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The Importance of Diagnosis and Treatment of May-Thurner and Pelvic Congestion Syndromes Before Complications, in Patients with Thrombophilia

Received: 1 May 2018     Accepted: 28 May 2018     Published: 14 June 2018
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Abstract

May-Thurner syndrome (MTS), initially observed in 1851 by Virchow as an anatomical variation of the left common iliac vein. In 1965, Cockett and Thomas supplemented the work of May and Thurner correlating with the observed symptoms. The syndrome is characterized by an anatomical anomaly that results in compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) [3]. It is also known as Cockett Syndrome, iliac vein compression syndrome and iliocaval compression syndrome [3]. Because of the stress arising from the pulsation of the artery, the intima layer of the vein undergoes a hypertrophy with consequent development of Deep Vein Thrombosis (DVT) [1, 3]. Because it prevents drainage to the inferior vena cava, MTS is related to the appearance of pelvic varices characterized by dilatation and reflux, venous stasis of the pelvic organs, having as main manifestation chronic pelvic pain (CPP) without inflammatory signs, although the CPP does not is a well-defined diagnostic criterion [5, 6]. In substitution for open surgery, appeared more effective methods such as endovascular surgery [7]. The patient in this case authorized the authors to describe her clinical case. We performed a search on the PubMed and Bireme databases. A white woman was complaining of pain in her lower extremities (LE), apart from feeling of heaviness and tiredness in her Right Lower Extremity (RLE), ankle edema, legs and pelvic varices. At physical examination, the patient had the presence (according to the CEAP classification) of C1, 3 varicose veins in the RLE and C1, 2, 3 varicose veins in the Left Lower Extremity (LLE). She was submitted to varied clinical treatment, and the investigation of the causes of the symptoms, including thrombophilia. She was not responding well to the treatment and the endovascular treatment of Cockett's syndrome was performed. Due to the non-release of the embolization of the ovarian veins by the patient's health plan there was a delaying for the right treatment of the patient, because she has ovarian varicose veins. The endovascular treatment of the May-Thurner and Pelvic Congestion Syndrome is safe and has excellent primary patency in the medium to long term.

Published in Journal of Surgery (Volume 6, Issue 4)
DOI 10.11648/j.js.20180604.12
Page(s) 88-91
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

May-Thurner Syndrome, Venous Insufficiency, Pelvic, Cockett Symdrome, Therapeutic, Trombophilia

References
[1] Cunha JJRd, Neves DQ, Fontes FA, Solano GP, Cardoso MCT, Lima MHd, et al. Endovascular treatment of the iliac vein compression syndrome (May-Thurner): case report. Jornal Vascular Brasileiro 2011; 10 (1):72-6.
[2] Butros SR, Liu R, Oliveira GR, Ganguli S, Kalva S. Venous compression syndromes: clinical features, imaging findings and management. Br J Radiol. 2013; 86 (1030):20130284.
[3] Cavalcante LP, Souza JEdS, Pereira RM, Bernardes MV, Amanajás AMdS, Parisati MH, et al. Iliac vein compression syndrome: literature review. Jornal Vascular Brasileiro. 2015; 14 (1):78-83.
[4] Calvaresi E, Swaminathan M, Jokela J. A Case of May-Thurner Syndrome. Carle Sel Pap. 2016; 59 (1):46-47. PMID:27489392.
[5] Galego GdN, Silveira PG, Bortoluzzi CT, Franklin RN, Ronchi TM. Pelvic Congestion Syndrome case series: results of endovascular treatment. Jornal Vascular Brasileiro. 2015; 14 (3):262-6.
[6] Daniels J, Champaneria R, Shah L, Gupta J, Birch J, Moss J. Effectiveness of Embolization or Sclerotherapy of Pelvic Veins for Reducing Chronic Pelvic Pain: A Systematic Review. Journal of vascular and interventional radiology. 2016; 27 (10):1478-86.
[7] Zhang X, Shi X, Gao P, Wang J, Li S, Yao S, et al. Endovascular Management of May-Thurner Syndrome: A Case Report. Medicine (Baltimore). 2016; 95 (4):e2541.
[8] Nazzal M, El-Fedaly M, Kazan V, Qu W, Renno AW, Al-Natour M, et al. Incidence and clinical significance of iliac vein compression. Vascular. 2015; 23 (4):337-43.
[9] Titus, Jessica M. et al. Iliofemoral stenting for venous occlusive disease. J Vasc Surg. 2011;Mar; 53 (3):706-12. doi: 10.1016/j.jvs.2010.09.011. Epub 2010 Dec 3. PMID:21129907.
[10] Park JY, Ahn JH, Jeon YS, Cho SG, Kim JY, Hong KC. Iliac vein stenting as a durable option for residual stenosis after catheter-directed thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May–Thurner syndrome. Phlebology. 2014 Aug; 29 (7):461-70. doi:10.1177/0268355513491724. Epub 2013 May 28. PMID:23761876.
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    Diego Victor Nascimento, Gabrielle Maria de Oliveira Kraychete da Silveira, Helena Chaves de Queiroga, Lidie Anne Diniz Viégas, Sérgio Ricardo Ferreira Vieira, et al. (2018). The Importance of Diagnosis and Treatment of May-Thurner and Pelvic Congestion Syndromes Before Complications, in Patients with Thrombophilia. Journal of Surgery, 6(4), 88-91. https://doi.org/10.11648/j.js.20180604.12

