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May-Thurner Syndrome

May-Thurner Syndrome is more common in women

Women with MTS tend to present at a younger age and have increased risk of pulmonary embolism compared with men although the latter experience more pain with the syndrome
Open procedures had significantly higher complications compared with endovascular interventions (p=0.021)

May-Thurner Syndrome (MTS) - sometimes inaccurately used in the literature to describe iliac vein compression - is more common in women with a ratio of at least 2:1 compared with men, according to a systematic review, according to researchers from the University of Pittsburgh and Yale University. The authors noted that women with MTS tend to present at a younger age and have increased risk of pulmonary embolism compared with men although the latter experience more pain with the syndrome.

In 1957, two German researchers, R May and J Thurner, performed an autopsy series of 430 cadavers and anatomical compression in 22%. Cockett and Thomas first described a large series of patients presenting with this diagnosis in 1965, coining the term iliac compression syndrome. Up to 5% of patients with symptoms of chronic venous insufficiency have MTS.

In the paper, ‘Systematic review of May-Thurner syndrome with emphasis on gender differences’, published in the Journal of Vascular Surgery Venous and Lymphatic Disorders, researchers led by vascular surgeon Dr Cassius Iyad Ochoa Chaar, performed an extensive review of the literature dating back to 1967. They found 174 articles dating back to 1967, along with consistent descriptions of the syndrome.

“May-Thurner Syndrome is increasingly recognized as a cause of chronic venous insufficiency and a precipitating factor for venous thromboembolism,” explained Dr Chaar. “Despite controversy about the exact definition of the pathology, this review confirms endovascular treatment to be safe and effective therapy for acute venous thrombosis or chronic compression.”

They compiled the information gathered within 137 articles (asymptomatic patients with just anatomic compression without symptoms were excluded) describing the presentation and treatment of 1,569 patients (976 females, 480 males). One of the main features of the article was determination of differences in presentation with respect to patient gender.

The 50-year review of May-Thurner research found:

  • Female patients outnumber males 2:1 (976 [67.1%] vs 480 [32.9%])
  • Females presented at a younger age than men - average age of 39 compared to 46 for males (38.7 ± 14.0 years vs 46.2 ± 16.9 years; 0=0.02)
  • Males reported significantly more pain and swelling (92.7% vs 80.8%; p=0.037)
  •  No gender difference in deep vein thrombosis (89% vs 82%; p=0.14), but significant difference in pulmonary embolism (9.9% vs 1.6%; p=0.035) in females

With regard to treatment observations, the researchers found the most used treatments were endovascular without thrombolysis (53%), endovascular with lysis (33%), open surgery (7%) and medical management (7%). A summation of results showed that 12-month iliac vein patency was achieved in 96% for endovascular therapy and 64% for open surgery.

However, because of lack of sufficient data, it was not possible to distinguish treatment methods between female and male patients. Interestingly, they noted no no statistically significant difference in complication rate between men and women based on the articles that provided that information (p=0.34), although open procedures had significantly higher complications compared with endovascular interventions (p=0.021).

In addition to the gender differences, the authors closely evaluated MTS treatment during pregnancy. Unfortunately, this evaluation was unable to come to any consensus on treatment in this difficult situation.