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May-Thurner Syndrome


Presentation

  • Women presented at a younger age compared with men (38.7 14.0 years vs 46.2 16.9 years; P .02).[ncbi.nlm.nih.gov]
  • Six patients presented with acute deep vein thrombosis and one presented with chronic venous insufficiency.[ncbi.nlm.nih.gov]
  • Spontaneous iliac vein rupture resulting in a retroperitoneal hematoma is extremely rare and can present as a life-threatening emergency. There is often a delay in diagnosis with no established treatment recommendations.[ncbi.nlm.nih.gov]
  • The most common clinical presentation is left lower extremity deep vein thrombosis. Rarely, a patient with IVCS can present with obstruction of venous outflow, without deep vein thrombosis.[ncbi.nlm.nih.gov]
  • MTS is estimated to be present in 2% to 5% of patients undergoing evaluation for lower extremity venous disorders.[ncbi.nlm.nih.gov]
Leg Edema
  • RESULTS: Of the 63 patients evaluated, 32 (51%) had nonthrombotic MTS and presented with leg edema (100%) or venous claudication (47%).[ncbi.nlm.nih.gov]
  • Abstract May-Thurner syndrome is an uncommon process in which the right common iliac artery compresses the left common iliac vein, resulting in left iliofemoral deep vein thrombosis and severe leg edema.[ncbi.nlm.nih.gov]
  • edema, thigh discomfort, and deep venous thrombosis.[ncbi.nlm.nih.gov]
  • The authors experienced a rare case of abrupt leg edema with DVT-like symptoms due to iliac vein compression by an overdistended bladder that had developed after cerebrovascular stroke.[ncbi.nlm.nih.gov]
  • Unilateral left leg edema: a variation of the May-Thurner syndrome. Cardiovasc Intervent Radiol. 1987;10:89–91. PubMed CrossRef Google Scholar 2. Steinberg JB, Jacocks MA. May-Thurner syndrome: a previously unreported variant.[link.springer.com]
Venous Insufficiency of Leg
  • Symptoms of venous insufficiency include: leg pain skin discoloration leg swelling leg ulcers May-Thurner syndrome is caused by the right iliac artery being on top of and putting pressure on the left iliac vein in your pelvis.[healthline.com]
Oral Ulcers
  • In the interim, he had been diagnosed with Behcet's disease by a rheumatologist who was consulted due to oral ulcers and skin lesions and accordingly started on prednisone, colchicine, and azathioprine.[ncbi.nlm.nih.gov]
Calf Pain
Skin Lesion
  • In the interim, he had been diagnosed with Behcet's disease by a rheumatologist who was consulted due to oral ulcers and skin lesions and accordingly started on prednisone, colchicine, and azathioprine.[ncbi.nlm.nih.gov]

Workup

  • We review the differential diagnosis, diagnostic workup, and initial ED management of deep venous thrombosis and provide a brief discussion of May-Thurner syndrome and the association of isotretinoin and vascular thrombi.[ncbi.nlm.nih.gov]
  • Follow-up laboratory workup revealed that subtherapeutic azathioprine dosing, and after appropriate adjustment, the patient has been asymptomatic for 12 months.[ncbi.nlm.nih.gov]
  • On further workup, she was diagnosed with May-Thurner syndrome and underwent left common iliac and left external iliac vein stenting.[ncbi.nlm.nih.gov]
  • Figure 5: Follow up ultrasound at 2 weeks with patent stent (arrow) within the left EIV extending into the CIV and normal phasic flow (arrowhead) A hypercoagulability workup, including Factor V Leiden, Antithrombin III, homocysteine and prothrombin gene[elynsgroup.com]
  • Subsequent workup for hypercoagulability, including tests for protein C, protein S, antithrombin III, anticardiolipin antibodies, and factor-V Leiden, were negative.[ispub.com]

Treatment

  • Endovascular treatment is a safe and effective treatment of MTS.[ncbi.nlm.nih.gov]
  • Treatment modalities included endovascular interventions without thrombolysis (53%) or with thrombolysis (33.2%), open surgery (6.8%), and medical management (7%). Endovascular treatment was more common than surgical or medical treatment (P .001).[ncbi.nlm.nih.gov]
  • As anticoagulation alone is ineffective for DVT treatment in the setting of May-Thurner anatomy, more aggressive treatment is warranted.[ncbi.nlm.nih.gov]
  • Endovascular therapy is the current mainstay of treatment for May-Thurner syndrome. Review of the current literature supports treatment via catheter-directed thrombolysis followed by stent placement with good early results.[ncbi.nlm.nih.gov]
  • There is often a delay in diagnosis with no established treatment recommendations.[ncbi.nlm.nih.gov]

