Management of Nonthrombotic May-Thurner Syndrome

2018 ◽  
Author(s):  
Albeir Y Mousa
Keyword(s):  
Lower Extremity ◽  
Management Strategies ◽  
Iliac Vein ◽  
Venous Hypertension ◽  
Venous Stasis ◽  
Venous Outflow ◽  
Vein Thrombosis ◽  
Extrinsic Compression ◽  
Vein Segment ◽  
Venous Segment

Venous outflow pathology of the lower extremity may be categorized into thrombotic or nonthrombotic etiology. This chapter focuses on the nonthrombotic etiology that results from the compression of the left iliac vein or May-Thurner syndrome (MTS). MTS is an anatomic variant condition associated with venous outflow stenosis due to extrinsic compression of the iliocaval venous segment. The most common cause of the partial obstruction is left iliac vein compression by the overlying right common iliac artery, although other anatomic varieties of MTS do exist. Partial or complete impedance to the venous outflow in the iliocaval venous segment may lead to extensive deep vein thrombosis of the ipsilateral extremity. Clinical presentations may include, but are not limited to, pain, extensive lower-extremity swelling, venous stasis ulcers, and skin discolorations. Treatment is based entirely on the clinical presentation; normally for nonthrombotic MTS, angioplasty and stenting of the diseased iliac vein segment are usually sufficient after defining the location and extent of stenosis. In this review, we (1) describe and define MTS, (2) highlight variable presentations of MTS, and (3) outline the possible management strategies within the current Society for Vascular Surgery updated consensus guidelines. This review contains 3 Figures, 2 Videos, 3 Tables and 66 references Key Words: angioplasty, artery compression, deep venous thrombosis, iliac vein, iliofemoral stenosis, May-Thurner syndrome, spur, stent, venogram, venous hypertension

Management of Nonthrombotic May-Thurner Syndrome

2018 ◽  
Author(s):  
Albeir Y Mousa
Keyword(s):  
Lower Extremity ◽  
Management Strategies ◽  
Iliac Vein ◽  
Venous Hypertension ◽  
Venous Stasis ◽  
Venous Outflow ◽  
Vein Thrombosis ◽  
Extrinsic Compression ◽  
Vein Segment ◽  
Venous Segment

Venous outflow pathology of the lower extremity may be categorized into thrombotic or nonthrombotic etiology. This chapter focuses on the nonthrombotic etiology that results from the compression of the left iliac vein or May-Thurner syndrome (MTS). MTS is an anatomic variant condition associated with venous outflow stenosis due to extrinsic compression of the iliocaval venous segment. The most common cause of the partial obstruction is left iliac vein compression by the overlying right common iliac artery, although other anatomic varieties of MTS do exist. Partial or complete impedance to the venous outflow in the iliocaval venous segment may lead to extensive deep vein thrombosis of the ipsilateral extremity. Clinical presentations may include, but are not limited to, pain, extensive lower-extremity swelling, venous stasis ulcers, and skin discolorations. Treatment is based entirely on the clinical presentation; normally for nonthrombotic MTS, angioplasty and stenting of the diseased iliac vein segment are usually sufficient after defining the location and extent of stenosis. In this review, we (1) describe and define MTS, (2) highlight variable presentations of MTS, and (3) outline the possible management strategies within the current Society for Vascular Surgery updated consensus guidelines. This review contains 3 Figures, 2 Videos, 3 Tables and 66 references Key Words: angioplasty, artery compression, deep venous thrombosis, iliac vein, iliofemoral stenosis, May-Thurner syndrome, spur, stent, venogram, venous hypertension

Standards for recanalisation of chronic venous outflow obstructions

VASA ◽  
2018 ◽  
Vol 47 (4) ◽  
pp. 259-266 ◽  
Author(s):  
Michael Lichtenberg ◽  
Rick de Graaf ◽  
Christian Erbel
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Symptoms ◽  
Vena Cava ◽  
Iliac Vein ◽  
Venous Hypertension ◽  
Postthrombotic Syndrome ◽  
Venous Outflow ◽  
Vein Thrombosis ◽  
Technical Developments ◽  
Deep Vein

Abstract. Postthrombotic syndrome (PTS) is the most common complication after iliofemoral deep vein thrombosis. It reduces quality of life and increases deep vein thrombosis (DVT)-related costs. The clinical symptoms and severity of PTS may vary; the most common symptoms include edema, pain (venous claudication), hyperpigmentation, lipodermatosclerosis, and ulceration. PTS is based on the principle of outflow obstruction, which may be caused by venous hypertension and may lead to valvular damage and venous reflux or insufficiency. Recent technical developments and new stent techniques now allow recanalisation of even complex venous outflow obstructions within the iliac vein and the inferior vena cava. This manuscript gives an overview on the latest standards for venous recanalisation.

