May Thurner’s Syndrome/NIVL/ILIAC VEIN Compression Syndrome
What is May Thurner’s Syndrome?
A substantial number of patients with chronic venous disease complain of disabling pain and swelling of the lower limbs without skin changes. It is possible that these symptoms are mainly attributable to obstruction and the iliac vein is the common outflow tract of the lower extremity, and chronic obstruction of this segment appears to result in more severe symptoms than does lower segmental blockage.
Symptomatic Non thrombotic iliac vein obstructive lesions have previously been described as May-Thurner syndrome or Cockett’s or iliac vein compression syndrome. All though, iliac vein compression syndrome typically involves the left proximal common iliac vein and is clinically expressed only in the left lower extremity of predominantly young women of childbearing age, Compression Lesions can occur in Men also involving Right lower limb also. Intraluminal web or band formation of the iliac vein causes varying degrees of external compression in Iliac vein in general population.
Compression of the common iliac vein was seen in 36%, of the external iliac vein in 18%, and of both sites in 46% of limbs in symptomatic patients. The ages of the patients with non-thrombotic blockage ranged from 18 to 90 years (median, 54 years); 20% of patients were men, and 25% of the symptomatic lower limbs were on the right side.
When is May Thurner’s Syndrome Considered a Cause for Concern?
Deep venous obstructive disease in combination with venous insufficiency has been noted in up to 55% of patients with CVI(Chronic Venous insufficiency), especially in those with the most severe symptoms. More than half of patients with leg ulcers that do not improve with conservative treatment and saphenous vein ablation or phlebectomy have been found to have iliac vein outflow obstruction. It is well recognized that the combination of reflux and obstruction results in the highest levels of venous hypertension in patients with chronic venous disease with severe symptoms like disabling pain and swelling of the lower limbs without skin changes or with leg ulcers.
Certainly patients with decreased quality of life and moderate disability have significant outflow obstruction in 10 to 20% of patients who will need further evaluation.
What are the Clinical Signs of Deep Venous Obstruction?
Obstruction of the deep veins may limit the outflow of blood and cause increased venous pressure with muscle contraction and secondary muscle pump dysfunction. Symptoms of obstruction Causing chronic venous disease, ranges from moderate swelling and pain to discoloration and stasis ulcer. The clinical expression is also influenced by any concomitant deep or superficial reflux. Limb swelling and pain are related to the obstructive component, whereas limb ulceration results from valve reflux. Debilitating “venous claudication” (Bursting pain) is found in 15% to 44% of patients, and venous ulcer has developed in 15% of limbs.
Symptomatic Nonthrombotic iliac vein obstructive lesions(NIVL) have been described as May-Thurner syndrome or Cockett’s or iliac vein compression syndrome. Compression of the common iliac vein was seen in 36%, of the external iliac vein in 18%, and of both sites in 46% of limbs in symptomatic patients and is commonly seen in left side, but compression of Iliac veins can also be present in right side also, Symptoms of Iliac vein obstruction or May THURNER’S Syndrome may be any of those associated with Chronic venous disease, ranging from moderate swelling and pain to discoloration and Non healing ulcer in Patients with previous DVT, patients with limb symptoms (especially pain out of proportion to detectable disease), patients not improving with conservative treatment.