May–Thurner Syndrome: Update and Review

Extensive Lower-Extremity Deep Venous Thrombosis Following Arthroscopic Anterior Cruciate Ligament Reconstruction Related to May-Thurner Syndrome

“…Imaging of the external iliac and common iliac vasculature with venous duplex ultrasound can be limited in obese patients and patients with extensive bowel gases and is dependent on ultrasonographer experience 6 . Consequently, intravascular ultrasound at the time of intervention is the best modality with which to visualize the morphology and degree of stenosis 6 .…”

“…Patients must be transitioned to therapeutic warfarin for a minimum of six months and often require lifelong aspirin treatment for stent patency. In addition, a hematological evaluation should be recommended for the assessment of a hypercoagulable condition 6 . Overall, stent patency rates have been reported to exceed 90% at one year of follow-up 6,18 .…”

“…The prevalence of an anatomic variant characterized by stenosis of the left common iliac vein (>50% diameter reduction) was recently reported to be 24% in a cohort of asymptomatic patients who were evaluated with computed tomographic imaging 8 . Additional reports of compression of the right iliac vasculature have been further described in the literature 6,9 . We describe the case of a patient with an extensive iliofemoralpopliteal DVT caused by May-Thurner syndrome that followed arthroscopic ACL reconstruction.…”

“…MayThurner syndrome is an anatomic condition of venous outflow obstruction caused by chronic endothelial changes due to pulsations of the right common iliac artery crossing over the left common iliac vein and compressing the common iliac vein against the lumbar vertebrae. Patients are predisposed to developing extensive left lower-extremity DVTs because of a focal stenosis in the left common iliac vein 6 . This syndrome was first described by May and Thurner as they identified intraluminal venous changes in the common iliac veins that directly correlated with extensive DVTs of the left lower extremity in 22% of 430 cadaveric dissections 7 .…”

May-Thurner Syndrome, the Role of Endovascular Intervention with Review of Published Treatment and Follow up Strategies

“…The mainstay of treatment of proximal iliofemoral obstruction in acutely symptomatic patients, is catheter directed thrombolysis plus angioplasty [7]. Embolic event has been previously reported in MTS [8].…”