Managing May-Thurner Syndrome: A Review Focusing on Evolving Treatment Modalities

May-Thurner syndrome (MTS), also known as iliac vein compression syndrome, was first reported in 1957 by May and Thurner on the basis of dissecting 430 cadavers. MTS is a clinical entity of left iliac vein compression by the anteriorly positioned right common iliac artery (RCIA) causing isolated left lower extremity swelling and pain. In this retrospective review of previously treated MTS patients, we present those case particulars and discuss the changes of surgical corrections over the years. From February 2006 to December 2010, 278 patients with chronic swelling of lower extremity were reviewed. Patients with history of gynecological surgery and/or pelvic radiotherapy were excluded; 15 patients without any known etiology were classified as primary lymphedema. Image study with iliac venography, and multi-detector computed tomography confirmed the diagnosis of MTS. Fifteen patients with MTS underwent surgical treatment with different modalities. Prior to the era of endovascular therapy in our institute, three patients were treated with decompression surgery by division of RCIA with reconstruction through retroperitoneal approach; two patients received pelvic angiolysis with relocation of RCIA without arterial division; two patients underwent angiolysis and relocation of RCIA with percutaneous angioplastic balloon dilation; two patients underwent pelvic angiolysis, angioplastic balloon dilation with iliac vein stenting. Six patients underwent percutaneous angioplastic dilatation with iliac vein stenting without open angiolysis. The postoperative results were satisfactory in terms of subsidence of clinical symptoms. No operative mortality encountered and morbidities were acceptable. MTS should not be neglected because of its progressiveness and the long-term disabling complications. The principle of treatment is to relieve the extrinsic compression and to expand the narrowed portion of iliac vein. We consider that endovascular balloon dilatation with stenting is the treatment of choice. Open pelvic angiolysis with iliac vein stenting is reserved for the balloon-dilatation resistant patient. Long-term follow up is necessary to verify the benefit of this endovenous stenting procedure.