The therapeutic approach of the May-Thurner Syndrome without Deep Venous Thrombosis: a systematic review

Abstract

May-Thurner Syndrome is a clinical condition which causes a variety of vascular symptoms, resulting from pelvic and lower extremity venous flow obstruction caused by the compression of the iliac vein by overlying iliac artery. Treatment paradigms have changed as experience with endovascular modalities has evolved, making traditional surgical treatment strategies essentially obsolete and a endovascular treatment with angioplasty and stenting along selective thrombolysis has become the standard for symptomatic the syndrome. The objective of this present study is to show the therapeutic approach in treatment when there’s no presence of Deep Venous Thrombosis (DVT) symptoms. To accomplish this purpose, a systematic review of articles about May-Thurner Syndrome and its management therapies, published from January 1, 2005 to September 20, 2015, on PubMED and SCOPUS databases, was carried out. Search terms were “may-thurner syndrome” (medical subject headings [MeSH term]), “iliocaval compression syndrome” (MeSH), “cockett syndrome” (MeSH), “peripheral vascular diseases” (MeSH), and “treatment” (keyword). Of the 89 retrieved studies, 14 met the elegibility criteria. Retrieved studies covered that without correction of this syndrome, patients are at continued risk for recurrent deep vein thrombosis and post-thrombotic syndrome. Considering the therapy, systemic anticoagulation is the first component, and endovascular treatment appears to be superior to conventional surgical treatment. It should be the first line of therapy. Furthermore, there has been multiple advences in the recent years for chronic arterial occlusions using techniques such as blunt micro dissection, radiofrequency energy and laser. In the absence of deep venous trombosis, conservative treatments are preferred. To conclude, based on the review of the literature, a combination of conservative and endovascular therapy usually provides the best treatment in most cases. Thus, further researches must be done to advance in the matter of therapeutic of the non-DVT form of May-Thurner Syndrome.   Keywords: May-Thurner Syndrome, Iliocaval Compression Syndrome, Cockett Syndrome, Peripheral Vascular Disease, Treatment.