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    ACS Style

    Diego Victor Nascimento; Gabrielle Maria de Oliveira Kraychete da Silveira; Helena Chaves de Queiroga; Lidie Anne Diniz Viégas; Sérgio Ricardo Ferreira Vieira, et al. The Importance of Diagnosis and Treatment of May-Thurner and Pelvic Congestion Syndromes Before Complications, in Patients with Thrombophilia. J. Surg. 2018, 6(4), 88-91. doi: 10.11648/j.js.20180604.12

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    AMA Style

    Diego Victor Nascimento, Gabrielle Maria de Oliveira Kraychete da Silveira, Helena Chaves de Queiroga, Lidie Anne Diniz Viégas, Sérgio Ricardo Ferreira Vieira, et al. The Importance of Diagnosis and Treatment of May-Thurner and Pelvic Congestion Syndromes Before Complications, in Patients with Thrombophilia. J Surg. 2018;6(4):88-91. doi: 10.11648/j.js.20180604.12

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  • @article{10.11648/j.js.20180604.12,
      author = {Diego Victor Nascimento and Gabrielle Maria de Oliveira Kraychete da Silveira and Helena Chaves de Queiroga and Lidie Anne Diniz Viégas and Sérgio Ricardo Ferreira Vieira and Francisco Chavier Vieira Bandeira and Paulo Roberto da Silva Lima},
      title = {The Importance of Diagnosis and Treatment of May-Thurner and Pelvic Congestion Syndromes Before Complications, in Patients with Thrombophilia},
      journal = {Journal of Surgery},
      volume = {6},
      number = {4},
      pages = {88-91},
      doi = {10.11648/j.js.20180604.12},
      url = {https://doi.org/10.11648/j.js.20180604.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20180604.12},
      abstract = {May-Thurner syndrome (MTS), initially observed in 1851 by Virchow as an anatomical variation of the left common iliac vein. In 1965, Cockett and Thomas supplemented the work of May and Thurner correlating with the observed symptoms. The syndrome is characterized by an anatomical anomaly that results in compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) [3]. It is also known as Cockett Syndrome, iliac vein compression syndrome and iliocaval compression syndrome [3]. Because of the stress arising from the pulsation of the artery, the intima layer of the vein undergoes a hypertrophy with consequent development of Deep Vein Thrombosis (DVT) [1, 3]. Because it prevents drainage to the inferior vena cava, MTS is related to the appearance of pelvic varices characterized by dilatation and reflux, venous stasis of the pelvic organs, having as main manifestation chronic pelvic pain (CPP) without inflammatory signs, although the CPP does not is a well-defined diagnostic criterion [5, 6]. In substitution for open surgery, appeared more effective methods such as endovascular surgery [7]. The patient in this case authorized the authors to describe her clinical case. We performed a search on the PubMed and Bireme databases. A white woman was complaining of pain in her lower extremities (LE), apart from feeling of heaviness and tiredness in her Right Lower Extremity (RLE), ankle edema, legs and pelvic varices. At physical examination, the patient had the presence (according to the CEAP classification) of C1, 3 varicose veins in the RLE and C1, 2, 3 varicose veins in the Left Lower Extremity (LLE). She was submitted to varied clinical treatment, and the investigation of the causes of the symptoms, including thrombophilia. She was not responding well to the treatment and the endovascular treatment of Cockett's syndrome was performed. Due to the non-release of the embolization of the ovarian veins by the patient's health plan there was a delaying for the right treatment of the patient, because she has ovarian varicose veins. The endovascular treatment of the May-Thurner and Pelvic Congestion Syndrome is safe and has excellent primary patency in the medium to long term.},
     year = {2018}
    }
    

