Fact-sheet: Iliac vein compression syndrom
Updated on 08/17/2020 at 3:23 PM
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Definition
Synonym: "May-Thurner syndrome"
Compression of the left iliac vein (common > external) by the right common iliac artery
Young women
Unknown prevalence (underestimated ++)
Recurrence risk ++
Should be considered in young women with acute idiopathic left iliofemoral vein thrombosis
Pathophysiology:
- extrinsic: compression of the left common iliac vein between the right common iliac artery and the vertebral body
- intrinsic: local hypertrophy (formation of intimal spurs within the left common iliac vein secondary to the pulsatile force of the right common iliac artery)
Clinical features
Asymptomatic
Chronic venous stasis:- left lower limb edema- recurrent left iliofemoral thrombosis- varicosities, pelvic congestion syndrome, chronic venous ulcers
Complications:- pulmonary embolism- phlegmasia cerulea dolens
Ultrasound
Decreased respiratory variability of the iliac veins: indirect sign
CT
Study of choice
Visualization of venous compression
Assessment for possible thrombosis
Search for collateral veins draining into the contralateral venous system
MRI
Dynamic X-Ray Angiography sequence, coronal MIP
Impression on the left common iliac vein by the right common iliac artery and the sacral promontory
Left ovarian vein reflux
Vascular intervention
Ascending iliac venography: Gold standard
- Venous compression
- Ilio-caval pressure measurement
- Left ilio-caval venous return
- Mapping of venous collaterals
Management
Relief of compression
In situ thrombolysis + stenting
Prophylactic anticoagulation therapy
Differential diagnosis
Other compression