Talk:May–Thurner syndrome

Broader Disease profile associated with May-Thurner syndrome

The current term Nonthrombotic iliac vein lesions((NIVL) describes the broader disease profile that has emerged with the use of intravascular ultrasound (IVUS) scanning for diagnosis. Non-thrombotic iliac vein lesions NIVLs are found in both the right and left common iliac veins as well as the right and left external iliac veins. Most commonly they are caused by arterial compression as is thought to be the case in May-Thurner syndrome. Other causes of external compression may also cause them as is the case in the inguinal ligament with involvement of the Common Femoral Vein.

Significant symptoms affecting Quality of Life have been attributed a broader disease profile known as Nonthrombotic iliac vein lesions (NIVL). These lesions and promising treatment is available. "Nonthrombotic iliac vein lesions (NIVL), such as webs and spurs described by May and Thurner, are commonly found in the asymptomatic general population. However, the clinical syndrome variously known as May-Thurner syndrome, Cockett syndrome, or iliac vein compression syndrorne, is thought to be a relatively rare contributor of chronic venous diseasc (CVD), predominantly affecting the left lower extremity of young women." Journal of Vascular Surgery 2006;44 page 136 In the broader and clinically much more common NIVL lesions Figure 7 page 141 JVS 2006;44 illustrates the bilaterallity as well as proximal and distal etiology of the lesions. "The pathologic anatomy of a nonthrombotic iliac vein lesion (NIVL). The classic left-sided proximal lesion is related to abrupt crossing of the left iliac vein by the right iliac artery. The subsequent course of the right iliac artery is variable (see text). The minority pattern (22%) is shown in the large drawing. Coursing lazily across the vein, the right iliac artery may be related to the proximal or distal NIVL, or both. In the majority pattern (prevalent in 75%, shown in the inset), the right iliac artery crosses the right common iliac vein more abruptly, but lower down at or near the external iliac vein level, inducing distal right NIVL but will not be a factor in the proximal right NIVL. The left hypogastric artery crossing may be related to left distal NIVL."JVS 2006 44; 141

In a broader more common context the NIVL lesions can affect Quality of Life in symptoms with Chronic Venous Disease (CVD). This is thought to be due to the iliac (proximal) outflow obstruction. For patients with symptoms from iliofemoral outflow obstruction the American Venous Forum gives a recommendation gives a grade 1A recommendation to correction using stents in the third edition published in 2009.

The syndromes that NIVLs can cause are more fully described by an original table referenced by the New England Journal of Medicine 360;22 page 2324 May 28, 2009 in Table 3. NIVLs are important components of the Venous hypertension syndrome, Venous leg swelling, and Complex multisystem venous disease.

Thrombotic and nonthrombotic iliac vein lesions can co-exist. Patients with symptoms of orthostatic pain and venous leg swelling will generally be followed on an outpatient basis by a specialist. Specialty centers such as the RANE center in Flowood, Mississippi fully examine these patients. More phlebologists and general/vascular surgeons and lymphologists are examining these patients. As opposed to acute thrombotic lesions the follow-up and treatment can be performed in an outpatient setting or even an office based clinic.

The rationale that the lesions are common but not symptomatic until another problem comes up has similarities in the medical world as a permissive lesion. Examples include the relationship between obesity and diabetes which is corrected by bariatric surgery as well as the paradoxical embolus from a patent foramen ovale.

— Preceding unsigned comment added by Hovorkamd (talk • contribs) 22:16, 23 August 2011 (UTC) 

Good review

doi:10.1111/jth.14707 JFW | T@lk 09:00, 21 October 2020 (UTC)