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    AU  - Diego Victor Nascimento
    AU  - Gabrielle Maria de Oliveira Kraychete da Silveira
    AU  - Helena Chaves de Queiroga
    AU  - Lidie Anne Diniz Viégas
    AU  - Sérgio Ricardo Ferreira Vieira
    AU  - Francisco Chavier Vieira Bandeira
    AU  - Paulo Roberto da Silva Lima
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    JF  - Journal of Surgery
    JO  - Journal of Surgery
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    PB  - Science Publishing Group
    SN  - 2330-0930
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    AB  - May-Thurner syndrome (MTS), initially observed in 1851 by Virchow as an anatomical variation of the left common iliac vein. In 1965, Cockett and Thomas supplemented the work of May and Thurner correlating with the observed symptoms. The syndrome is characterized by an anatomical anomaly that results in compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) [3]. It is also known as Cockett Syndrome, iliac vein compression syndrome and iliocaval compression syndrome [3]. Because of the stress arising from the pulsation of the artery, the intima layer of the vein undergoes a hypertrophy with consequent development of Deep Vein Thrombosis (DVT) [1, 3]. Because it prevents drainage to the inferior vena cava, MTS is related to the appearance of pelvic varices characterized by dilatation and reflux, venous stasis of the pelvic organs, having as main manifestation chronic pelvic pain (CPP) without inflammatory signs, although the CPP does not is a well-defined diagnostic criterion [5, 6]. In substitution for open surgery, appeared more effective methods such as endovascular surgery [7]. The patient in this case authorized the authors to describe her clinical case. We performed a search on the PubMed and Bireme databases. A white woman was complaining of pain in her lower extremities (LE), apart from feeling of heaviness and tiredness in her Right Lower Extremity (RLE), ankle edema, legs and pelvic varices. At physical examination, the patient had the presence (according to the CEAP classification) of C1, 3 varicose veins in the RLE and C1, 2, 3 varicose veins in the Left Lower Extremity (LLE). She was submitted to varied clinical treatment, and the investigation of the causes of the symptoms, including thrombophilia. She was not responding well to the treatment and the endovascular treatment of Cockett's syndrome was performed. Due to the non-release of the embolization of the ovarian veins by the patient's health plan there was a delaying for the right treatment of the patient, because she has ovarian varicose veins. The endovascular treatment of the May-Thurner and Pelvic Congestion Syndrome is safe and has excellent primary patency in the medium to long term.
    VL  - 6
    IS  - 4
    ER  - 

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Author Information
  • Department of Medicine, Universetary Center of Jo?o Pessoa (UNIPê), Jo?o Pessoa - PB, Brazil

  • Department of Medicine, Universetary Center of Jo?o Pessoa (UNIPê), Jo?o Pessoa - PB, Brazil

  • Department of Medicine, Universetary Center of Jo?o Pessoa (UNIPê), Jo?o Pessoa - PB, Brazil

  • Department of Medicine, Universetary Center of Jo?o Pessoa (UNIPê), Jo?o Pessoa - PB, Brazil

  • Department of Medicine, Faculty of Medical Sciences of Paraíba (FCM), Jo?o Pessoa - PB, Brazil

  • Department of Medicine, Federal University of Paraíba (UFPB), Jo?o Pessoa - PB, Brazil

  • Department of Medicine, Universetary Center of Jo?o Pessoa (UNIPê), Jo?o Pessoa - PB, Brazil

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