The May-Thurner Syndrome or the Cockett Syndrome constitutes the compression of the left Common Iliac Vein by the right common Iliac artery against the lumbar vertebrae. The artery crossing in front of the vein is an usual condition but, in approximately 20% of the eastern population, it causes a considerable narrowing of the vein, leading to symptoms like pain, limb swelling, weight in the limbs and varicose veins. It is also the only anatomical risk factor for Deep Venous Thrombosis (DVT). In order to maintain the venous return, collateral veins are developed and may cause symptoms as well, leading to Pelvic Venous Congestion. It is a frequent cause of pelvic pain usually not controlled by the usual gynecological treatment.
The diagnosis is suspected by the personal history and the physical examination when varicose veins, swelling and dystrophic alterations of the skin can be noticed.
The diagnosis is confirmed by means of an AngioCT or AngioMR. By those methods, a compression of the vein can be seen and measured, as well as the collateral circulation developed.
Phlebography is a precise and detailed method but Intravascular Ultrasound is the Gold Standard since it can identify intravascular complications such as partial Thrombus, Webs and Spurs.
With the rise of the Endovascular Surgery, a new perspective came out to treat this disease. A stent Angioplasty at the level of the compression increases the direct flow, downsizing symptoms.
Unfortunately there are other types of venous compressions along the Iliac veins due to the high incidence of anatomical variance and other pathologies leading to similar symptoms.
The clinical treatment with the use of compression stockings and rest is an alternative for the intervention but, the abandon rate along the time is high, reaching as much as 70%.
The best approach to each patient shall be balanced by the physician in conjunction with the patients expectation.
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