May-Thurner Syndrome Presenting With Pelvic Pain in a Healthy 22-Year-Old Woman Successfully Treated With Intravascular Ultrasound Guided Stenting of the Left Common Iliac Vein

May-Turner syndrome is a condition where the left common iliac vein is compressed between the lumbar spine and the overlying right common iliac artery. Left iliac vein compression is common (up to 24%) in the general population, but clinical manifestations occur in a few patients. This syndrome should be considered in case of unexplained edema of the left lower extremity since routine duplex ultrasound does not possess optimal sensitivity and specificity in the study of the iliac veins and the inferior vena cava. Intravascular ultrasound is the most accurate diagnostic method. However, the advent of computed tomography angiography and magnetic resonance angiography providing high-quality images of the vasculature have become a promising alternative to invasive intravascular ultrasound. Treatment for May-Turner syndrome usually involves stenting of the left common iliac vein along with medical therapy, including antithrombotic (anticoagulant and antiplatelet) therapy combined with phlebotonics. Our review reports modern methods of diagnosis and treatment of May-Turner syndrome.

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Dimensional disparity between duplex and intravascular ultrasound in the assessment of iliac vein stenosis

Vascular Medicine ◽

10.1177/1358863x211003663 ◽

2021 ◽

pp. 1358863X2110036

Author(s):

Seshadri Raju ◽

William Walker ◽

Chandler Noel ◽

Riley Kuykendall ◽

Thomas Powell ◽

...

Keyword(s):

Intravascular Ultrasound ◽

Venous Pressure ◽

Iliac Vein ◽

Common Iliac Vein ◽

Systematic Bias ◽

Cross Sectional ◽

External Iliac Vein ◽

The Difference ◽

Vein Stenosis ◽

Linear Regressions

Minimum iliac vein caliber necessary to maintain normal peripheral venous pressure can be derived by the Poiseuille equation. Duplex was compared to intravascular ultrasound (IVUS) in the assessment of iliac vein stenosis in this single center retrospective study. Parallel IVUS and duplex caliber data for common iliac vein (CIV) and external iliac vein (EIV) in 382 limbs were separately compared. One or both segments were stenotic by IVUS criteria in 213 limbs. Neither segment was stenotic by IVUS in 22 limbs. Bland–Altman analyses and Passing–Bablok linear regressions were used. Duplex calibers were dimensionally smaller than corresponding IVUS images of CIV and EIV segments in Bland–Altman comparison by a mean of 54 mm2 and 34 mm2, respectively. Passing–Bablok regression suggested the difference was due to a systematic bias and not proportional. Duplex yields a smaller cross-sectional image of CIV and EIV compared to IVUS. Duplex is not a reliable diagnostic test for iliac vein stenosis.

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A rare case of May-Thurner-like syndrome in an elderly lady

Case Reports in Internal Medicine ◽

10.5430/crim.v1n2p19 ◽

2014 ◽

Vol 1 (2) ◽

pp. 19

Author(s):

Kapil Sahnan ◽

Chris Pui Yan Yee ◽

Robert Hywel Thomas ◽

Kaji Sritharan

Keyword(s):

Iliac Artery ◽

Common Iliac Artery ◽

Imaging Modality ◽

Lumbar Vertebrae ◽

Kidney Injury ◽

Iliac Vein ◽

Common Iliac Vein ◽

Left Common Iliac Vein ◽

Extrinsic Compression ◽

Duplex Imaging

An elderly lady presented with decreased mobility, sputum production and intermittent confusion. She was treated for chest sepsis, fast atrial fibrillation, and acute kidney injury, and also noted to have a swollen left leg. Venous duplex imaging showed extensive thrombus within the left common iliac, left external iliac and left common femoral veins. A CT Venogram showed compression of the left common iliac vein between an osteophyte at L5 and a calcified ipsilateral common iliac artery. It also showed a pelvic kidney with an extra renal pelvis and large renal cyst which was indirectly contributing to venous compression by splinting the left iliac artery. A decision was made after discussion at the Vascular MDT that the patient was not fit enough for surgery and to manage her medically with anticoagulation. Discussion: Proximal DVT’s are rarer than distal thrombosis, but have similar causes. One of the rarer causes of proximal DVT is May-Thurner syndrome and its variants known collectively as non-thrombotic iliac vein lesions. May-Thurner originally described DVT formation caused by extrinsic compression of the left common iliac vein between the overriding contralateral (right) common iliac artery and adjacent lumbar vertebrae. The best imaging modality is a CT Venogram. Duplex ultrasonography can be used, although it can be difficult to visualize the iliac veins. The mainstay of management is surgical thrombectomy, or thrombolysis, followed by stenting of the affected vessel. However, if intervention is not appropriate, then it can be managed medically with anticoagulation.

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Absence of the Right Common Iliac Vein with the Right Internal Iliac Vein Arising from the Left Common Iliac Vein: Case Report

Cureus ◽

10.7759/cureus.4575 ◽

2019 ◽

Cited By ~ 1

Author(s):

Karishma Mehta ◽

Joe Iwanaga ◽

R. Shane Tubbs

Keyword(s):

Case Report ◽

Iliac Vein ◽

Common Iliac Vein ◽

Left Common Iliac Vein ◽

Internal Iliac Vein ◽

Internal Iliac ◽

The Right

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Percutaneous thrombectomy using a novel single session device for acute iliofemoral deep vein thrombosis

VASA ◽

10.1024/0301-1526/a000928 ◽

2021 ◽

Vol 50 (1) ◽

pp. 74-77

Author(s):

Gerard O’Sullivan

Keyword(s):

Deep Vein Thrombosis ◽

Iliac Vein ◽

Left Thigh ◽

Common Iliac Vein ◽

Single Session ◽

Venous Thrombectomy ◽

Vein Thrombosis ◽

Left Common Iliac Vein ◽

Deep Vein ◽

Percutaneous Thrombectomy

Summary: A 74-year-old woman presented with acute symptomatic left thigh and calf swelling; imaging demonstrated evidence of occlusive thrombosis from the upper left common iliac vein to the mid-thigh. Single session zero-thrombolysis venous thrombectomy was performed using the ReVeneTM Thrombectomy Catheter.

