May–Thurner syndrome: a modern view on the problem

• Akhmetzianov R.V.
• Ignatyev I.M.
• Bredikhin R.A.
• Evseeva V.V.
• Kamaltdinov R.R.

Abstract

May–Thurner syndrome belongs to venous compression syndromes with predominant hemodynamic and morphological lesions of the left common iliac vein. Despite sufficient knowledge of the anatomical and pathomorphological components of this condition, there is significant variability in revealing the incidence of its symptomatic and asymptomatic manifestations.

Our current understanding of this pathology does not allow us to explain the mechanisms of many pathophysiological and clinical processes, serving as its indicators. Scattered data of the known studies turn out to be largely incomparable and contradictory by the studied parameters. Presently, there are no answers to the key questions concerning the criteria of hemodynamic significance of stenosis of the common iliac vein and consequential indications for performing an operation.

This article covers the history of studying May–Thurner syndrome, discussing problems of variant anatomy and pathophysiology, diagnostic arsenal of assessing the disease, modern methods of surgical and endovascular treatment.

Venous stenting as a method of choice in treatment of May–Thurner syndrome is broadly justified by high frequency of technical success and low complication rates.

Further studies are warranted to get a deeper insight into the pathophysiological mechanisms of extravasal compression of the left iliac vein, to be followed by the development of clear-cut diagnostic parameters making it possible to define this condition as pathological and implying surgery, as well as to distinguish it from other variants of the course, not requiring invasive methods of treatment.

Keywords: May–Thurner syndrome; venous compression syndromes; nonthrombotic iliac vein lesion; obstructive iliac vein lesion; iliac vein stenting

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