Diagnosis and management of iliac vein thrombosis in pregnancy resulting from May–Thurner Syndrome

DeStephano, C.C.; Werner, Erika F.; Holly, B.; Lessne, Mark L.

doi:10.1038/jp.2014.38

Cited by 32 publications

(19 citation statements)

References 14 publications

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“…6,7 Patients that develop a left-sided DVT in the context of MTS are typically young adults that exhibit sudden swelling of the left lower extremity following surgery, during immobilization, or during pregnancy and/or the postpartum period. 3,6,[8][9][10][11][12] The occurrence of MTS in adolescents has also been documented in various case reports. [13][14][15][16][17][18][19][20][21] While MTS does occur among men, it is more common in females though the reason for this has not yet been completely explained.…”

Section: Overvie W Of May-th Urner Syndome (Mts) Pathophys Iology Amentioning

confidence: 90%

“…Clinical phases of MTS include a prolonged asymptomatic period of left iliac vein compression followed by the gradual development of an intraluminal venous fibrous band (ie, spur), which can subsequently progress to an acute unilateral left iliofemoral DVT that can be accompanied either with or without a pulmonary embolism (PE) . Patients that develop a left‐sided DVT in the context of MTS are typically young adults that exhibit sudden swelling of the left lower extremity following surgery, during immobilization, or during pregnancy and/or the postpartum period . The occurrence of MTS in adolescents has also been documented in various case reports .…”

Section: Overview Of May‐thurner Syndome (Mts) Pathophysiology and CLmentioning

confidence: 99%

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May‐Thurner syndrome: History of understanding and need for defining population prevalence

Harbin

Lutsey

2020

Journal of Thrombosis and Haemostasis

100

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Patients with May‐Thurner syndrome (MTS) are at elevated risk of developing an extensive left iliofemoral deep vein thrombosis (DVT; localized blood clot) due to an anatomical variant where the right common iliac artery compresses the left common iliac vein against the lumbar spine. While MTS was initially presumed to be rare when it was first anatomically defined in 1957, case reports of this syndrome have recently become more frequent, perhaps due to improved imaging techniques allowing for enhanced visualization of the iliac veins. Still, the population burden of this condition is unknown, and there is speculation it may be higher than generally perceived. In the present review, we (a) review history of how MTS became recognized, (b) describe practical challenges of studying MTS in population‐based settings due to the specialized imaging required for diagnosis, (c) discuss why the contribution of MTS to DVT may be underestimated, (d) describe uncertainty regarding the degree of venous compression which leads to DVT, and (e) outline future research needs. Our goal is to raise awareness of MTS and spark additional research into the epidemiology of this condition, which may be an underappreciated causative venous thromboembolism risk factor.

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Section: Overvie W Of May-th Urner Syndome (Mts) Pathophys Iology Amentioning

confidence: 90%

Section: Overview Of May‐thurner Syndome (Mts) Pathophysiology and CLmentioning

confidence: 99%

May‐Thurner syndrome: History of understanding and need for defining population prevalence

Harbin

Lutsey

2020

Journal of Thrombosis and Haemostasis

100

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“…Recently, an important strategy has been to provide endovascular treatment or a combination of endovascular and surgical treatment (5,6). A recent report showed that these treatments decrease the incidence of DVT, known as postthrombotic syndrome (PTS), and venous obstruction compared with systemic anticoagulation (RR =0.19, 95% CI 0.07 to 0.48) (7,8).…”

Section: Discussionmentioning

confidence: 99%

Anticoagulant Therapy in a Pregnant Woman with May-Thurner Syndrome

et al. 2016

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A 39-year-old woman with a 9-week abdominal pregnancy noted pain in her lower abdomen and left leg. Since successive thrombi were observed extending from the left common iliac vein to the popliteal vein along with a thrombus in the left pulmonary artery, we diagnosed her with pulmonary thromboembolism with deep venous thrombosis (DVT). May-Thurner syndrome may have contributed to DVT in the left leg when the left iliac vein was compressed by the right iliac artery. She underwent anticoagulant therapy with heparin, followed by the subcutaneous injection of heparin at home after discharge. We herein report the case of a pregnant woman with May-Thurner syndrome who safely gave birth.

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“…In addition, leukocytes and platelets may be displaced from their central flow streamlines and make a closer contact with an activated endothelium. Moreover, anatomical perturbation of the compression of the left common iliac vein by the gravid uterus leads to vasoconstriction, which could increase the risk of thrombosis during pregnancy (DeStephano et al, ).…”

Section: Venous Thrombosis During Pregnancymentioning

confidence: 99%

Nonclinical aspects of venous thrombosis in pregnancy

Struble

Harrouk

DeFelice

et al. 2015

Birth Defects Research Pt C

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Pregnancy is a hypercoagulable state which carries an excess risk of maternal venous thrombosis. Endothelial injury, alterations in blood flow and activation of the coagulation pathway are proposed to contribute to the hypercoagulability. The risk for thrombosis may be accentuated by certain drugs and device implants that directly or indirectly affect the coagulation pathway. To help ensure that these interventions do not result in adverse maternal or fetal outcomes during pregnancy, gravid experimental animals can be exposed to such treatments at various stages of gestation and over a dosage range that would identify hazards and inform risk assessment. Circulating soluble biomarkers can also be evaluated for enhancing the assessment of any increased risk of venous thrombosis during pregnancy. In addition to traditional in vivo animal testing, efforts are under way to incorporate reliable non-animal methods in the assessment of embryofetal toxicity and thrombogenic effects. This review summarizes hemostatic balance during pregnancy in animal species, embryofetal development, biomarkers of venous thrombosis, and alterations caused by drug-induced venous thrombosis.

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Diagnosis and management of iliac vein thrombosis in pregnancy resulting from May–Thurner Syndrome

Cited by 32 publications

References 14 publications

May‐Thurner syndrome: History of understanding and need for defining population prevalence

May‐Thurner syndrome: History of understanding and need for defining population prevalence

Anticoagulant Therapy in a Pregnant Woman with May-Thurner Syndrome

Nonclinical aspects of venous thrombosis in pregnancy

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