A comprehensive review of the history, pathophysiology, diagnosis, and treatment of iliac vein entrapment syndrome, also known as May-Thurner syndrome

Domenico Baccellieri,MD, Associate Professor Vein Center, Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy Ferdinando B. A. Valente, MD Vein Center, Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy Vincenzo Ardita, MD, PhD Vein Center, Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy Mert Dumantepe, MD, PhD Florence Nightingale Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey ABSTRACT May-Thurner syndrome (MTS), also known as iliac vein entrapment syndrome, is caused by extrinsic compression of the left common iliac vein—most often by the right common iliac artery—leading to venostasis and potential development of deep vein thrombosis…

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Role of anticoagulation treatment in the prevention of post-thrombotic syndrome

Christos KARATHANOS, MD, PhD1; Athanasios GIANNOUKAS,MD, PhD2; 1Consultant Vascular Surgeon; 2Professor of Vascular Surgery and Head of the Department; Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece Abstract Post-thrombotic syndrome (PTS) develops after deep vein thrombosis (DVT) of the lower limbs and may affect up to 50% of patients after proximal DVT. Prevention is of paramount importance as there is no gold standard for treatment of established PTS. Pharmacological or mechanical thromboprophylaxis is recommended to prevent PTS. Effective DVT treatment with vitamin K antagonists (VKAs), direct oral anticoagulants…

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What is postthrombotic venous obstruction and how can it be avoided?

What is postthrombotic venous obstruction and how can it be avoided? Anthony J. COMEROTA, MD, FACS, FACC Director, Jobst Vascular Institute, The Toledo Hospital, Toledo, OH, USA; Adjunct Professor of Surgery, University of Michigan Abstract Postthrombotic venous obstruction is part of the pathophysiology of a postthrombotic syndrome. When the obstruction occurs in the iliofemoral segment, postthrombotic morbidity is often severe. In a recent study, the intraluminal contents of chronically occluded postthrombotic common femoral veins were analyzed. Approximately 80% to 90% of the tissues analyzed were composed of type I collagen, with type III collagen comprising the remainder. Vascular endothelial growth…

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Residual rates of reflux and obstruction and their correlation to post-thrombotic syndrome in a randomized study on catheter-directed thrombolysis for deep vein thrombosis.

Haig Y, Enden T, Slagsvold CE, Sandvik L, Sandset PM, Kløw NE. J Vasc Surg: Venous Lymphat Disord. 2014;2:123-130. Catheter-directed thrombolysis, venous abnormalities, and postthrombotic syndrome Despite appropriate anticoagulant therapy, at least 1 of every 2 to 3 patients with proximal deep vein thrombosis (DVT) of the lower extremities will develop (severe) postthrombotic sequelae (PTS). Among parameters that have been found to be associated with an increased risk of PTS are venous thrombosis of the common femoral or iliac vein, obesity, previous ipsilateral DVT, older age, and female sex.1,2 By contrast, the role played by the development of venous reflux…

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Operative treatment in postthrombotic syndrome: an update

Oscar MALETI1, Marzia LUGLI2, Michel PERRIN3 1. Department of Cardiovascular Surgery, Hesperia Hospital Modena, Italy Interuniversity Center of Phlebolymphology. 2. Department of Cardiovascular Surgery, Hesperia Hospital Modena, Italy. 3. Associate Professor of Surgery Grenoble and for Institution Unité de Pathologie Vasculaire Jean Kunlin, Clinique du Grand Large, Chassieu, Lyon, France. ABSTRACT Postthrombotic deep vein obstruction and/or incompetence can lead to severe chronic venous insufficiency in a significant number of cases. Postthrombotic lesions are essentially of two types: (i) obstruction of various degrees; and (ii) valve destruction with subsequent reflux. These two elements are variously present at different levels. The most…

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Investigations in postthrombotic syndrome according to clinical status

Michel PERRIN Vascular Surgery, France INTRODUCTION Many angiologists and vascular surgeons consider that postthrombotic syndrome (PTS) should only be managed noninterventional treatment. Unaware of the real possibilities provided by operational treatment, they limit investigation to color duplex scanning (CDS), which in this perspective is logical and reasonable. Compression, drugs, and lifestyle recommendations do not call for level III investigation according to the CEAP classification.1 Conservative treatment as far as etiology is concerned relies mainly on the signs and symptoms, independently of the location, extension of anatomical lesions, and pathophysiological abnormality. Conversely, when surgical or endovenous treatment is considered, the CEAP…

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Advances in the surgical treatment of postthrombotic syndrome

Alessandra PUGGIONI* and Fedor LURIE** * Marco Polo Fellow of the Society for Vascular Surgery, year 2007 ** Department of Surgery, John A. Burns School of Medicine, University of Hawaii ABSTRACT Postthrombotic syndrome (PTS) is the late complication of lower extremitiy deep venous thrombosis (DVT). Its incidence is approximately 3/1000 per year in the adult population. A combination of reflux and obstruction is often seen in limbs with more advanced clinical disease than obstruction alone. A thorough workup of the patient with disabling PTS is necessary to identify patients amenable to open surgical or endovascular intervention. Duplex scanning is the…

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The role of compression in the prevention of postthrombotic syndrome

Athanasios D. GIANNOUKAS Department of Vascular Surgery, University Hospital of Larissa, University of Thessaly Medical School, Larissa, Greece. ABSTRACT The role of compression with or without early ambulation in patients with deep venous thrombosis (DVT) in the prevention of postthrombotic syndrome (PTS) has not been widely accepted in clinical practice. This article investigates the existing evidence regarding the effects of compression in the prevention of PTS, with or without early ambulation after proximal DVT. Electronic and hand searching of the relevant literature was undertaken. Two systematic reviews and four randomized studies were identified. In these four studies there was lack…

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Neovalve reconstruction in postthrombotic syndrome. Technique, indications, and results

Oscar MALETI Marzia LUGLI Department of Cardiac, Thoracic, Vascular Surgery Hesperia Hospital Modena, Italy ABSTRACT Patients with leg venous ulcer (C6 patients according to the CEAP classification) affected by deep venous reflux often fail to respond to conservative therapies, and the presence of non-healing or recurrent ulcers may lead one to consider surgery. However, even if surgery is properly indicated, traditional techniques such as femoral transposition and valve transplantation are not always suitable, and in these cases a de novo valve reconstruction represents a surgical opportunity. Our neovalve reconstruction technique consists in creating an intimal flap by performing a wall…

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