Figure - available from: Case Reports in Vascular Medicine
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Catheter-based venogram confirmed May-Thurner anatomy with sequelae of chronic DVT in the left iliac vein and cross-pelvic drainage via pelvic and abdominal wall varices (red arrows).
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May-Thurner syndrome (MTS) is a venous outflow obstruction disorder characterized by compression of the left common iliac vein by an overriding right common iliac artery. MTS primarily affects young to middle-aged women, although many patients remain entirely asymptomatic. Anatomic variations of MTS, while uncommon, have been described. Treatment u...
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Introduction May–Thurner syndrome (MTS) is a vascular anatomic variant resulting in compression of the left common iliac vein by the right common iliac artery, affecting approximately 22% of the population. In adults, following acute deep vein thrombosis (DVT) of the iliofemoral veins, the incidence of postthrombotic syndrome (PTS) and recurrent DV...
Citations
... Наличие варикозного расширения вен на лобке и передней брюшной стенке (надлобковый шунт) традиционно рассматривается в качестве признака тромботической или нетромботической обструкции подвздошных вен [1][2][3][4]. Последняя может лежать в основе варикозной болезни таза с явлениями тазовой венозной недостаточности и (или) пельвиоперинеального рефлюкса [5]. Между тем описаны единичные случаи наличия варикозного расширения вен надлобковой области без ясной причины [6], а также их возникновение после эмболизации гонадных вен и последующей беременности при отсутствии верифицированной венозной обструкции [7,8]. ...
The presence of dilated suprapubic veins (suprapubic shunt) is considered to be a classic symptom of post-thrombotic and non-thrombotic venous outflow obstruction. Meanwhile, the descriptions of isolated cases of the creation of a suprapubic shunt during pregnancy in women with pelvic varicose disease are presented in the literature. We present a clinical case report of successful treatment of pelvic varicose disease with the presence of dilated veins in the suprapubic region. A 33-year-old patient complained of the presence of varicose veins in the lower extremities, in the perineum and suprapubic region, heaviness and pain in the lower extremities, a periodic heavy feeling and burning in the varicose vein area, painful menstruation and pain during intercourse. The symptoms appeared and progressed during four pregnancies, after the last one the patient noted the appearance of dilated veins in the suprapubic region. The ultrasound angiography of the lower extremity veins revealed valvular incompetence of the saphenofemoral junction and the trunks of the great saphenous vein bilaterally, the left anterior accessory saphenous vein, signs of pelvioperineal reflux, dilated veins of the perineum and round ligament of the uterus. The first stage surgery involved phlebography and embolization of the ovarian veins bilaterally. The patient showed positive response to treatment, which resulted in relief of dyspareunia and reduction of algodismenorrhea. The second stage surgery involved endovenous laser coagulation of the trunks of the great saphenous vein bilaterally and the left anterior accessory saphenous vein. Varicose vein tributaries on the lower extremities were removed by means of miniphlebectomy, while varicose veins of the perineum and suprapubic region were obliterated by foam sclerotherapy. Three months after the intervention, the patient had a stable obliteration of all target veins, clinical improvement, disappearance of dilated veins in the suprapubic region, regression of pain in the lower extremities and complete relief of dyspareunia and algodismenorrhea. Thus, the presence of varicose veins in the suprapubic region can be not only a consequence of venous obstruction, but also a symptom of pelvic varicose disease. If a suprapubic shunt is identified, a detailed examination of the patient, including imaging methods for evaluating abdominal or pelvic veins is required. The results of the tests will help develop an individual treatment plan.
... Becuase of the patient's femoral fracture and subsequent edema following his MVA in 2019, it is likely the patient has been experiencing DVT and associated PTS since 2019. Importantly, there have been several case studies published indicating a relationship between DVT's resulting in May-Thurner syndrome and abdominal varicosities and abdominal pain [5]. May-Thurner syndrome occurs when the right common iliac artery overrides and compresses the left common iliac vein [5]. ...
... Importantly, there have been several case studies published indicating a relationship between DVT's resulting in May-Thurner syndrome and abdominal varicosities and abdominal pain [5]. May-Thurner syndrome occurs when the right common iliac artery overrides and compresses the left common iliac vein [5]. Common manifestations of May-Thurner syndrome include lower abdominal pain, groin discomfort, itching, swelling and pelvic/abdominal varicosities [5]. ...
... May-Thurner syndrome occurs when the right common iliac artery overrides and compresses the left common iliac vein [5]. Common manifestations of May-Thurner syndrome include lower abdominal pain, groin discomfort, itching, swelling and pelvic/abdominal varicosities [5]. Although still poorly understood, it is likely the varicosities develop in relation to May-Thurner syndrome due to deterioration of the venous walls and subsequent backf low of blood into abdominal veins, in this case the epigastric veins [5]. ...
Deep venous thrombosis (DVT) is a common medical finding occurring in ~25% of hospitalized patients with roughly half of these patients experiencing post-thrombotic complications [Baldwin, Moore, Rudarakanchana, Gohel, Davies (Post-thrombotic syndrome: a clinical review. J Thromb Haemost 2013;11:795-805.)]. There are many associated complications of DVTs, including pulmonary embolism and lower extremity swelling; however, the occurrence of abdominal wall varicosities with DVT's is rare [Baldwin, Moore, Rudarakanchana, Gohel, Davies (Post-thrombotic syndrome: a clinical review. J Thromb Haemost 2013;11:795-805.)]. The purpose of this case study is to rare presentation of abdominal vein varicosities as manifestation of DVT.
... MTS primarily affects young to middle-aged women, although many patients remain entirely asymptomatic. 1 Anatomic variations of MTS, though uncommon, have been described. Treatment usually involves endovascular management, including thrombolysis and/or thrombectomy with or without inferior vena cava (IVC) filter placement, followed by angioplasty and stenting of the left common iliac vein. ...
May-Thurner syndrome/Cockets syndrome/ileocaval syndrome is a rarely diagnosed, anatomical and pathologically variable condition, causing venous flow obstruction in iliocaval territory. We report a case of 64 year old male patient who presented with unprovoked proximal deep venous thrombosis (DVT) of left lower limb. Evaluated for hypercoagulable state, which was negative, the patient underwent catheter guided thrombolysis and anticoagulation for 6 months. Two years later, he developed left lower limb swelling, and venous doppler revealed acute DVT; CT venogram was consistent with left common iliac vein compression by right common iliac artery suggestive of May-Thurner syndrome. Catheter-guided thrombolysis was done, and percutaneous transluminal peripheral angioplasty/stent was placed from inferior vena cava to left common iliac vein. This case highlights the importance of high index of suspicion in managing patients with DVT for possible ileocaval syndrome wherein anticoagulation alone is insufficient and needs more aggressive and definitive treatment to relieve the obstruction and to prevent recurrence.
May-Thurner syndrome (MTS) is a clinical syndrome of iliac vein compression leading to venous hypertension. MTS may present with chronic lower extremity swelling and pain or acutely with a deep venous thrombosis (DVT). Women are predominantly affected by this condition, and the presentation and outcomes of MTS have been shown to differ by sex. In addition, several considerations unique to women warrant attention in the setting of MTS. In this chapter, we review the diagnosis and management of MTS in women.
