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How should we treat MayaThurner syndrome and other causes of iliac vein obstruction? Examining the evidence

A Azarbal, V Santo & G Moneta

May and Thurner originally described intimal abnormalities or ‘spurs’ in the proximal left iliac vein in a very large series of cadaver dissections. May and Thurner proposed that this abnormality, thought to be due to compression by the overlying right iliac artery, accounted for the fourfold increase in left-sided iliofemoral deep vein thromboses (IFDVTs) compared with right-sided IFDVTs. Since that time, other variants of iliac vein compression have since been described; it is recognized that iliac vein obstruction can be associated with both acute IFDVT as well as symptoms of chronic venous insufficiency. With the advent of endovascular treatment options, the source of iliac vein compression has become less important to treatment options, and therefore the term ‘nonthrombotic iliac vein lesion’ is often used to refer to cases of iliac vein stenosis secondary to external compression. In addition, the distinction between thrombotic and nonthrombotic causes of iliac vein obstruction may make little difference in terms of treatment options and outcomes of iliac vein obstruction.