May-Thurner Syndrome


May-Thurner Syndrome is an anatomical compression of the left iliac vein by the right iliac artery which crosses over it.


  • The anatomy is normal but in some people the compression can cause a stenotic obstruction and lead to the thrombosis of the iliac vein.
  • The resultant deep vein thrombosis (DVT) can result in venous hypertension, valvular damage, skin ulceration and post-thrombotic syndrome (PTS).


    • Typical treatment is endovascular thrombus removal followed by percutaneous transluminal angioplasty and/or stenting to maintain vessel patency.

    Endovascular Management of Iliac Vein Compression (May-Thurner) Syndrome

     

    Compression of the left iliac vein by the artery is thought to be a contributing factor to development of DVT. Fifty to sixty percent of patients presenting with left leg DVT will have intraluminal webs due to vein compression. May-Thurner or iliac vein compression syndrome (IVCS) is now more readily identified as today’s thrombolysis techniques can reveal the underlying stenosis. A retrospective analysis of 39 patients with documented left iliac vein thrombosis was undertaken to determine the safety and clinical success of endovascular treatment of IVCS.

     

    Nineteen of the patients had acute iliofemoral thrombosis, the remaining 20 had chronic thrombosis. Early in the study, all patients were treated with catheter-directed thrombolysis (CDT); later in the study, only acute patients were treated with CDT. CDT was performed overnight, then the patient examined with venography. If complete thrombolysis had been achieved, any underlying stenosis underwent angioplasty and stenting. Partial thrombolysis resulted in repositioning of the catheter and another day of CDT. Patients with no thrombolysis were deemed technical failures.

     

    Patients with acute DVT who were stented had a 93.1% patency rate at one year follow-up. Patients with chronic DVT who were stented had a 93.9% patency rate at one year follow-up. Patients with chronic DVT who underwent thrombolysis prior to stenting had a one year follow-up patency rate of 88.2%. Chronic DVT patients who had angioplasty and stenting without thrombolysis had a one year patency rate of 100%. There were only two major complications, both rethrombosis of the iliac segment in less than 24 hours.

    Reference: O’ Sullivan, JG, Semba, CP, et al. Endovascular Management of Iliac Vein Compression (May-Thurner) Syndrome. J Vasc Interv Radiol 2000; 11: 823-836.