New Description of Unique Sonographic Findings in Patients with May Thurner Syndrome.
Samuel S. Ahn, MD, Amanda Combs, BS, Jasmine L. Richmond, MS, Robert W. Feldtman, MD, William Peper, MD.
DFW Vascular Group, Dallas, TX, USA.
OBJECTIVES: May-Thurner (MT) syndrome is often under diagnosed or missed as a cause of leg edema and pain, thus we need a way to better identify patients with this disease. We describe in this report unique sonographic findings in these patients that facility proper diagnosis and treatment.
METHODS: We identified 38 patients with suspected MT based upon unexplained leg swelling and pain despite Duplex Scan findings of no DVT or reflux. However these studies showed arterial pulsatility in the venous flow signal at the common femoral vein level in 33 of our patients and venous reflux with inspiration at the common femoral vein on the right in 18 and left in 18 patients. Based on these Duplex scan abnormalities, which haven't been previous descripted to out knowledge, we subsequently studied all these patients in our outpatient endovascular angiosuite with venography and IVUS. We treated these patients with angioplasty and/or stent as indicated at levels of stenosis greater than 50% shown on IVUS. Twenty five were female and 14 were male with an average age of 61.8 years.
RESULTS: 36 of these 38 patients( 94.7%) were subsuently proven to have pelvic vein compression syndrome by venography and IVUS. Bilateral lesions were seen in 16 patients with 11 having only left sided vein compression and 4 patients with only right-sided lesions. Nineteen patients had venoplasty alone, 12 had venoplasty and stent. Twenty-five patients (65.8%) were identified to have DVT that was previously unsuspected and undefined by pre-operative Duplex Scan. Six of these patients underwent thrombolysis in addition to venoplasty of the pelvic veins. Post-op all 37 patients who underwent treatment had initial improvement in leg edema and pain. Of the 23 patients with post intervention Duplex Scan, 19 (82.6%) showed resolution of arterial pulsatility.
CONCLUSIONS: Patients with unexplained leg edema and pain are often overlooked when they have a treatable pelvic venous compression syndrome. Furthermore two thirds of these patients had previous undetected pelvic DVT not seen on Duplex Scan. An ultrasound finding of arterial pulsatility in the venous flow signals and/or venous reflux with inspiration of the common femoral vein is highly suggestive of central pelvic vein stenosis and/or DVT. Patients with these findings should undergo subsequent routine venography and IVUS for proper diagnostic and treatment.
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