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May-Thurner syndrome Volume 30, issue 2, March-April 2018

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Author
CHU Grenoble-Alpes, Clinique universitaire de médecine vasculaire, France
* Tirés à part

More than 50 years ago, May and Thurner, on autopsy series, then Cockett and Thomas, on phlebographic series, described this venous vascular trap of the May-Thurner syndrome. It concerns most of the time the left primary iliac vein, trapped between the right primitive iliac artery and the anterior vertebral wall. This compression would be a factor of thrombosis and would explain the predominant left localization of the thrombotic events. The 1990s saw the development of venous endovascular techniques and thus the possibilities of treatment of this syndrome. There are many publications regarding this treatment. However, data are extremely heterogeneous, and no consensual strategy has yet been proposed. The circumstances leading to the diagnosis are varied: acute thrombosis, post-thrombotic syndrome, even symptomatic patients out of any thrombotic context. They are many methods to explore deep venous obstruction but none is specifically validated. Despite this heterogeneity, published series show very good results in terms of technical success, rate of permeability or clinical improvement. Endovascular treatment has been shown to be effective and safe in retrospective case series, but objective criteria for the indication of the deployment of an endoprosthesis remain to be defined. In the absence of thrombosis, establishing a causal link between clinical symptomatology and imaging data in favor of May-Thurner syndrome may be difficult. Determining criteria to establish this link is an essential prerequisite before proposing invasive therapy.

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