What is pathological May–Thurner syndrome?

Hameed, Maira; Onida, Sarah; Davies, Alun H.

doi:10.1177/0268355516680458

Cited by 12 publications

(9 citation statements)

References 11 publications

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“…Especially, the definition of MTS may alter the decision to perform a deep venous intervention. 28 In our centre, treatment is based on a combination of DUS, MRV and phlebography showing a compression of >50% and apparent collaterals. Other countries may use an intravascular ultrasound to plan their treatment decisions.…”

Section: Discussionmentioning

confidence: 99%

A randomised controlled trial comparing venous stenting with conservative treatment in patients with deep venous obstruction: research protocol

Vuuren¹,

Laanen

Geus³

et al. 2017

BMJ Open

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IntroductionDeep venous obstruction (DVO) has a great impact on quality of life (QoL) comparable to angina pectoris or chronic pulmonary disease. Post-thrombotic scar formation and May-Thurner syndrome (MTS) are the most common causes of DVO. Conventional treatment of DVO focuses on reducing pain or leg swelling by use of (pain) medication and therapeutic elastic stockings. In the past, a venous bypass was offered in severe post-thrombotic cases, but this procedure showed bad clinical and patency outcomes. With the introduction of percutaneous angioplasty and dedicated venous stents new opportunities were created. Deep venous stenting has been shown to be effective in retrospective case series. However, there is no prior research in which QoL after interventional treatment is compared with QoL after conventional treatment. Currently, there is a debate about the true additional value of interventional treatment. We investigate whether those patients who are treated with stenting experience a change in short form 36 (SF-36) and the Veines-QoL/Sym questionnaires compared with conventionally treated patients.Methods and analysisThis is a randomised trial comparing conservative deep venous management to interventional treatment. A total of 130 patients with post-thrombotic syndrome (PTS) or MTS, eligible for interventional percutaneous treatment, who did not have previous deep venous intervention will be included. Patients will be randomised to conservative treatment or venous stenting and stratified for the PTS or MTS subgroup. Conservative treatment consists of either one or a combination of pain medications, manual lymphatic drainage, compression stockings and regular post-thrombotic anticoagulant therapy.The primary outcome is the QoL change after 12 months compared with baseline QoL. Secondary outcomes are QoL changes at 6 weeks, clinical assessment of DVO, recurrence rate of deep venous thrombosis at 6 weeks and 12 months, and the total amount of working days lost. Intervention-specific outcomes include complications and patency.Ethics and disseminationThe protocol is approved by the Medical Ethics Committee of Academisch ziekenhuis Maastricht/Universiteit Maastricht, The Netherlands (protocol number NLNL55641.068.15 / METC 161008).We aim to publish the results of this study in a peer reviewed journal and present our findings at national or international conferences.Trial registration numberThe study protocol was registered at www.clinicaltrials.gov (registration number: NCT03026049) on 17 January 2017.

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Section: Discussionmentioning

confidence: 99%

A randomised controlled trial comparing venous stenting with conservative treatment in patients with deep venous obstruction: research protocol

Vuuren¹,

Laanen

Geus³

et al. 2017

BMJ Open

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“…Knowing that asymptomatic subjects with MT anatomy do not required treatment the diagnostic approach must be meticulous in order to avoid overtreatment. 96 Since the early 2000’s some authors have emphasized this difference.…”

Section: Diagnostic Assessment and Risk Of Overtreatmentmentioning

confidence: 99%

May Thurner syndrome: Sixty years later

et al. 2021

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May-Thurner syndrome (MTS) was described sixty years ago. Once ignored for several years, it is currently a recognized pathology in the vascular surgery community; but not long ago due to several factors, it was underdiagnosed and sub-optimally treated. In the last 20 years, with renewed interest in venous pathology, technical imaging advances and the recent interventional procedures, it has become a better known disease. On the other hand, nowadays the easiness in diagnosis and treatment of the syndrome has lead to overtreatment of such patients. In this article, we do a historical review and describe the significant advances and current management of May-Thurner syndrome.

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“…This potentially may lead to MTS becoming a myth as justifiably the question is asked to define a pathological MTS [8].…”

Section: Introductionmentioning

confidence: 99%

The Myth of May Thurner

Toonder

2020

Phlebologie

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Less invasive contemporary endovenous techniques with improved stents have made treatment of the May Thurner Syndrome(MTS) more accessible and safer. However, clear criteria for the accurate diagnosis remain obscure. All imaging modalities are performed with patients in a supine position were compression of the left Common Iliac Vein is seen in both asymptomatic and symptomatic patients. There is no clear threshold value. There are no validated hemodynamic criteria. This leads to the necessity of additional information such as measurements performed in an upright position as well as greater scrutiny in detecting fibrous wall thickening and spurs as well as identifying the presence of venous collaterals. Moreover, those contemplating treating MTS should not only identify specific symptoms, but also should consider that patient complaints may be related to a more complex presentation of pelvic congestion.

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What is pathological May–Thurner syndrome?

Cited by 12 publications

References 11 publications

A randomised controlled trial comparing venous stenting with conservative treatment in patients with deep venous obstruction: research protocol

A randomised controlled trial comparing venous stenting with conservative treatment in patients with deep venous obstruction: research protocol

May Thurner syndrome: Sixty years later

The Myth of May Thurner

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