English Polski
Vol 23, No 1-2 (2021)
Research paper
Published online: 2022-09-21
Page views 3260
Article views/downloads 21
Get Citation

Connect on Social Media

Connect on Social Media

Lumbar overlordosis — towards the better understanding of the May-Thurner syndrome pathogenesis

Katarzyna Kościelna-Buczek1, Ewa Mędoń1, Michał Widuch1, Bartosz Kończyk1, Wacław Kuczmik1, Tomasz Urbanek1
Chirurgia Polska 2021;23(1-2):1-10.

Abstract

Introduction: May-Thurner Syndrome (MTS) is a condition in which the left common iliac vein is compressed
by the right common iliac artery, which together with intraluminal vein changes can lead to clinically
symptomatic venous outflow obstruction. Patients having such pathology may suffer from symptoms of
venous hypertension as well as lower leg deep venous thrombosis. In most of the MTS cases, static and
continuous compression is observed which can also lead to the intraluminal spur formation. According to
the literature, among the factors which can influence the severity of iliac vein compression, lumbar spinal
degeneration can also be mentioned. Considering the aortic bifurcation anatomical conditions, also other,
non — degenerative changes of the lumbar vertebral column segment can be taken into consideration.

Aim: This study aimed to reveal the prevalence of the left common iliac vein compression in young healthy
individuals as well as to assess the severity of the left iliac vein compression provoked by lumbar
hyperlordosis.

Material and methods: The study was performed on a group of 207 volunteers of both sexes, aged 21–27

yrs. using ultrasound examination to measure the diameter of the right common iliac vein as well as the
diameter of the left common iliac vein in the area of the possible compression by the right iliac artery.
In all the patients the measurements were performed in the supine position as well as in the provoked
lumbar hyperlordosis position. In all the individuals the presence of the symptoms and signs of the lower
leg chronic venous disease were investigated.

Results: The mean anterior-posterior diameter of the right common iliac vein in the standard supine position
in the whole study group was 5.71 mm (± 0.6 mm). The mean diameter of the left common iliac vein in
a normal horizontal position was 4.87 mm (± 0.6 mm) with a range from 3.8 mm to 6.2 mm. In most of
the cases, the difference between the left and iliac common vein diameter (when measured in the place
of the right iliac artery crossing) did not exceed 20%. In 15.9% of the study subjects, the right and left iliac
vein diameter difference ranges between 20–30% and in 2.41% only, the diameter difference over 30%
was noticed (in none of the cases the stenosis exceeding 40% of the vein diameter was found). Looking
for the effect of the overlordosis on the proclivity to decrease left iliac vein diameter, in the provoked
hyperlordosis position the changes of the iliac vein diameter in the range of 21–30% were observed in
15.9% and over 30% in 2.4% of the study subjects. Hyperlordosis presence was also responsible for the
shift towards lower left iliac vein diameter — in 36.2% of the patients, the left iliac vein diameter below
4 mm was noticed including 1.9% of individuals with a diameter not exceeding 3 mm. In the analysis,
there was no statistically significant correlation between the presence of the reported CVD symptoms in
the left leg and the reported diameter reduction between the right and left iliac veins in the population of
the studied young individuals.

Conclusions: Left common iliac vein compression may be anatomically conditioned at least in some of
the young population individuals. Lumbar hyperlordosis influence on the left common iliac vein diameter
suggests that also in healthily individuals, an incorrect spinal position can promote the occurrence of the
left iliac vein compression. Further studies are needed to assess the haemodynamic influence of these
findings on the lower leg venous outflow.

Article available in PDF format

Add to basket: 49.00 PLN

Aready have access?

