May–Thurner and Paget–Schroetter Syndromes: A Review

Abstract

May-Thurner and Paget-Schroetter syndromes are rare conditions encountered by vascular surgeons. An updated knowledge about these conditions is crucial for the effective management of patients with these syndromes who are mostly young. May-Thurner syndrome (MTS) is caused by the compression of the left common iliac vein by the right common iliac artery, and it is a risk factor for left leg deep venous thrombosis (DVT). Imaging (conventional venogram, computed tomography venography (CTV), magnetic resonance imaging (MRV)) can reveal the stenotic venous segment where the artery crosses. Stenting in symptomatic patients yields good results with minimal recurrence. Paget-Schroetter syndrome (PSS) is an idiopathic axillary-subclavian vein thrombosis mostly affecting the young population, particularly those who have repeated overhead arm activities. Narrower costoclavicular space along with other anatomical and coagulation factors can possibly lead to this condition. Patients can present with acute DVT, post-thrombotic syndrome or subclinical syndromes. Venogram, CTV or MRV with provocative maneuvres can confirm the dynamic obstruction. Thrombolysis followed by early bony decompression is advocated in patients presenting with acute arm DVT, as this approach is associated with limited residual disability and recurrence. This review discusses the current concepts and treatment options of both conditions.