May‐Thurner Syndrome – Diagnostic and therapeutic dilemmas (RCD code: I‐1D.2)
May‐Thurner Syndrome is a rare vascular disease in which the right common iliac artery compresses the left common iliac vein. It occurs 5 times more often in women than in men, usually in their 20s and 40s. Patients suffer from deep vein thrombosis, post‐thrombotic syndrome, and pulmonary embolism. They usually present with swelling of the left leg, chronic leg pain, skin colour changes, tingling and/or numbness of the affected limb, varicosities, phlebitis, and venous stasis ulcers. Available diagnostic tests include venous duplex
ultrasound, computed tomography, magnetic resonance imaging, venography, and intravascular ultrasound. Endovascular therapy, including angioplasty, stenting, and catheter‐directed thrombolysis is the current mainstay of treatment. Long‐term anticoagulation and elastic compression stockings are used to prevent recurrent blood clot formation and decrease the risk of post‐thrombotic syndrome.
Thrombophilia screening is essential, as it would aid in the decision‐making process regarding continuation of anticoagulant therapy. We present the case of a 38‐year‐old woman in her fourth pregnancy, presenting with persistent left leg oedema and recurrent deep vein thrombosis, eventually diagnosed with May‐Thurner Syndrome. JRCD 2018; 4 (1): 22-25.
Duran C, Rohatgi S, Wake N, et al. May‐Thurner syndrome: a case report. Eurasian J Med 2011; 43:129–131.
Liddell RP, Evans NS. May‐Thurner Syndrome. Vasc Med 2018; 23: 493–496.
Al‐Nouri O, Milner R. May‐Thurner Syndrome. Vascular Disease managements. 2011; 8 (3).
McKean D, Allman Sutcliffe J, El Hassan H, et al. May‐Thurner variant secondary to degenerative lumbag spondylolisthesis: a case report. BJR Case Rep 2017; 3: 20 170 011.
Moudgill N, Hager E, Gonsalves C, et al. May‐Thurner syndrome: case report and review of the literature involving modern endovascular therapy. Vascular 2009;17:330–335.
O’Sullivan GJ, Semba CP, Bittner CA, et al. Endovascular management of iliac vein compression (May‐Thurner) syndrome. J Vasc Interv Radiol 2000; 11: 823–836.
Eijgenraam P, ten Cate H,tenCate‐Hoek AJ. Venous stenting after deep venous thrombosis and antithrombotic therapy: A systematic review. Reviews in Vascular Medicine 2014; 2: 88–97.
Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence‐Based Clinical Practice Guidelines. Chest 2012; 141: 419–496.
Milinis K, Thapar A, Shalhoub J, et al. Antithrombotic Therapy Following Venous Stenting: International Delphi Consensus. Eur J Vasc Endovasc Surg 2018; 55: 537–544.
McBane RD 2nd, Leadley RJ Jr, Baxi SM, et al. Iliac venous stenting: antithrombotic efficacy of PD0 348 292, an oral direct Factor Xa inhibitor, compared with antiplatelet agents in pigs. Arterioscler Thromb Vasc Biol 2008; 28: 413–418.
Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 26: 338–400.
Baekgaard N, Fanelli F, O’Sullivan GJ. New horizons in deep venous disease managment. Edizioni Minerva Medica, 1st edition, Turin 2017.
Windyga J, Pasierski T, Torbicki A. Zakrzepy i zatory. Tom 1. Wydawnictwo Lekarskie PZWL, Warszawa 2014.
- There are currently no refbacks.