References

  1. McMurrich JP. The occurrence of congenital adhesions in the common iliac veins, and their relation to thrombosis of the femoral and iliac veins. Am J Med Sci. 1908; 135: 342–5.
  2. MAY R, THURNER J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957; 8(5): 419–427.
  3. Cockett FB, Thomas ML. The iliac compression syndrome. Br J Surg. 1965; 52(10): 816–821.
  4. Kibbe MR, Ujiki M, Goodwin AL, et al. Iliac vein compression in an asymptomatic patient population. J Vasc Surg. 2004; 39(5): 937–943.
  5. Corrêa MP, Kurtz GS, Bianchini L, et al. Prevalence of left iliac vein compression on computed tomography scans from a population. J Vasc Bras. 2020; 19: e20190060.
  6. Birn J, Vedantham S. May-Thurner syndrome and other obstructive iliac vein lesions: meaning, myth, and mystery. Vasc Med. 2015; 20(1): 74–83.
  7. Radaideh Q, Patel NM, Shammas NW. Iliac vein compression: epidemiology, diagnosis and treatment. Vasc Health Risk Manag. 2019; 15: 115–122.
  8. Liddell RP, Evans NS. May-Thurner syndrome. Vasc Med. 2018; 23(5): 493–496.
  9. Kahn SR, Solymoss S, Lamping DL, et al. Long-term outcomes after deep vein thrombosis: postphlebitic syndrome and quality of life. J Gen Intern Med. 2000; 15(6): 425–429.
  10. Bergan JJ, Schmid-Schönbein GW, Smith PD, et al. Chronic venous disease. N Engl J Med. 2006; 355(5): 488–498.
  11. Tran NT, Meissner MH. The epidemiology, pathophysiology, and natural history of chronic venous disease. Semin Vasc Surg. 2002; 15(1): 5–12.
  12. Radaideh Q, Patel NM, Shammas NW. Iliac vein compression: epidemiology, diagnosis and treatment. Vasc Health Risk Manag. 2019; 15: 115–122.
  13. Raju S. Best management options for chronic iliac vein stenosis and occlusion. J Vasc Surg. 2013; 57(4): 1163–1169.
  14. Santoshi RKN, Lakhanpal S, Satwah V, et al. Iliac vein stenosis is an underdiagnosed cause of pelvic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2018; 6(2): 202–211.
  15. Daugherty SF, Gillespie DL. Venous angioplasty and stenting improve pelvic congestion syndrome caused by venous outflow obstruction. J Vasc Surg Venous Lymphat Disord. 2015; 3(3): 283–289.
  16. Meissner MH, Khilnani NM, Labropoulos N, et al. The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. J Vasc Surg Venous Lymphat Disord. 2021; 9(3): 568–584.
  17. O'Sullivan GJ, Semba CP, Bittner CA, et al. Endovascular management of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 2000; 11(7): 823–836.
  18. Yue L, Fu HY, Sun HL. Acute deep venous thrombosis induced by May-Thurner syndrome after spondylolisthesis surgery: A case report and review of literature. World J Clin Cases. 2021; 9(25): 7490–7497.
  19. Kasirajan K, Gray B, Ouriel K. Percutaneous AngioJet thrombectomy in the management of extensive deep venous thrombosis. J Vasc Interv Radiol. 2001; 12(2): 179–185.
  20. Thijs W, Rabe KF, Rosendaal FR, et al. Predominance of left-sided deep vein thrombosis and body weight. J Thromb Haemost. 2010; 8(9): 2083–2084.
  21. Nazzal M, El-Fedaly M, Kazan V, et al. Incidence and clinical significance of iliac vein compression. Vascular. 2015; 23(4): 337–343.
  22. Choi JW, Jae HJ, Kim HC, et al. CT venography for deep venous thrombosis: can it predict catheter-directed thrombolysis prognosis in patients with iliac vein compression syndrome? Int J Cardiovasc Imaging. 2015; 31(2): 417–426.
  23. Chung JW, Yoon CJ, Jung SIl, et al. Acute iliofemoral deep vein thrombosis: evaluation of underlying anatomic abnormalities by spiral CT venography. J Vasc Interv Radiol. 2004; 15(3): 249–256.
  24. Patel NH, Stookey KR, Ketcham DB, et al. et al.. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome, J Vasc Interv Radiol. 2000; 11(10): 1297–1302.
  25. Radaideh Q, Patel NM, Shammas NW. Iliac vein compression: epidemiology, diagnosis and treatment. Vasc Health Risk Manag. 2019; 15: 115–122.
  26. Raffini L, Raybagkar D, Cahill AM, et al. May-Thurner syndrome (iliac vein compression) and thrombosis in adolescents. Pediatr Blood Cancer. 2006; 47(6): 834–838.