Prognosis

  • Treatment and prognosis Because of the high prevalence of asymptomatic iliac vein compression, follow up is not necessary unless the patient is symptomatic from the process.[radiopaedia.org]
  • The prognosis for patients with May-Thurner syndrome is usually good, particularly if the syndrome is diagnosed and treated in its early stages.[minimallyinvasivevascularcenters.com]

Etiology

  • Abstract BACKGROUND The etiology of deep venous thrombosis (DVT) may pose a significant diagnostic challenge because truly reversible causes of DVT are rare.[ncbi.nlm.nih.gov]
  • […] vascular diseases/therapy/ultrasonography; thrombosis/therapy; treatment outcome; venous thrombosis/diagnosis/etiology/therapy[ncbi.nlm.nih.gov]
  • BACKGROUND: May-Thurner syndrome (MTS) has a different etiology from that of general deep vein thrombosis (DVT). However, few clinical comparisons of MTS-induced and non-MTS-induced DVT have been reported.[ncbi.nlm.nih.gov]
  • We describe a case of iliac vein compression (May-Thurner) syndrome and review its etiology, diagnosis, significance, and treatment.[ncbi.nlm.nih.gov]
  • Outcome measures included presenting Clinical, Etiology, Anatomy, Pathophysiology (CEAP) score, postintervention CEAP score, primary patency, and secondary patency.[ncbi.nlm.nih.gov]

Epidemiology

  • KEYWORDS: Combined modality therapy; constriction, pathologic/complications/diagnosis/epidemiology/therapy; edema/etiology/pathophysiology; iliac vein/pathology/ultrasonography; lower extremity/blood supply; magnetic resonance angiography; peripheral[ncbi.nlm.nih.gov]
  • Epidemiology [ edit ] May-Thurner syndrome (MTS) is thought to represent between two and five percent of lower-extremity venous disorders. [ medical citation needed ] May-Thurner syndrome is often unrecognized; however, current estimates are that this[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • The current pictorial essay will review the pathophysiology, imaging, and treatment of MTS. KEYWORDS: Computed tomography; Deep vein thrombosis; Iliac vein compression syndrome; May–Thurner syndrome[ncbi.nlm.nih.gov]
  • KEYWORDS: Combined modality therapy; constriction, pathologic/complications/diagnosis/epidemiology/therapy; edema/etiology/pathophysiology; iliac vein/pathology/ultrasonography; lower extremity/blood supply; magnetic resonance angiography; peripheral[ncbi.nlm.nih.gov]
  • The positive correlation between anatomical and hemodynamic properties corresponds with the underlying pathophysiology. Copyright 2013. Published by Elsevier B.V.[ncbi.nlm.nih.gov]
  • Outcome measures included presenting Clinical, Etiology, Anatomy, Pathophysiology (CEAP) score, postintervention CEAP score, primary patency, and secondary patency.[ncbi.nlm.nih.gov]
  • ANATOMY AND PATHOPHYSIOLOGY Iliac vein compression was first described in the 19th century by Virchow.[mhmedical.com]

Prevention

  • Early recognition of May-Thurner could prevent a DVT and provide symptomatic relief.[ncbi.nlm.nih.gov]
  • While anticoagulation remains the mainstay treatment of acute DVT, catheter-directed thrombolysis combined with stenting provides a safe and effective method for relieving acute symptoms and preventing postthrombotic syndrome in patients with MTS.[ncbi.nlm.nih.gov]
  • Compression socks help to manage and prevent a variety of ailments, including varicose veins, swelling, fatigue, lymphedema, diabetes, DVT, Dysautonomia and much more.[brightlifego.com]
  • An active early diagnostic approach can prevent significant overall morbidity and help patients to ease back into their daily-life activities.[ncbi.nlm.nih.gov]
  • Prevention of May-Thurner Syndrome There is no way to prevent May-Thurner syndrome as it is simply a consequence of anatomy. Am I At Risk? May-Thurner syndrome develops as a consequence of anatomy. Pregnancy and pelvic tumors may worsen symptoms.[floridasurgicalclinic.com]

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