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Clinical correlation of anatomical location of non-thrombotic iliac vein lesion

Vascular ◽

10.1177/1708538116682906 ◽

2016 ◽

Vol 25 (4) ◽

pp. 359-363 ◽

Cited By ~ 5

Author(s):

Afsha Aurshina ◽

Borislav Kheyson ◽

Justin Eisenberg ◽

Anil Hingorani ◽

Arkady Ganelin ◽

...

Keyword(s):

Lower Extremity ◽

Intravascular Ultrasound ◽

Iliac Vein ◽

Clinical Findings ◽

Common Iliac Vein ◽

Anatomical Location ◽

Clinical Correlation ◽

Common Site ◽

External Iliac Vein ◽

Left Lower Extremity

Objective Treatment of non-thrombotic iliac vein lesions is an active area of research. Intravascular ultrasound allows its localization. We chose intravascular ultrasound to clarify the exact anatomical location of non-thrombotic iliac vein lesions and correlate it with clinical findings. Materials and methods Over seven months, we performed ilio-femoral intravascular ultrasound studies on 217 patients, in 141 women and 76 men. The average age ± standard deviation was 68 ± 14 years. We used intravascular ultrasound intraoperatively to measure the ilio-femoral veins and compared it with adjacent non-stenotic ilio-femoral veins. If more than 50% area or diameter reduction was found, it was treated with appropriate balloon and stent. Results We identified 244 lesions, 124 in left lower extremity and 120 in the right lower extremity. The most common site was the proximal common iliac vein 38.7% (22.5% females and 16.12% males) in left lower extremity and middle external iliac vein 29.16% (18.33% females and 10.83% males) in right lower extremity. The least common site was the distal external iliac vein in 3.2% (all 3.2% females) and the distal external iliac vein 7.5% (5% females and 2.5% males) in right lower extremity. Clinical correlation was noted between laterality and location of the NIVL lesion ( p < 0.0001). Conclusion This analysis gives an insight into understanding the exact anatomical locations of the non-thrombotic iliac vein lesions helping clinicians and researchers guide their treatment and research.

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A RARE CASE OF MAY- THURNER SYNDROME

10.36106/gjra/8100743 ◽

2021 ◽

pp. 17-19

Author(s):

B. Santhi ◽

Manigandan Manigandan ◽

Nishok Nishok

Keyword(s):

Iliac Artery ◽

Lower Limb ◽

Rare Case ◽

Common Iliac Artery ◽

Iliac Vein ◽

Common Iliac Vein ◽

Middle Aged ◽

Unique Case ◽

Left Common Iliac Vein ◽

Left Lower Limb

May-Thurner syndrome (MTS) is a venous outow obstruction disorder characterized by compression of the left common iliac vein by an overriding right common iliac artery. MTS primarily affects young to middle-aged women, although many patients remain entirely asymptomatic.We report a unique case of a 25 -year-old male who presented with MTS-related multiple varicosities in left lower limb.

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Abstract No. 592 Two steps forward, one step back: development of contralateral DVT following left common iliac vein stenting

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2018.12.673 ◽

2019 ◽

Vol 30 (3) ◽

pp. S255

Author(s):

T. Khaddash ◽

C. Malone ◽

S. Connolly ◽

J. Giardina ◽

O. Akinwande ◽

...

Keyword(s):

Iliac Vein ◽

Common Iliac Vein ◽

Left Common Iliac Vein ◽

One Step

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May-Thurner Syndrome with Large Abdominal Varicosity, Treated Successfully Using Multiple Approaches

Case Reports in Vascular Medicine ◽

10.1155/2019/7079307 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Lori Jia ◽

Jason Alexander ◽

Nedaa Skeik

Keyword(s):

Vena Cava ◽

Iliac Vein ◽

Postthrombotic Syndrome ◽

Common Iliac Vein ◽

Filter Placement ◽

Vein Thrombosis ◽

Left Common Iliac Vein ◽

Venous Outflow Obstruction ◽

Angioplasty And Stenting ◽

Deep Vein

May-Thurner syndrome (MTS) is a venous outflow obstruction disorder characterized by compression of the left common iliac vein by an overriding right common iliac artery. MTS primarily affects young to middle-aged women, although many patients remain entirely asymptomatic. Anatomic variations of MTS, while uncommon, have been described. Treatment usually involves endovascular management, including thrombolysis and/or thrombectomy with or without inferior vena cava filter placement, followed by angioplasty and stenting of the left common iliac vein. We report a unique case of a 31-year-old woman who presented with MTS-related deep vein thrombosis accompanied by symptomatic abdominal and pelvic varicosities. The varicosities were treated successfully using multiple procedures, resulting in complete resolution of all symptoms. Our case discusses a treatment approach for an unusual presentation of MTS-related postthrombotic syndrome, and provides a brief literature review of MTS complications and management.

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