  27. Ou-Yang L, Lu GM. Underlying Anatomy and Typing Diagnosis of May-Thurner Syndrome and Clinical Significance: An Observation Based on CT. Spine (Phila Pa 1976). 2016; 41(21): E1284–E1291.
  28. Kim DuH, Boudier-Revéret M, Sung DH, et al. Deep vein thrombosis of the common iliac vein caused by neurogenic heterotopic ossification in the anterior lower lumbar spine of a patient with complete paraplegia due to radiation-induced myelopathy. J Spinal Cord Med. 2022; 45(2): 316–319.
  29. Xu F, Tian Z, Huang X, et al. A case report of May-Thurner syndrome induced by anterior lumbar disc herniation: Novel treatment with radiofrequency thermocoagulation. Medicine (Baltimore). 2019; 98(44): e17706.
  30. McKean D, Allman Sutcliffe J, El Hassan H, et al. May-Thurner variant secondary to degenerative lumbar spondylolisthesis: a case report. BJR Case Rep. 2017; 3(4): 20170011.
  31. Khalid S, Youn YJ, Azrin M, et al. Late-Onset Nonthrombotic Left Common Iliac Vein Compression Secondary to Degenerative Lumbar Disc: A Case Report of May-Thurner Variant. Vasc Endovascular Surg. 2019; 53(1): 62–65.
  32. Delara R, Cornella J, Knuttinen MG. May-Thurner Syndrome from Spinal Anterolisthesis. J Minim Invasive Gynecol. 2021; 28(2): 160–161.
  33. Rachaiah JM, Goyal V, Nagesh C, et al. An interesting case of iatrogenic may thurner like syndrome. Int J Med Res Health Sci. 2016; 5(6): 83–86.
  34. Reddy D, Mikhael MM, Shapiro GS, et al. Extensive Deep Venous Thrombosis Resulting from Anterior Lumbar Spine Surgery in a Patient with Iliac Vein Compression Syndrome: A Case Report and Literature Review. Global Spine J. 2015; 5(4): e22–e27.
  35. Oteros Fernández R, Bravo Rodríguez F, Delgado Acosta F, et al. [May-Thurner syndrome and surgery for scoliosis]. Radiologia. 2008; 50(3): 245–247.
  36. Lee AJ, Robertson LA, Boghossian SM, et al. Progression of varicose veins and chronic venous insufficiency in the general population in the Edinburgh Vein Study. J Vasc Surg Venous Lymphat Disord. 2015; 3(1): 18–26.
  37. Giacon Co, Tachibana A. da Silva Magao F . Magnetic Resonance Imaging Evaluation of Left Common Iliac Vein Compression in Patients With and Without Symptoms of Venous Disease Circulation Journal Circ J. 2020; 84: 763.
  38. Liu P, Peng J, Zheng L, et al. Application of computed tomography venography in the diagnosis and severity assessment of iliac vein compression syndrome: A retrospective study. Medicine (Baltimore). 2018; 97(34): e12002.
  39. Raju S, Neglen P. High prevalence of nonthrombotic iliac vein lesions in chronic venous disease: a permissive role in pathogenicity. J Vasc Surg. 2006; 44(1): 136–43; discussion 144.
  40. Friedrich de Wolf MA, Arnoldussen CW, Grommes J, et al. Minimally invasive treatment of chronic iliofemoral venous occlusive disease. J Vasc Surg Venous Lymphat Disord. 2013; 1(2): 146–153.
  41. Friedrich de Wolf MA, Arnoldussen CW, Grommes J, et al. Minimally invasive treatment of chronic iliofemoral venous occlusive disease. J Vasc Surg Venous Lymphat Disord. 2013; 1(2): 146–153.
  42. Anderson FA, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003; 107(23 Suppl 1): I9–16.
  43. Chen F, Den J, Yuan QW, et al. Compression of left common iliac vein is independently associated with left-sided deep vein thrombosis. J Vasc Surg Venous Lymphat Disord. 2013; 1(4): 364–369.
  44. Narayan A, Eng J, Carmi L, et al. Iliac vein compression as risk factor for left- versus right-sided deep venous thrombosis: case-control study. Radiology. 2012; 265(3): 949–957.
  45. Carr S, Chan K, Rosenberg J, et al. Correlation of the diameter of the left common iliac vein with the risk of lower-extremity deep venous thrombosis. J Vasc Interv Radiol. 2012; 23(11): 1467–1472.
  46. Gagne PJ, Tahara RW, Fastabend CP, et al. Venography versus intravascular ultrasound for diagnosing and treating iliofemoral vein obstruction. J Vasc Surg Venous Lymphat Disord. 2017; 5(5): 678–687.



Chirurgia Polska (Polish Surgery)