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May Thurner Syndrome or Iliac Vein Compression Syndrome

Description: https://johnsonfrancis.org/profession... Discussion on May-Thurner syndrome or iliac vein compression syndrome. May-Thurner syndrome denotes iliac vein compression by the crossing iliac artery at the iliocaval junction. Usually it is the left iliac vein which is compressed by the right iliac artery. The compression increases the risk of deep vein thrombosis. Other names for the syndrome are iliac vein compression syndrome and Cockett syndrome. The obstruction may cause varicosities in the affected limb and ulcers due to chronic venous stasis. The pulsations of the overlying artery cause intimal hypertrophy of the vein which adds to the severity of the obstruction. Some reports show that deep vein thrombosis occurs three to eight times more commonly on the left side. The original report was from May R and Thurner J in 1957. May-Thurner syndrome should be thought of in the differential diagnosis of edema of the left leg and the diagnosis can be confirmed by venography. A report of right sided Cockett syndrome was described by Du Pont B et al. According to the authors, Cockett and Thomas described iliac vein compression syndrome and named Cockett’s syndrome in 1965. It was seen on the left side and mostly in women during second to fourth decade. The patient presented by Du Pont B et al had an un-complicated right sided Cockett’s syndrome which was successfully treated with balloon dilatation and stenting of right common iliac vein. Patient improved and was fine at six month follow up. Since May-Thurner syndrome is a progressive disease, surgical options like vein patch angioplasty and repositioning of the iliac artery have been tried in the past. Implantation of a self-expanding stent in the iliac vein is another option as described above. Xu J et al reported mid-term and long term data of 412 patients with Cockett syndrome. Of these 231 had acute left iliac-femoral vein thrombosis while 181 had chronic venous insufficiency. Endovascular treatment with venous stenting had good mid-term and long term results. Follow up period ranged from 3 months to 8 years. 89 patients who had valvular incompetence of left superficial femoral vein needed a second stage femoral valve repair.