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Armenta Flores R, Armenta-Villalobos D, Ramirez-Centeno E, Harrison-Ragle D, Carrillo LGD. May Thurner syndrome: Sixty years later. Phlebology 2021; 37:5-13. [PMID: 34494483 DOI: 10.1177/02683555211045202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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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Affiliation(s)
- Romulo Armenta Flores
- Hospital Medica Campestre, Department of Cardiovascular Surgery, Leon, Guanajuato, Mexico
| | - Diego Armenta-Villalobos
- Guanajuato University Medical School, Department of Medicine and Nutrition, Leon, Guanajuato, Mexico
| | | | - Derek Harrison-Ragle
- Hospital General del Norte de Puebla SSA, Department of Internal Medicine, Puebla, Puebla, Mexico
| | - Luis G Dominguez Carrillo
- Guanajuato University Medical School, Department of Medicine and Nutrition, Leon, Guanajuato, Mexico
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A Novel Approach to a Patient with both Aortoiliac and Venous Occlusive Disease. Ann Vasc Surg 2021; 72:668.e5-668.e8. [PMID: 33333185 DOI: 10.1016/j.avsg.2020.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/09/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022]
Abstract
Radiation-induced arteritis is a well-recognized complication of radiotherapy; however, radiation-induced venous stenosis is very rare (Zhou W, Bush RL, Lin PH, et al. Radiation-associated venous stenosis: endovascular treatment options. J Vasc Surg 2004;40:179-182). We describe a case of mixed aortoiliac arterial occlusive disease and iliac venous outflow obstruction secondary to radiation-induced vascular disease. Several endovascular procedures were undertaken to treat aortoiliac occlusive disease, which was followed by stenting for venous occlusive disease.
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Gatmaitan R, Werner-Gibbings K, Donati T, Saha P, Black S. Treatment of May–Thurner Syndrome in a Patient with an Iliac Artery Stent. VASCULAR AND ENDOVASCULAR REVIEW 2020. [DOI: 10.15420/ver.2020.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
May–Thurner syndrome (MTS) is caused by compression of the left iliac vein by the right iliac artery, leading to clinical manifestations of outflow obstruction in the lower limb and deep vein thrombosis. There have been increasing reports of iatrogenic MTS caused by medical implants. The authors report the case of a 60-year-old man who developed MTS after stenting of the right common iliac artery. Due to the debilitating nature of the patient’s symptoms of venous congestion in the left leg, he proceeded with endovascular venoplasty and venous stent insertion with concurrent intra-arterial balloon angioplasty of the existing right common iliac artery stent. Technical success and primary patency of arterial and venous stents were achieved. The patient remained asymptomatic at 6 weeks and 3 months follow-up and arterial and venous stents were found to be patent on duplex ultrasound. Surgical management of MTS may include thrombolysis, thrombectomy, venoplasty and stenting of the left common iliac vein. Care must be taken to preserve existing medical implants during treatment of MTS. The authors demonstrate that concurrent angioplasty of the right common iliac artery during treatment of the vein is an effective method of preventing arterial stent disruption during surgical management of MTS.
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Affiliation(s)
- Raleene Gatmaitan
- Department of Vascular Surgery, Nepean Hospital, Kingswood, NSW, Australia
| | - Keagan Werner-Gibbings
- Department of Vascular Surgery, Nepean Hospital, Kingswood, NSW, Australia; Department of Vascular Surgery, Guy’s Hospital, London, UK;. Department of Vascular Surgery, St Thomas’ Hospital, London, UK
| | - Tommaso Donati
- Department of Vascular Surgery, Guy’s Hospital, London, UK;. Department of Vascular Surgery, St Thomas’ Hospital, London, UK
| | - Prakash Saha
- Department of Vascular Surgery, Guy’s Hospital, London, UK;. Department of Vascular Surgery, St Thomas’ Hospital, London, UK
| | - Stephen Black
- Department of Vascular Surgery, Guy’s Hospital, London, UK;. Department of Vascular Surgery, St Thomas’ Hospital, London, UK
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Enta Y, Tanaka A, Saigan M, Tada N, Hata M. Iatrogenic Iliac Vein Compression Syndrome Caused Because of Inappropriate Length and Positioning of Vascular Graft. Ann Vasc Dis 2020; 13:194-197. [PMID: 32595800 PMCID: PMC7315228 DOI: 10.3400/avd.cr.20-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Iliac vein compression syndrome (IVCS) can occasionally be iatrogenic; however, iatrogenic IVCS cases occurring because of inappropriate length and positioning of vascular grafts have not been reported. We present the case of an 80-year-old woman with iatrogenic IVCS resulting from kinked and overlapping limbs of a bifurcated abdominal vascular prosthesis for an abdominal aortic aneurysm. She complained of discomfort in her left leg immediately after aortic replacement. Venous stenting was effective for IVCS occurring because of compression of the vascular prosthesis. Iatrogenic IVCS occurred because of inappropriate length and positioning of the vascular graft and was considered a postoperative complication.
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Affiliation(s)
- Yusuke Enta
- Department of Cardiovascular Internal Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Akiko Tanaka
- Department of Cardiovascular Internal Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Makoto Saigan
- Department of Cardiovascular Internal Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Norio Tada
- Department of Cardiovascular Internal Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Masaki Hata
- Department of Cardiovascular Surgery, Sendai Kousei Hospital, Sendai, Miyagi, Japan
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Yi JA, Hadley JB, Kuwayama DP. Atypical May-Thurner syndrome caused by endovascular aortic aneurysm repair. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:397-400. [PMID: 32715178 PMCID: PMC7369519 DOI: 10.1016/j.jvscit.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Abstract
May-Thurner syndrome is characterized by unilateral lower extremity venous hypertension and stasis due to compression of an iliac vein between an iliac artery and the lumbar spine. In almost all cases, the left common iliac vein is compressed by the right common iliac artery; however, other patterns have been described. Rarely, May-Thurner syndrome may be created iatrogenically as a result of iliac artery stenting. We present an unusual case of new left common iliac vein thrombosis caused by ipsilateral left iliac artery compression after aortobi-iliac endovascular aneurysm repair.
