Iliac vein compression syndrome: literature review

Abstract

Iliac vein compression syndrome is a clinical condition in which the right common iliac artery extrinsically compresses the left common iliac vein. The syndrome predominantly affects young women between their 2nd and 4th decades of life. In view of the syndrome's potential complications, it should be recognized/diagnosed and treated in symptomatic patients before it causes irreversible damage to patients' venous systems. Noninvasive methods, such as venous color Doppler US are reasonable screening methods, but angiotomography and magnetic resonance angiography are more reliable diagnostic tools and the method of choice for confirmation of diagnosis remains multi-plane phlebography with measurement of pressure gradients. Endovascular treatment (angioplasty with placement of self-expanding stents) is safe and effective and can replace open surgical reconstruction and/or anticoagulation alone.

Endovascular treatment of deep venous thrombosis related to May-Thurner syndrome

“…Entretanto, é necessário considerar a possibilidade da variante anatômica relacionada ao cruzamento entre a veia ilíaca comum esquerda e a artéria ilíaca comum direita, que caracteriza a síndrome de May-Thurner. Essa síndrome está presente entre 18 a 49% das pessoas com TVP, 13,14 o que pode ter como consequência evitar a ocorrência de 1:6 casos de tromboembolismo. 15,16 Pode-se, portanto, questionar a profilaxia medicamentosa para TVP em paciente com diagnóstico de síndrome May-Thurner.…”

“…[3][4][5][6][7][8][9][10][11][12] Acredita-se que a artéria ilíaca comum direita, sobrejacente à veia ilíaca comum esquerda, pode promover sua obstrução por intermédio da compressão mecânica determinada pela própria artéria e a vértebra localizada posteriormente (Figura 1); ou pela hipertrofia intimal extensa venosa, resultante de repetitivas compressões da pulsatilidade arterial sobrejacente, e o desencadeamento consequente de algum grau de cisalhamento entre as paredes venosas anterior e posterior. 13 Figura 1 -representação gráfica da compressão da artéria iliaca direita sobre a veia iliaca esquerda. Desenho feito pelos autores do artigo Este relato apresenta paciente feminino, na quarta década de vida com TVP em membro inferior esquerdo, aparentemente, sem fatores de risco associados, em que se observaram alterações anatomofuncionais da síndrome de May-Thurner.…”

The Importance of Diagnosis and Treatment of May-Thurner and Pelvic Congestion Syndromes Before Complications, in Patients with Thrombophilia

“…May-Thurner syndrome (MTS), initially observed in 1851 by Virchow as an anatomical variation of the left common iliac vein, had its pathophysiology described by May and Thurner in 1956, which also detailed anatomical description of this compression. In 1965, Cockett and Thomas supplemented the work of May and Thurner correlating with the observed symptoms, evidencing how a small change can cause such an important injury [1][2][3]. The syndrome is characterized by an anatomical anomaly that results in compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA), although cases of right vein compression have already been reported [3].…”

“…In 1965, Cockett and Thomas supplemented the work of May and Thurner correlating with the observed symptoms, evidencing how a small change can cause such an important injury [1][2][3]. The syndrome is characterized by an anatomical anomaly that results in compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA), although cases of right vein compression have already been reported [3]. It is also known as Cockett Syndrome, iliac vein compression syndrome and iliocaval compression syndrome [3].…”

“…The syndrome is characterized by an anatomical anomaly that results in compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA), although cases of right vein compression have already been reported [3]. It is also known as Cockett Syndrome, iliac vein compression syndrome and iliocaval compression syndrome [3]. LCIV is partially compressed between the RCIA and the fifth lumbar vertebra, and because of the stress arising from the pulsation of the artery, the intima layer of the vein undergoes a hypertrophy with consequent development of Deep Vein Thrombosis (DVT) [1,3].…”