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A 36-year-old man with Sjögren's syndrome presented with a 3-year history of left pelvic pain and an inability to sit for long periods of time. Angiography revealed a filling defect at the proximal left common iliac vein (Fig. 1) consistent with May-Thurner syndrome. Intravascular ultrasound (IVUS) (Visions® PV8.2F catheter, Volcano Corporation; San Diego, Calif) revealed severe venous compression with reduced cross-sectional area (Fig. 2). Stenting was performed with a Palmaz 5010 stent (Cordis Corporation, a Johnson & Johnson company; Miami Lakes, Fla) on a Maxi LD™ 16 × 16-mm balloon (Cordis) (Fig. 3). After stenting, IVUS revealed good wall apposition and improved cross-sectional area (Fig. 4). On follow-up, the patient's symptoms had improved, and he had resumed all previous activities.
Obstructive compression of the left common iliac vein by the right common iliac artery was first described by May and Thurner in 1957.1 This compression of the iliac vein, known as May-Thurner syndrome, can cause iliofemoral deep venous thrombosis, leg or pelvic pain, edema, or limb-threatening acute inflammation.
Endovascular treatment of May-Thurner has emerged within the last decade as the cornerstone of therapy. Although endovascular balloon angioplasty has been attempted in May-Thurner syndrome, endovascular stenting remains the 1st-line therapy, due to continued arterial compression of the iliac vein. Small, nonrandomized studies of endovascular stenting for this condition2,3 have shown good initial patency rates and extensive symptomatic relief on long-term follow-up. As a result of high technical success rates and the clear relief of symptoms, endovascular stenting is now the preferred initial therapy.
Intravascular ultrasonography has aided in both the diagnostic and therapeutic aspects of intravascular interventions by providing valuable information on vascular size and morphology. In a small study of 16 patients who had May-Thurner syndrome,4 IVUS-guided endovascular repair influenced decisions on additional therapy in 50% of the patients.
In summary, IVUS provides an important diagnostic and therapeutic tool in the endovascular treatment of May-Thurner syndrome.
Address for reprints: Zvonimir Krajcer, MD, 6624 Fannin St., Suite 2780, Houston, TX 77030