SÍNDROME DE MAY-THURNER: UM CASO CLÍNICO DOIS ANOS APÓS TRATAMENTO ENDOVASCULAR
DOI:
https://doi.org/10.48750/acv.125Palavras-chave:
Trombose venosa profunda, TVP, veias ilíacas, Síndrome de May-Thurner, Síndrome de Cockett, Síndrome de compressão da veia ilíaca, stenting venosoResumo
Previamente considerada como uma entidade clínica rara, o desenvolvimento de métodos de imagem cada vez mais sofisticados e a proliferação do tratamento endovascular da TVP, tornou a Síndrome de May-Thurner um diagnóstico cada vez mais frequente na nossa prática clínica.
Apresentamos o caso de uma doente de 68 anos de idade com queixas crónicas de dor e edema do membro inferior esquerdo e um achado em angio-TC de compressão da veia ilíaca primitiva. A flebografia confirmou a presença de uma estenose na confluência entre a veia ilíaca primitiva esquerda com a veia cava inferior, a dilatação da veia ovárica esquerda e uma volumosa rede de colaterais da fossa pélvica com comunicação com os vasos ilíacos contralaterais — aspetos sugestivos da Síndrome de May-Thurner. A lesão foi tratada com angioplastia transluminal percutânea com implantação de stent na veia ilíaca primitiva esquerda. O periodo pós-operatório decorreu sem intercorrências. A doente teve alta sob antiagregação e anticoagulação com uma notória melhoria clínica.
A Síndrome de May-Thurner é uma entidade clínica que deve ser suspeitada em doentes com sintomatologia crónica de insuficiência venosa ou eventos de trombose venosa profunda no membro inferior esquerdo.
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Referências
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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
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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
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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
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
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Publicado
2018-12-21
Como Citar
1.
Soares TR, Tiago J, Manuel V, Amorim P, Leitão J, Martins C, et al. SÍNDROME DE MAY-THURNER: UM CASO CLÍNICO DOIS ANOS APÓS TRATAMENTO ENDOVASCULAR. Angiol Cir Vasc [Internet]. 21 de dezembro de 2018 [citado 14 de novembro de 2025];14(3):208-11. Disponível em: https://acvjournal.com/index.php/acv/article/view/125
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