PRIMARY MAY-THURNER SYNDROME, CLINICAL AND ENDOVASCULAR SURGICAL RESULTS. OUR EXPERIENCE.
Objective: To evaluate the experience on endovascular treatment of primary May-Thurner Syndrome (MTS)
Introduction: Primary May-Thurner Syndrome, results from the compression of the left common iliac vein by the right common iliac artery and the 5fth vertebral body.
Methods and material: Retrospective analysis based on the clinical and imagiological records related to 21 patients diagnosed with non complicated May-Thurner Syndrome who underwent endovascular surgical treatment. The SPSS statistic 21 IBM was used to do a uni and bivariated descriptive analysis as so as the realization of the hypothesis test.
Results: The mean age was 44 years old, and 90% were female,with two peaks of incidence: one during the third decade of life, and the other during the fifth and sixth decades. The most common symptom was left inferior limb edema (85%), the mean time between the beginning of the symptoms and the diagnosis was 5,05 years and the treatment was primary stenting in 90,5% of the cases. With a mean follow-up of 54,43 months, the primary patency was 85,7% and the primary assisted patency was 100%. All patients submitted to angioplasty alone necessitate a stenting posteriorly. On the sixteen patients that were classified by the Venous Clinical Severity Score (VCSS), it was shown a statistically significant improvement on the post-operatory scores related to pain, the left inferior limb edema and the global score. There was a significant correlation between the time between the beginning of symptoms and diagnosis ,and the post-operatory edema score.
Discussion/Conclusion: An assisted primary patency of 100% was observed according to the published literature. The delayed diagnosis of the MTS may correspond to the lack of clinical knowledge and was associated with poor results.
(May-Thurner) syndrome. J Vasc Interv Radiol. 11, 2000, pp. 823-836.
2. Patel, NH, et al. Endovascular management of acute extensive iliofemoral
deep venous thrombosis caused by May-Thurner syndrome. J
Vasc Interv Radiol. 11, 2000, pp. 1297-302.
3. McMurrich, JP. The occurrence of congenital adhesions in the
common iliac veins and their relation to thrombosis of the femoral
and iliac veins. Am J Med Sci. 135, 1908, pp. 342-346.
4. Ehrich, WE e Krumbhaar, EB. A frequent obstructive anomaly of the
mouth of the left common iliac vein. Am Heart J. 26, 1943, pp. 737-750.
5. May, R e Thurner, J. The cause of the predominantly sinistral occurrence
of thrombosis of the pelvic veins. Angiology. 8, 1957, pp. 419-448.
6. Cockett, FB e Thomas, ML. The iliac compression syndrome. Br J Surg.
52, 1965, pp. 816-21.
7. Taheri, SA, et al. Iliocaval compression syndrome. Am J Surg. 154,
1987, pp. 169-172.
8. Ahmed, O, et al. Endovascular stent placement for May-Thurner
syndrome in the absense of acute deep vein thrombosis. J Vasc
Interv Radiol. 27, 2016, pp. 167-173.
9. Shebel, ND e Whalen, CC. Diagnosis and management of iliac vein
compression syndrome. J Vasc Nurs. 23, 2005, pp. 10-17.
10. Hurst, DR, et al. Dagnosis and endovascular treatment of iliocaval
compression syndrome. J Vasc Surg. 34, 2001, pp. 106-113.
11. Wolpert, LM, et al. Magnetic resonance venography in the diagnosis
and management of May-Thurner syndrome. Vasc Endovascular
Surg. 36, 2002, pp. 51-57.
12. Ley, EJ, et al. Endovascular management of iliac vein occlusive disease.
Ann Vasc Surg. 18, 2004, pp. 228-233.
13. Forauer, AR, et al. Intravascular ultrasound in the diagnosis and
treatment of iliac vein compression (May-Thurner) syndrome. J Vasc
Interv Radiol. 13, 2002, pp. 523-527.
14. Neglén, P e Raju, S. Intravascular utltrasound scan evaluation of the
obstructed vein. J vasc Surg. 35, 2002, pp. 694-700.
15. Rigas, A, Vomyoyannis, A e Tsardakas, E. Iliac compression syndrome:
report of ten cases. J Cardiovasc Surg. 11, 1970, pp. 389-392.
16. Taheri, S, Taheri, P e Schultz, R. Iliocaval compression syndrome. Br J
Surg. 40, 1992, pp. 9-15.
17. Gloviczki, P e Cho, JS. Surgical treatment of chronic occlusions of the
ilicaval veins. [autor do livro] RB Rutherford. Rutherford's vascular
surgery. Philadelphia: Elsevier, 2005, pp. 2303-2320.
18. Jost, CJ, et al. Surgical reconstruction of ilio-femoral veins and the inferior
vena cava for nonmalignant occlusive disease. J Vasc Surg. 33, pp. 320-328.
19. Ye, K, et al. Long-term outcomes of stent placement for symptomatic
nonthrombotic iliac vein compression lesions in chronic venous
disease. J Vasc Interv Radiol. 23, 2012, Vol. 4, pp. 497-502.
20. Meng, QY, et al. Endovascular treatment of iliac vein compression
syndrome. Chin Med J (Engl). 124, 2011, Vol. 20, pp. 3281-3284.
21. Neglen, P, et al. Stenting of the venous outflow in chronic venous
disease: long-term stent-related outcome, clinical, and hemodynamic
result. J Vasc Surg. 46, 2007, Vol. 5, pp. 979-990.
22. Raju, S, Ward, Jr M e Kirk, O. A modification of iliac vein stent technique.
Ann Vasc Surg. 28, 2014, Vol. 6, pp. 1485-1492.
23. Mahnken, AH, et al. Cirse standars of practice guidelines on iliocaval
stenting. Cardiovasc Intervent Radiol. 37, 2014, pp. 889-897.
24. Shi, WY, et al. Endovascular treatment for iliac vein compression
syndrome with or without lower extremeity deep vein thrombosis:
a retrospective study on mind-term-in-stent patency from a single
center. European Journal of Radiology. 85, 2015, pp. 7-14.
25. Titus, JM, et al. Iliofemoral stenting for venous occlusive disease. J
Vasc Surg. 53, 2011, pp. 706-712.
26. Knipp, BS, et al. Factors associated with outcome after interventional
treatment of symptomatic iliac vein compression syndrome. J Vasc
Surg. 46, 2007, pp. 743-749.
27. Lee, B-B, et al. Venous hemodynamic changes in lower limb
venous disease: the UIP consensus according to scientific evidence.
International Angiology. 35, 2016, Vol. 3, pp. 236-352.
28. Vasquez, MA, et al. Revision of the venous clinical severity score:
Venous outcomes consensus statement: Special communication of
the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc
Surg. 52, 2010, pp. 1387-96.
29. Machado M, Machado R, Mendes D, Almeida R. Síndrome de May-Thurner
associado a um síndrome de nutcracker: caso cíinico e revisão da
literatura. Angiologia e Cirurgia Vascular. 2. 2017. 13. 52-57