May-Thurner syndrome

May-Thurner syndrome refers to deep venous thrombosis resulting from chronic compression of the left common iliac vein (CIV) against the lumbar vertebrae by the overlying right common iliac artery.

Although both left and right CIVs lie deep to the right common iliac artery, the left CIV has a more transverse course and is predisposed to compression whereas the right CIV ascends more vertically and is therefore not similarly predisposed.

The presence of a spur, possibly from injury to the vein endothelium from the arterial pulsations, predisposes to the development of DVT and differentiates this condition from bland DVT.

Epidemiology

Cadaveric and CT studies show a prevalence of ~25% in the population 7. A predilection for this disorder is seen in young women in their 2nd to 4th  decades, usually after prolonged immobilisation or pregnancy.

Clinical presentation

Patients can present with unilateral (left) lower extremity oedema and pain.

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.

First line treatment is with thrombolysis and stenting 2, which removes the clot and relieves the compression to prevent recurrence.

History and etymology

It is named after R May and J Thurner  who initially anatomically described the phenomenon in 1957 4-5.

Differential diagnosis

In imaging modalities where cross sectional anatomy is difficult to appreciate, the differential includes

iliac vein compression from some other source (e.g. occult pelvic mass / lymph node)

Figure 1: diagram – May-Thurner syndrome

Case 1

Compression of th...

Case 2: CT

There is a deep v...

Case 2: ultrasound

Retrieved on July 17, 2015 from http://radiopaedia.org/articles/may-thurner-syndrome-2

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