scholarly journals External iliac vein compression and lower-extremity swelling caused by an iliopectineal ganglion: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Kiyokazu Fukui ◽  
Ayumi Kaneuji ◽  
Norio Kawahara
Keyword(s):  
Lower Extremity ◽  
Femoral Vein ◽  
Signs And Symptoms ◽  
Iliac Vein ◽  
Needle Aspiration ◽  
Case Presentation ◽  
Vein Thrombosis ◽  
External Iliac Vein ◽  
Iliac Vein Compression ◽  
Deep Vein

Abstract Background A hip joint ganglion is a rare cause of lower-extremity swelling. Case presentation We report a case of a Japanese patient with ganglion of the hip with compression of the external iliac/femoral vein that produced signs and symptoms mimicking those of deep vein thrombosis. Conclusions Needle aspiration of the ganglion was performed, and swelling of the lower extremity promptly decreased. At 7.5 years after aspiration, there was no recurrence of swelling of the leg. Although the recurrence rate for ganglions after needle aspiration is high, it is worthwhile trying aspiration first.

Iliocaval Compression Syndrome

1987 ◽  
Vol 2 (3) ◽  
pp. 173-179 ◽  
Author(s):  
Syde A. Taheri ◽  
Paul Nowakowski ◽  
David Pendergast ◽  
Julie Cullen ◽  
Steve Pisano ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Common Iliac Artery ◽  
Vena Cava ◽  
Signs And Symptoms ◽  
Iliac Vein ◽  
Venous Hypertension ◽  
Common Iliac Vein ◽  
Compression Syndrome ◽  
Extrinsic Compression ◽  
The Right

The iliocaval compression syndrome is a disorder, frequently found in young women, in which extrinsic compression of the left iliocaval junction produces signs and symptoms of lower extremity venous insufficiency. The anatomic variant which gives rise to this syndrome consists of compression of the left common iliac vein by the overlying right common iliac artery, near its junction with the vena cava. Additional reduction of outflow results from intraluminal venous webs and tight adhesions between the iliac artery and vein. Pain, swelling, pigmentation, and venous claudication characterize this syndrome, which affects predominantly the left leg. The syndrome may progress to iliofemoral thrombosis, phlegmasia cerulea dolens, and venous gangrene. Longstanding iliocaval stenosis may produce valvular incompetence. Exercise plethysmography is a non-invasive test useful in screening patients for iliocaval compression. The definitive diagnosis is made by venography, both ascending and descending, to determine the degree of outflow stenosis. Iliocaval patch angioplasty with retrocaval positioning of the right iliac artery, decreases venous hypertension and leads to improvement in the clinical condition. To date, we have performed iliocaval angioplasty, with retrocaval repositioning of the right common iliac artery, on 18 patients. Of these, 83% have had good results as determined by hemodynamic and clinical assessment.

Successful treatment of a spontaneous rupture of the left external iliac vein in a man

Vascular ◽  
2013 ◽  
Vol 22 (1) ◽  
pp. 68-70 ◽  
Author(s):  
Nirvana Sadaghianloo ◽  
Elixène Jean-Baptiste ◽  
Pierre Haudebourg ◽  
Serge Declemy ◽  
Aurélien Mousnier ◽  
...  
Keyword(s):  
Successful Treatment ◽  
Spontaneous Rupture ◽  
Iliac Vein ◽  
Venous Hypertension ◽  
Vein Thrombosis ◽  
External Iliac Vein ◽  
Iliac Vein Thrombosis ◽  
Emergent Laparotomy ◽  
Longitudinal Tear ◽  
Venous Wall

Spontaneous rupture of the external iliac vein associated with a May–Thurner syndrome is infrequent, particularly in men. We report a case of previously healthy 73-year-old man with a left iliac vein thrombosis, who presented a large lower left abdominal hematoma of sudden-unset. Emergent laparotomy revealed a 3-cm longitudinal tear in the left external iliac vein, which was repaired primarily. Patient's recovery was uneventful. Possible etiological factors have been identified as venous hypertension due to iliac vein thrombosis associated with Cockett syndrome, as well as inflammatory venous wall. Some other estrogenic factors could explain female preponderance of the event.

