May-Thurner syndrome
- characterized by venous insufficiency, obstruction, or thrombosis due to impaired venous return secondary to venous compression
- is a rarely diagnosed condition in which patients develop iliofemoral deep venous thrombosis (DVT) due to an anatomical variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine (1):
- the anatomical variant has been shown to be present in over 20% of the population (1)
- may be asymptomatic,
- typical symptoms include pain, swelling, and skin changes in the ipsilateral lower extremity.
- venous compression usually occurs between the aortic origination of the common iliac artery and the iliofemoral junction
- pulsations of the overriding artery compress the vein against the lower lumbar vertebrae, injure the venous endothelium, and promote the formation of endovenous fibrous bands or spurs
May-Thurner syndrome is an underdiagnosed cause of iliofemoral deep vein thrombosis, accounting for 2% to 5% of all deep vein thromboses (2):
- iliofemoral venous thromboses can be extensive and, without proper diagnosis and treatment, have significant morbidity
- May-Thurner syndrome may be thrombotic or nonthrombotic but should be considered in all persons presenting with an iliofemoral deep venous thrombosis (DVT)
Treatment principles in symptomatic May-Thurner syndrome (1,2):
- reestablish venous flow, alleviate strictures and venous hypertension, reduce the incidence of postthrombotic syndrome
- it is generally accepted that long-term anticoagulation, while indicated, is not adequate to prevent long-term sequelae in May-Thurner syndrome patients and that a more invasive therapeutic approach is indicated
- anticoagulation or catheter-directed therapy with mechanical lysis is followed by vascular stenting due to the irreversible fibrotic nature of the syndrome
Reference:
- Peters M, et al. May-Thurner syndrome: a not so uncommon cause of a common condition. Proc (Bayl Univ Med Cent). 2012 Jul;25(3):231-3.
- Mangla A, Hamad H. May-Thurner Syndrome. [Updated 2024 Mar 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.