The Importance of Diagnosis and Treatment of May-Thurner and Pelvic Congestion Syndromes Before Complications, in Patients with Thrombophilia

Diego Victor Nascimento

doi:10.11648/j.js.20180604.12

Abstract

May-Thurner syndrome (MTS), initially observed in 1851 by Virchow as an anatomical variation of the left common iliac vein. In 1965, Cockett and Thomas supplemented the work of May and Thurner correlating with the observed symptoms. The syndrome is characterized by an anatomical anomaly that results in compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) [3]. It is also known as Cockett Syndrome, iliac vein compression syndrome and iliocaval compression syndrome [3]. Because of the stress arising from the pulsation of the artery, the intima layer of the vein undergoes a hypertrophy with consequent development of Deep Vein Thrombosis (DVT) [1, 3]. Because it prevents drainage to the inferior vena cava, MTS is related to the appearance of pelvic varices characterized by dilatation and reflux, venous stasis of the pelvic organs, having as main manifestation chronic pelvic pain (CPP) without inflammatory signs, although the CPP does not is a well-defined diagnostic criterion [5, 6]. In substitution for open surgery, appeared more effective methods such as endovascular surgery [7]. The patient in this case authorized the authors to describe her clinical case. We performed a search on the PubMed and Bireme databases. A white woman was complaining of pain in her lower extremities (LE), apart from feeling of heaviness and tiredness in her Right Lower Extremity (RLE), ankle edema, legs and pelvic varices. At physical examination, the patient had the presence (according to the CEAP classification) of C1, 3 varicose veins in the RLE and C1, 2, 3 varicose veins in the Left Lower Extremity (LLE). She was submitted to varied clinical treatment, and the investigation of the causes of the symptoms, including thrombophilia. She was not responding well to the treatment and the endovascular treatment of Cockett's syndrome was performed. Due to the non-release of the embolization of the ovarian veins by the patient's health plan there was a delaying for the right treatment of the patient, because she has ovarian varicose veins. The endovascular treatment of the May-Thurner and Pelvic Congestion Syndrome is safe and has excellent primary patency in the medium to long term.

Highlights

May-Thurner syndrome (MTS), initially observed in 1851 by Virchow as an anatomical variation of the left common iliac vein, had its pathophysiology described by May and Thurner in 1956, which detailed anatomical descriptionDiego Victor Nascimento et al.: The Importance of Diagnosis and Treatment of May-Thurner and Pelvic CongestionSyndromes Before Complications, in Patients with Thrombophilia of this compression
left common iliac vein (LCIV) is partially compressed between the right common iliac artery (RCIA) and the fifth lumbar vertebra, and because of the stress arising from the pulsation of the artery, the intima layer of the vein undergoes a hypertrophy with consequent development of Deep Vein Thrombosis (DVT) [1, 3]
On 11/2007, a 49-year-old white woman was complaining of pain in her lower extremities (LE), apart from feeling of heaviness and tiredness in her Right Lower Extremity (RLE), ankle edema, legs and pelvic varices

Summary

Introduction

May-Thurner syndrome (MTS), initially observed in 1851 by Virchow as an anatomical variation of the left common iliac vein, had its pathophysiology described by May and Thurner in 1956, which detailed anatomical description. The syndrome is characterized by an anatomical anomaly that results in compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA), cases of right vein compression have already been reported [3]. It is known as Cockett Syndrome, iliac vein compression syndrome and iliocaval compression syndrome [3]. Skin changes that indicate chronic venous insufficiency such as varicose veins, lipodermatosclerosis, phlebopathic ulcers, and moderate edema. Risk factors such as prolonged immobility, recent surgeries and pregnancy are predisposing to the development of MTS. In substitution for open surgery, more effective methods such as endovascular surgery with uncoated stent implantation, in addition to iliac vein adhesiolysis, anastomosis after RCIA transection of LCIV, resection of the involved segment of the iliac vein and vascular graft in situ have been used [7]

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Conclusion