Treatment of Nonthrombotic Iliac Vein Lesions

2021 ◽  
Vol 38 (02) ◽  
pp. 155-159
Author(s):  
Maria Joh ◽  
Kush R. Desai
Keyword(s):  
Stent Placement ◽  
Duplex Ultrasound ◽  
Iliac Vein ◽  
Venous Stasis ◽  
Venous Disease ◽  
Stent Patency ◽  
Extrinsic Compression ◽  
Low Incidence ◽  
Primary Modality

AbstractNonthrombotic iliac vein lesions (NIVLs) most frequently result from extrinsic compression of various segments of the common or external iliac vein. Patients develop symptoms associated with chronic venous insufficiency (CVI); female patients may develop symptoms of pelvic venous disease. Given that iliac vein compression can be clinically silent, a thorough history and physical examination is mandatory to exclude other causes of a patient's symptoms. Venous duplex ultrasound, insufficiency examinations, and axial imaging are most commonly used to assess for the presence of a NIVL. Catheter venography and intravascular ultrasound (IVUS) are the mainstay for invasive assessment of NIVLs and planning prior to stent placement. IVUS in particular has become the primary modality by which NIVLs are evaluated; recent evidence has clarified the lesion threshold for stent placement, which is indicated in patients with moderate to severe symptoms. In appropriately selected patients, stent placement results in improved pain, swelling, quality of life, and, when present, healing of venous stasis ulcers. Stent patency is well preserved in the majority of cases, with a low incidence of clinically driven need for reintervention. In this article, we will discuss the clinical features, workup, endovascular management, and treatment outcomes of NIVL.

Prevention and treatment of deep-vein thrombosis

1972 ◽  
Vol 10 (6) ◽  
pp. 21-24
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Signs ◽  
Iliac Vein ◽  
Venous Hypertension ◽  
Tissue Necrosis ◽  
Vein Thrombosis ◽  
Perforating Veins ◽  
Prevention And Treatment ◽  
Deep Vein ◽  
Deep Vein Thromboses

Venous thrombosis and pulmonary embolism are serious hazards after operations and trauma, in childbirth, and in a variety of medical conditions including cardiac failure and infarction. Almost half the patients have no clinical signs or symptoms of the thrombosis itself, and fatal pulmonary embolism may occur without warning.1 Pulmonary embolism occurs in almost 50% of patients with thrombosis of a popliteal, femoral or iliac vein; it is less common and rarely of clinical significance if only the calf veins are involved,2–4 and this is so in 85% of all deep-vein thromboses.5 Most deep veins recanalise after thrombosis, but often the valves in the main veins and ankle-perforating veins are left incompetent, leading to the post-phlebitic syndrome of venous hypertension, capillary dilatation, swelling and eventually tissue necrosis with ulceration.6

Venous Compression Syndromes

2017 ◽  
Vol 51 (3) ◽  
pp. 155-168 ◽  
Author(s):  
Joseph M. White ◽  
Anthony J. Comerota
Keyword(s):  
Left Renal Vein ◽  
Iliac Vein ◽  
Venous Hypertension ◽  
Diagnostic Methods ◽  
Common Iliac Vein ◽  
Management Options ◽  
Venous Compression ◽  
Extrinsic Compression ◽  
Venous Compression Syndromes ◽  
Compression Syndromes

Venous compression syndromes occur due to extrinsic compression causing complications of venous hypertension or venous thrombosis. This review focuses on 4 venous compression syndromes involving the left common iliac vein, subclavian vein, left renal vein, and popliteal vein. Clinical presentation, diagnostic methods, and management options are reviewed. When properly diagnosed and treated, long-term consequences can be avoided.

scholarly journals Sonography’s Role in the Diagnosis of May–Thurner Syndrome

2017 ◽  
Vol 34 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Ashley Barry
Keyword(s):  
Lower Extremity ◽  
Iliac Vein ◽  
Postthrombotic Syndrome ◽  
Venous Disease ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Anatomic Variant ◽  
Left Lower Extremity ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome

May–Thurner syndrome (MTS), also known as Cockett syndrome or iliac vein compression syndrome, is a condition in which patients develop swelling, deep vein thrombosis (DVT), venous insufficiency, and other symptoms of the left lower extremity due to an anatomic variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. Although it is an uncommonly diagnosed condition, it is estimated to compose up to half of cases of left lower extremity venous disease. Although having some degree of iliac vein compression is considered a normal anatomic variant in an asymptomatic patient, those who experience severe swelling, venous reflux, and DVT often have anatomically abnormal veins with a spur formation. With proper technique and proficiency, transabdominal sonography can be used as a valuable diagnostic tool in the discovery and to facilitate treatment of May–Thurner syndrome. Diagnostic ultrasound also can monitor the development of recurring DVT and identify symptoms of postthrombotic syndrome.

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