• Marta Machado Hospital CUF Viseu, Portugal
  • Miguel Machado Hospital CUF Viseu, Portugal
  • Arlindo Machado Hospital CUF Viseu, Portugal
  • Rui Machado Hospital CUF Viseu, Portugal



Cockett Syndrome, May Thurner syndrome, Iliac vein stentig, Compression syndrome, Stenting, IVUS


Introduction : May Thurner Syndrome (MTS) is a clinical condition as a result of an anatomical compression of the left common iliac vein by the fifth lumbar vertebra posteriorly, and by the right common iliac artery anteriorly associated with symptomatology. Affirming the diagnosis can be difficult and intravascular ultrasonography (IVUS) can help in the definitive decision.

Clinical Case: A 43 years old man with a past history of a deep venous thrombosis of the left lower limb presented at our clinical appointment with a 5 months history of left limb edema and inability to stand up for long periods of time, disabling him from working.
A venous-CT scan was obtained to diagnose the condition but was inconclusive.

It was proposed to the patient to carry out a phlebography and an IVUS to eliminate the doubt and increase the diagnosis acuity, which was accepted.
A phlebography and IVUS confirmed a significant compression of the left common iliac vein (image 1).
The patient was treated by endovenous placement of an Abre 16/80 medtronic stent followed by dilatation with a 16/40 balloon Boston scientific.

The phlebography and IVUS control showed complete resolution of the compression. (Image 2)

Discussion/Conclusion: The diagnosis of MTS can be difficult and implies a high degree of clinical suspicion.
The TC scan alone may not be diagnostic. The phlebography, and especially the more recent IVUS technology increases the accuracy of the diagnosis.
Emergence of endovascular surgery revolutionized the treatment of obstructive venous disease, and became the gold standard of treatment. However, the implantation of stents in a young population implies additional cautions due to the lack of knowledge about their behavior over the long term.
In this clinical case, the IVUS allowed us to reach the diagnosis and to increase the therapeutic accuracy of the ilio- cava stenting.

We recommend the routine use of IVUS in the management of MTS.


Download data is not yet available.


1. Machado M, Machado R et al. May thurner syndrome associated with nutcracker syndrome: clinical case and literature review. AngiolCirVasc 2017,Vol13,n.3,pp.52-57
2. 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.
3. 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.
4. 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.
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. O'Sullivan, GJ, et al. Endovascular management of iliac vein compression (MayThurner) syndrome. J Vasc Interv Radiol. 11, 2000, pp. 823-836.
7. O'Sullivan, GJ, et al. Endovascular management of iliac vein compression (MayThurner) syndrome. J Vasc Interv Radiol. 11, 2000, pp. 823-836.
8. Shebel, ND e Whalen, CC. Diagnosis and management of iliac vein compression syndrome. J Vasc Nurs. 23, 2005, pp. 10-17.
9. Hurst, DR, et al. Diagnosis and endovascular treatment of ilio- caval compression syndrome. J Vasc Surg. 34, 2001, pp. 106-113. Pages 43 de 74
10. Wolpert, LM, et al. Magnetic resonance venography in the diagnosis and management of May-Thurner syndrome. Vasc Endovascular Surg. 36, 2002, pp. 51-57.
11. Ley, EJ, et al. Endovascular management of iliac vein occlusive disease. Ann Vasc Surg. 18, 2004, pp. 228-233.
12. Rigas, A, Vomyoyannis, A e Tsardakas, E. Iliac compression syndrome: report of ten cases. J Cardiovasc Surg. 11, 1970, pp. 389-392.
13. Taheri, S, Taheri, P e Schultz, R. Iliocaval compression syndrome. Br J Surg. 40, 1992, pp. 9-15. 76. Gloviczki, P e Cho, JS. Surgical treatment of chronic occlusions of the ilicaval veins. RB Ruth- erford. Rutherford's vascular surgery. Philadelphia: Elsevier, 2005, pp. 2303-2320.
14. Canales J F, Krajcer Z. Intravascular ultrasound guid- ance in treating May Thurner Syndrome. Tex Heart Inst J 2010;37(4):496-497
15. 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.
16. Montminy M L et al A comparison between intravascular ultra- sound and venography in identifying key parameters essential for iliac vein stentingJ Vasc Surg Venous Lymphat Disord 2019 Nov;7(6):801-807.
17. Neglén, P e Raju, S. Intravascular ultrasound scan evaluation of the obstructed vein. J vasc Surg. 35, 2002, pp. 694-700.
18. Ye,K,etal.Long-termoutcomesofstentplacementforsymp- tomatic nonthrombotic iliac vein compression lesions in chronic venous disease. J Vasc Interv Radiol. 23, 2012, Vol. 4, pp. 497-502.
19. Meng, QY, et al. Endovascular treatment of iliac vein compres- sion syndrome. Chin Med J (Engl). 124, 2011, Vol. 20, pp. 3281-3284. 20. Raju S, Ward Jr M, Kirk O. A modification of iliac vein stent tech-
nique. Ann Vasc Surg. 28, 2014, Vol. 6, pp. 1485-1492.
21. Mahnken, AH, et al. Cirse standards of practice guidelines on iliocaval stenting. Cardiovasc Intervent Radiol. 37, 2014, pp.889-897.
22. Shi,WY,etal.Endovasculartreatmentforiliacveincompression syndrome with or without lower extremity deep vein thrombosis: a retrospective study on mind-term-in-stent patency from a single center. European Journal of Radiology
23. MachadoM,MachadoRetal.Primarymay-thurnersyndrome, clinical and endovascular surgical results: Our experience. Angiol Cir Vasc 2018, vol.14, n.1, pp.22-37. ISSN 1646-706X.

Additional Files





Clinical Case