From the Guidelines
May-Thurner syndrome should be treated with anticoagulation therapy and endovascular interventions, including angioplasty and stenting of the compressed vein, to reduce morbidity, mortality, and improve quality of life. Diagnosis typically begins with a Doppler ultrasound to detect deep vein thrombosis, followed by more definitive imaging such as CT venography, MR venography, or intravascular ultrasound to visualize the compression of the left iliac vein by the right iliac artery 1.
Key Considerations
- Anticoagulation therapy, such as heparin followed by warfarin or direct oral anticoagulants like rivaroxaban or apixaban, is a crucial component of treatment for 3-6 months 1.
- Catheter-directed thrombolysis for acute thrombosis using agents like alteplase may be necessary in severe cases.
- Endovascular interventions, including angioplasty and stenting of the compressed vein, are often necessary to maintain vein patency after the compression is relieved 1.
- Post-intervention, patients typically continue anticoagulation and may need compression stockings to manage residual symptoms.
- Regular follow-up with vascular specialists is important to monitor for recurrence or stent complications.
Treatment Approach
- For asymptomatic patients, observation may be sufficient.
- For those with symptoms or complications like deep vein thrombosis, a more aggressive treatment approach is necessary.
- In severe cases with extensive thrombosis, thrombectomy may be required.
- The treatment approach should be individualized based on symptom severity and presence of complications.
From the Research
Diagnosis of May-Thurner Syndrome
- May-Thurner syndrome is an anatomical variant where the left common iliac vein is compressed by the overlying right common iliac artery and the underlying lumbar vertebrae, leading to stenosis in the left common iliac vein 2.
- Diagnosis can be made using duplex ultrasound and computed tomography (CT) scans, which can show extensive deep vein thrombosis and underlying narrowing of the left common iliac vein 2, 3.
- Computer tomography venography can be used to visualize the common iliac vein and diagnose May-Thurner syndrome 3.
Treatment of May-Thurner Syndrome
- Endovascular intervention, including catheter-directed thrombolysis and stent placement, is a common treatment for May-Thurner syndrome associated with deep vein thrombosis 2, 4, 5, 6, 3.
- Anticoagulation therapy, such as warfarin or rivaroxaban, is often used in conjunction with endovascular intervention to prevent recurrent thrombosis 2, 4, 5, 6, 3.
- Thrombectomy, with or without the implant of a venous stent, is recommended to avoid recurrence of deep vein thrombosis 6.
- There is no consensus on the indication of antiaggregation therapy after anticoagulation therapy period 6.
Outcomes and Complications
- The 12-month rate of endovascular stent occlusion or recurrent deep vein thrombosis can range from 0% to 40% 4.
- The 12-month stent patency rate can range from 60% to 100% 4.
- Complications, such as heparin-induced thrombocytopenia, can occur during treatment 5.
- Endovascular treatment can be effective in minimizing the long-term sequelae of deep vein thrombosis, such as chronic venous hypertension in the lower limb 3.