Contributor: Sam Killian, MD

Educational Pearls:

• iliac vein compression syndrome is also called May-Thurner Syndrome
• The left leg more frequently develops deep venous thrombosis (DVT) in part because about 1/4 of the population has May-Thurner
• May-Thurner syndrome anatomic variant results in a right iliac artery compresses the left iliac vein against the spine, which can promote DVT formation
• This is thought to be the cause of 2-3% of DVTs in patients seen in the ED and suspicion for this disease should increased in those with recurrent DVT
• Diagnosis is made with MRV/MRA and will typically not be seen on duplex ultrasound
• Typical anticoagulation treatment fails to address the underlying structural cause

References

Demir MC, Kucur D, Çakır E, Aksu NM, Onur MR, Sabuncu T, Akkaş M. May-Thurner syndrome: A curious syndrome in the ED. Am J Emerg Med. 2016 Sep;34(9):1920.e1-3. doi: 10.1016/j.ajem.2016.02.045. Epub 2016 Feb 19. PMID: 26971822.

Sharafi S, Farsad K. Variant May-Thurner syndrome: Compression of the left common iliac vein by the ipsilateral internal iliac artery. Radiol Case Rep. 2018;13(2):419-423. Published 2018 Feb 20. doi:10.1016/j.radcr.2018.01.001

Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD