Prevalence of May-Thurner Syndrome in Patients with Deep Vein Thrombosis at a Large Medical Referral Center

Abstract

Objective We set out to investigate the prevalence of May-Thurner syndrome (MTS) in a cohort of patients diagnosed with iliofemoral deep vein thrombosis at a large medical referral center.

Materials and Methods We retrospectively analyzed a cohort of 496 patients who were referred to the emergency unit of a large medical referral center with suspected venous thromboembolism (VTE) and were diagnosed with deep vein thrombosis of the iliac veins and/or the thigh on ultrasound. We retrospectively assessed the presence of MTS in the primary ultrasound examination and on additional imaging (available in n = 193 patients).

Results Across all 496 patients with iliofemoral deep vein thrombosis, the median age was 70 years. 238 patients (48 %) were female. The thrombosis was left-sided in 263 cases (53 %), right-sided in 208 cases (42 %) and bilateral in 24 cases (5 %). In the subgroup of patients with left-sided and bilateral thrombosis, the growth pattern was classified as ascending in 142 patients (50 %), descending in 104 patients (36 %) and unclear in 41 patients (14 %). Additional imaging tests were available in 193 patients: 119 patients (41 %) underwent CT, 18 patients (6 %) MRI and 30 patients (10 %) underwent phlebography. Within the subgroup of patients with left-sided and bilateral thrombosis, MTS was confirmed in 88 patients (31 %), and the imaging findings in 17 patients (6 %) were highly suspicious of MTS. Differentiation was not possible in 86 patients (30 %) and MTS was excluded in 96 patients (33 %).

Conclusion Underlying MTS is not uncommon in the selected cohort of patients with deep iliofemoral vein thrombosis at a large referral center and should be excluded by imaging.

Key Points: 

• May-Thurner syndrome (MTS) is a relatively frequent cause of deep vein thrombosis.

• MTS should be excluded in patients with left-sided or bilateral iliofemoral thrombosis.

• Cross-sectional imaging is helpful in this setting.

• Approximately one third of patients in this subgroup show signs of MTS.

Citation Format

• Heller T, Teichert C, Hafer J et al. Prevalence of May-Thurner Syndrome in Patients with Deep Vein Thrombosis at a Large Medical Referral Center. Fortschr Röntgenstr 2019; 191: 1107 – 1117

Key words

iliac vein compression syndrome - May-Thurner syndrome - prevalence - iliofemoral deep vein thrombosis

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