Is May-Thurner Syndrome An Overused Diagnosis?
Daniel P. Berkowitz, B.S.1, Michael Shirazi, M.D.2, Caroline Burley, B.S.1, Clifford M. Sales, M.D.1.
1The Cardiovascular Care Group, Springfield, NJ, USA, 2Overlook Medical Center, Summit, NJ, USA.
Objective: The treatment—and, presumably, the incidence—of May-Thurner anatomy has seen a dramatic increase in recent years. We sought to understand the potential causes for the increase in patients being treated for left iliac vein stenosis caused by iliac artery compression (May-Thurner Syndrome). We hypothesized that left iliac vein stenosis (≥50%) is a common anatomy, even in asymptomatic individuals. If supported, the contribution of May-Thurner anatomy to left-sided venous pathology may be exaggerated and May-Thurner syndrome may be over-diagnosed.
Methods: The anatomic relationship of the left common iliac vein to the right common iliac artery was retrospectively evaluated in 116 consecutive CT Angiograms of the abdomen and pelvis—98 of which were included in the final analyses—that were ordered for reasons other than leg swelling or venous pathology. Degree of iliac venous stenosis was determined by comparing the luminal diameter of the left common iliac vein at the point of maximal compression to a distal, more patent point along the same vessel. The degree of compression was graded as <50%, 50%-75%, and >75%. Indications for the study and demographics were also noted.
Results: The mean age of the sample was 67 years (25-93 years.) Mean compression was 36% stenosis (Range, -65%-78% stenosis). 39 (40%) subjects had stenosis of 50% or greater and four subjects (4%) had a stenosis in excess of 75%. None of the patients had left sided leg swelling.
Conclusion: Our results support that left common iliac vein compression is a common anatomic variant in asymptomatic individuals and further supports the claim that May-Thurner anatomy may be underestimated. Our findings highlight the potential that a frequent anatomic variant (left iliac vein stenosis) may be identified as an indication to treat. The endovascular treatment of May-Thurner anatomy mandates close clinical correlation, and the presence of a radiographic finding of iliac vein stenosis is clearly not a sufficient indication, in itself, for intervention.
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