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Affiliation(s)
- Jeniann A Yi
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado, Aurora, Colo
| | - Jamie B Hadley
- Department of Surgery, University of Colorado, Aurora, Colo
| | - David P Kuwayama
- Section of Vascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Khalid S, Youn YJ, Azrin M, Lee J. Late-Onset Nonthrombotic Left Common Iliac Vein Compression Secondary to Degenerative Lumbar Disc: A Case Report of May-Thurner Variant. Vasc Endovascular Surg 2018; 53:62-65. [PMID: 30092721 DOI: 10.1177/1538574418791884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
May-Thurner syndrome (MTS) refers to venous outflow obstruction caused by extrinsic compression of the left common iliac vein (LCIV) by the overlying pulsatile right common iliac artery against lumbar vertebrae. The classic clinical presentation is acute unilateral left leg painful swelling due to deep venous thrombosis in a young woman in the second or third decade of life. We present a case of a 66-year-old woman who presented with late-onset left leg swelling caused by nonthrombotic venous hypertension due to degenerative lumbar disc bulge leading to LCIV compression against the left common iliac artery which was confirmed by computed tomography and intravascular ultrasound. Our case highlights the importance of high index of suspicion for MTS in elderly patients with unilateral leg swelling and the importance of multimodality imaging for understanding the mechanism and appropriate treatment of MTS.
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Affiliation(s)
- Salman Khalid
- 1 University of Connecticut School of Medicine, Farmington, CT, USA
| | - Young Jin Youn
- 2 Wonju College of Medicine, Yonsei University, Wonju, Gangwon, South Korea
| | - Michael Azrin
- 1 University of Connecticut School of Medicine, Farmington, CT, USA
| | - Juyong Lee
- 3 Vascular Medicine and Endovascular Therapy, Division of Interventional Cardiology, Calhoun Cardiology Center, UConn Health, University of Connecticut School of Medicine, Farmington, CT, USA
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Bilateral May-Thurner syndrome refractory to iliac aneurysm repair. J Vasc Surg Venous Lymphat Disord 2018; 6:657-660. [PMID: 29945821 DOI: 10.1016/j.jvsv.2018.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/13/2018] [Indexed: 12/29/2022]
Abstract
Venous complications of iliac artery aneurysms are rare. We report the case of bilateral iliac aneurysms that resulted in iliac vein outflow obstruction despite endovascular aneurysm repair. In our patient, bilateral iliac vein stenting resulted in symptom resolution.
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Kaltenmeier CT, Erben Y, Indes J, Lee A, Dardik A, Sarac T, Ochoa Chaar CI. Systematic review of May-Thurner syndrome with emphasis on gender differences. J Vasc Surg Venous Lymphat Disord 2018; 6:399-407.e4. [DOI: 10.1016/j.jvsv.2017.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 11/02/2017] [Indexed: 02/08/2023]
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Simonds E, Patel M, Vetter M, Iwanaga J, Oskouian RJ, Tubbs RS. May-Thurner Syndrome Variant Identified in a Cadaver: First Reported Case. Cureus 2018; 10:e2396. [PMID: 29854571 PMCID: PMC5976270 DOI: 10.7759/cureus.2396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
May–Thurner syndrome (MTS) is defined as the compression of the left common iliac vein by the right common iliac artery. Herein, we describe an unusual case of a male cadaver with right-sided compression of the inferior vena cava and the left and right common iliac veins by the right common iliac artery. This is an unusual variant of this syndrome and the first known case report. We suggest this variant be termed MTS type II due to the additional compression of the inferior vena cava.
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Affiliation(s)
| | - Mayank Patel
- Clinical Anatomy Research, Seattle Science Foundation
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Young L, Kwon J, Arosemena M, Salvatore D, DiMuzio P, Abai B. Symptomatic compression of right iliac vein after right iliac artery stent placement. J Vasc Surg Venous Lymphat Disord 2017; 5:735-738. [DOI: 10.1016/j.jvsv.2016.10.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/20/2016] [Indexed: 12/18/2022]
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DaSilva-DeAbreu A, Masha L, Peerbhai S. An Unusual Endovascular Therapeutic Approach for a Rare Case of May-Thurner Syndrome. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:226-229. [PMID: 28260745 PMCID: PMC5358844 DOI: 10.12659/ajcr.902776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Male, 69 Final Diagnosis: May-Thurner syndrome secondary to left common iliac artery aneurysm Symptoms: Left lower extremity edema • left lower extremity erythema • left lower extremity pain Medication: — Clinical Procedure: Endovascular aneurysm repair (EVAR) of the infra-renal abdominal aorta aneurysm and right common iliac artery aneurysm Specialty: Cardiology
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Affiliation(s)
- Adrian DaSilva-DeAbreu
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Luke Masha
- Department of Internal Medicine, Section of Cardiovascular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shareez Peerbhai
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Hermany PL, Badheka AO, Mena-Hurtado CI, Attaran RR. A Unique Case of May-Thurner Syndrome. JACC Cardiovasc Interv 2016; 9:e39-41. [DOI: 10.1016/j.jcin.2015.11.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/19/2015] [Indexed: 12/20/2022]
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