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Angiologie 13. Juni 2017

May-Thurner syndrome: old acquaintance, new perspective

May-Thurner syndrome (MTS) results from a frequent anatomic variant in which compression of the left common iliac vein between the body of the fifth lumbar vertebra and the pulsating right common iliac artery can cause deep venous thrombosis (DVT) of the left lower limb. 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. In this article the diagnostic and treatment methods are presented in the case report of a 65-year-old woman with MTS who suffered iliofemoral DVT. Knowledge of anatomy is crucial for understanding and recognizing MTS as well as for treating MTS with endovascular procedures.

Introduction

May-Thurner syndrome (MTS) is a long-known and well-recognized anatomic variant, associated with the risk of development of deep venous thrombosis (DVT) in the left lower limb due to compression of the left common iliac vein. The left common iliac vein is formed in front of the left sacroiliac joint by union of the left external iliac and left internal iliac veins. It ascends obliquely until it reaches the right side of the body of fifth lumbar vertebra where it is joined with the right common iliac vein to form the inferior vena cava. Slightly below the confluence point, the left common iliac vein is crossed anteriorly by the right common iliac artery, running from the point of aortic bifurcation lying anterior to the lower border of the fourth lumbar vertebra and left to the median plane, towards the right sacroiliac joint. The vein therefore lies between the body of fifth lumbar vertebra and the pulsating right common iliac artery which runs anterior to the vein (Fig.  1 ).

Because of new diagnostic and treatment possibilities, interest in MTS has been recently renewed. In this article we present the diagnostic and treatment procedures in a patient with MTS who suffered acute iliofemoral DVT of the left lower limb.

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