, et al. Endovascular management of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 2000;11(7):823–836. doi:10.1016/S1051-0443(07)61796-5

9. Mousa AY, AbuRahma AF. May–Thurner Syndrome: Update and Review. Ann Vasc Surg. 2013;27(7):984–995. doi:10.1016/j.avsg.2013.05.001

10. Taheri S a, Williams J, Powell S, et al. Iliocaval compression syndrome. Am J Surg. 1987;154(2):169–172. doi:10.1177/153100359200500211

11. Chamarthy MR, Sutphin P, Anderson M, Reddick M, Kalva SP. Evolving Concepts in the Diagnosis and Management of May–Thurner Syndrome. J Clin Interv Radiol. 2016;1:23–30. doi:10.1055/s-0036-1597954

12. Brinegar KN. Iliac vein compression syndrome: Clinical, imaging and pathologic findings. World J Radiol. 2015;7(11):375. doi:10.4329/wjr.v7.i11.375

13. Kuo Y-S, Chen C-J, Chen J-J, et al. May–Thurner syndrome: Correlation between digital subtraction and computed tomography venography. J Formos Med Assoc. 2015;114(4):363–368. doi:10.1016/j.jfma.2012.12.004

14. Knuttinen M-G, Naidu S, Oklu R, et al. May-Thurner: diagnosis and endovascular management. Cardiovasc Diagn Ther. 2017;7(S3):S159-S164. doi:10.21037/cdt.2017.10.14

15. Gagne PJ, Tahara RW, Fastabend CP, et al. Venography versus intravascular ultrasound for diagnosing and treating iliofemoral vein obstruction. J Vasc Surg Venous Lymphat Disord. 2017;5(5):678– 687. doi:10.1016/j.jvsv.2017.04.007

16. Birn J, Vedantham S. May–Thurner syndrome and other obstructive iliac vein lesions: Meaning, myth, and mystery. Vasc Med. 2015;20(1):74–83. doi:10.1177/1358863X14560429

17. Forauer AR, Gemmete JJ, Dasika NL, Cho KJ, Williams DM. Intravascular ultrasound in the diagnosis and treatment of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 2002;13(5):523–527. doi:10.1016/S1051-0443(07)61535-8

18. Akers DL, Creado B, Hewitt RL. Iliac vein compression syndrome: case report and review of the literature. J Vasc Surg. 1996;24(3):477–481.

19. 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(1):106–113. doi:10.1067/mva.2001.114213

20. Kwak H-S, Han Y-M, Lee Y-S, Jin G-Y, Chung G-H. Stents in common iliac vein obstruction with acute ipsilateral deep venous thrombosis: early and late results. J Vasc Interv Radiol. 2005;16(6):815– 822. doi:10.1097/01.RVI.0000157690.91690.38

21. Lamont JP, Pearl GJ, Patetsios P, et al. Prospective evaluation of endoluminal venous stents in the treatment of the May-Thurner syndrome. Ann Vasc Surg. 2002;16(1):61–64. doi:10.1007/s10016-001-0143-3

22. Liu Z, Gao N, Shen L, et al. Endovascular treatment for symptomatic iliac vein compression syndrome: a prospective consecutive series of 48 patients. Ann Vasc Surg. 2014;28(3):695–704. doi:10.1016/j. avsg.2013.05.019

23. Lee K, Sung J-A, Kim J-S, Park T-J. The roles of obesity and gender on the relationship between metabolic risk factors and non-alcoholic fatty liver disease in Koreans. Diabetes Metab Res Rev. 2009;25(2):150–155. doi:10.1002/dmrr.924

24. Ye K, Lu X, Li W, et al. Long-Term Outcomes of Stent Placement for Symptomatic Nonthrombotic Iliac Vein Compression Lesions in Chronic Venous Disease. J Vasc Interv Radiol. 2012;23(4):497–502. doi:10.1016/j.jvir.2011.12.021

25. Oguzkurt L, Tercan F, Ozkan U, Gulcan O. Iliac vein compression syndrome: outcome of endovascular treatment with long-term follow-up. Eur J Radiol. 2008;68(3):487–492. doi:10.1016/j.ejrad.2007.08.019

26. van Vuuren TMAJ, de Wolf MAF, Arnoldussen CWKP, et al. Editor’s Choice — Reconstruction of the femoro-ilio-caval outflow by percutaneous and hybrid interventions in symptomatic deep venous obstruction. Eur J Vasc Endovasc Surg. 2017;54(4):495–503. doi:10.1016/j.ejvs.2017.06.023

27. Stuck AK, Kunz S, Baumgartner I, Kucher N. Patency and Clinical Outcomes of a Dedicated, Self-Expanding, Hybrid Oblique Stent Used in the Treatment of Common Iliac Vein Compression. J Endovasc Ther. 2017;24(1):159–166. doi:10.1177/1526602816676803

28. 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(5):1449–1462. doi:10.1016/j.jvs.2011.12.081
Published
2018-12-21
Section
Clinical Case

Most read articles by the same author(s)