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QJM. 2016 May; 109(5): 349.
Published online 2016 February 24. doi:  10.1093/qjmed/hcw014
PMCID: PMC4888335

May-Thurner syndrome

T.-H. Ho
Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China

A 20-year-old man presented with a 2-month history of persistent painless edema of the left thigh. He had no prior illness in the past. Physical examination revealed a swollen left thigh, which was 7 cm larger in maximal circumference than the opposite. The pulses were intact of bilateral lower extremities. No varicose veins were noted. Contrast-enhanced computed tomography of the abdominopelvic and lower limbs demonstrated the left common iliac vein (Figure 1A) compressed by the right common iliac artery (Figure 1A) at the aortoiliac bifurcation to the right inguinal region. No pelvic mass or lymphadenopathy was found. The clinical history and imaging findings were diagnostic for May-Thurner syndrome. Typically, this crossing over was considered to be anatomically normal, whereas in some patients, the compression of the vein between the vertebral body posteriorly and the chronic pulsatile force from the artery anteriorly may contribute to extensive intimal hypertrophy of the vein and thus to interfere with venous return.1,2 Surgical interventions aim at relieving the extrinsic compressions or direct repairing the vein.1,3 The patient underwent percutaneous transluminal angioplasty with endovascular tandem stent (18 × 90 mm) implantation (Figure 1B) across the stenotic segment of the left common iliac vein. Postoperative period was uneventful and he had clinical improvement. At 8-month follow-up on outpatient department, there have been no recurrences.

Figure 1.
Abdominopelvic contrast-enhanced computed tomography showing left common iliac vein (A, black arrow) compressed by the right common iliac artery (A, white arrow). An endovascular stent (B, arrow) across the stenotic segment of the left common iliac vein. ...

Conflict of interest: None declared.

References

1. Wang YP, Zhang XQ, Yu WN, Hao B, Ren KW, Pan JJ., et al. Endovascular treatment of acute proximal deep venous thrombosis secondary to iliac vein compression syndrome: a novel technique for thrombus removal. Chin Med J 2013; 126:3184–6. [PubMed]
2. Duran C, Rohatgi S, Wake N, Rybicki FJ, Steigner M. May-Turner syndrome: a case report. Eurasian J Med 2011; 43:129–31. [PMC free article] [PubMed]
3. Molloy S, Jacob S, Buckenham T, Khaw KT, Taylor RS. Arterial compression of the right common iliac vein; an unusual anatomical variant. Cardiovasc Surg 2002; 10:291–2. [PubMed]

Articles from QJM: An International Journal of Medicine are provided here courtesy of Oxford University Press