Iliac vein compression syndrome: Clinical, imaging and pathologic findings

Abstract

May-Thurner syndrome (MTS) is the pathologic compression of the left common iliac vein by the right common iliac artery, resulting in left lower extremity pain, swelling, and deep venous thrombosis. Though this syndrome was first described in 1851, there are currently no standardized criteria to establish the diagnosis of MTS. Since MTS is treated by a wide array of specialties, including interventional radiology, vascular surgery, cardiology, and vascular medicine, the need for an established diagnostic criterion is imperative in order to reduce misdiagnosis and inappropriate treatment. Although MTS has historically been diagnosed by the presence of pathologic features, the use of dynamic imaging techniques has led to a more radiologic based diagnosis. Thus, imaging plays an integral part in screening patients for MTS, and the utility of a wide array of imaging modalities has been evaluated. Here, we summarize the historical aspects of the clinical features of this syndrome. We then provide a comprehensive assessment of the literature on the efficacy of imaging tools available to diagnose MTS. Lastly, we provide clinical pearls and recommendations to aid physicians in diagnosing the syndrome through the use of provocative measures.

Keywords: May-Thurner, Thrombosis, Diagnostic, Iliac compression, Vascular, Imaging

Core tip: There is currently no gold standard diagnostic criterion in iliac vein compression syndrome. Historically, the presence of pathologic factors has been the main component in diagnosis; however, imaging techniques have led to a more radiologic-based diagnosis. This review details the clinical and radiologic challenges in the diagnosis of Iliac vein compression syndrome and presents clinical pearls that may help in deciding whether an endovascular intervention should be performed.