Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Nov 28, 2015; 7(11): 375-381
Published online Nov 28, 2015. doi: 10.4329/wjr.v7.i11.375
Iliac vein compression syndrome: Clinical, imaging and pathologic findings
Katelyn N Brinegar, Rahul A Sheth, Ali Khademhosseini, Jemianne Bautista, Rahmi Oklu
Katelyn N Brinegar, Rahul A Sheth, Jemianne Bautista, Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
Ali Khademhosseini, Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, United States
Ali Khademhosseini, Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, United States
Ali Khademhosseini, Rahmi Oklu, Biomaterials Innovation Research Center, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02139, United States
Rahmi Oklu, Division of Interventional Radiology, Mayo Clinic, Scottsdale, AZ 85054, United States
Author contributions: Brinegar KN, Sheth RA, Khademhosseini A, Bautista J and Oklu R conceived the issues which formed the content of the manuscript and equally aided in its writing, editing, and revising.
Conflict-of-interest statement: The authors declared no conflicts of interest and have no financial disclosures.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Rahmi Oklu, MD, PhD, Division of Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Scottsdale, AZ 85054, United States.
Telephone: +1-480-3421650 Fax: +1-480-3421650
Received: May 6, 2015
Peer-review started: May 8, 2015
First decision: July 10, 2015
Revised: August 3, 2015
Accepted: September 10, 2015
Article in press: September 16, 2015
Published online: November 28, 2015

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.