Curr Probl Cardiol. 2026 Jul 19:103402. doi: 10.1016/j.cpcardiol.2026.103402. Online ahead of print.
ABSTRACT
May-Thurner Syndrome (MTS), or iliac vein compression syndrome, is an underdiagnosed vascular condition where the left common iliac vein is compressed, typically by the right common iliac artery. This impairs venous outflow from the left lower extremity, leading to manifestations ranging from chronic venous insufficiency to acute deep vein thrombosis (DVT). Historically noted by Virchow and detailed by May, Thurner, and Cockett, its true prevalence is uncertain due to nonspecific symptoms. This review examines MTS pathophysiology, clinical presentations, diagnostics, and management. MTS primarily affects young to middle-aged women, with risk factors including pregnancy and hormonal therapy. Clinical features vary from asymptomatic findings to iliofemoral DVT, chronic venous insufficiency, and pelvic congestion syndrome. Diagnosis combines Doppler ultrasound, CT venography, MR venography, and intravascular ultrasound (IVUS), the latter often used with conventional venography for detailed assessment. Management is tailored to severity, with conservative options like anticoagulation for milder cases. For symptomatic or thrombotic MTS, endovascular interventions such as catheter-directed thrombolysis, angioplasty, and stenting are primary treatments, offering good patency and symptom relief; surgical options are reserved for refractory situations. Timely diagnosis and intervention are key to improving outcomes and preventing complications like post-thrombotic syndrome.
PMID:42472601 | DOI:10.1016/j.cpcardiol.2026.103402