May-Thurner syndrome diagnosis and management with concurrent lymphedema

Abstract

Background

May-Thurner syndrome (MTS) is an anatomical anomaly characterized by compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) presenting with left lower extremity swelling and venous hypertension. Persistent symptoms after MTS treatment often lead to referral for lymphedema workup to explore non-venous causes. We aimed to describe the presentation of MTS and the findings from the lymphedema workup.

Methods

A retrospective review was conducted of patients with MTS and lower extremity lymphedema workup between 2013 and 2022 at a public academic hospital. Demographic data, diagnostic information, treatment details, and outcomes were collected. Descriptive statistical analysis was performed.

Results

Of 523 patients identified, 390(75%) were female, 133(25%) male with a mean BMI of 29.6 kg/m². Mean age at diagnosis and symptom onset was 54.9(±17.1) and 47.6 (±18.2 )years, respectively. 465 patients (89%) were treated operatively with a combination of stenting, venoplasty, and thrombolysis while 47 (9%) were managed conservatively with compression garments and/or anticoagulation only. The LCIV was most commonly affected, followed by the left external iliac vein. The predominant symptoms were lower extremity deep vein thrombosis in 341 (65%) patients, lower limb edema in 286 (54%), and varicose veins in 129 (24.6%). Of six patients with lymphedema workup, three(50%) showed asymmetric or delayed uptake on lymphoscintigraphy and the remaining three had normal studies.

Conclusion

In our study, May-Thurner syndrome was an uncommon but significant cause of lower extremity swelling and venous thromboembolism, especially in middle-aged females. Patients with persistent symptoms after intervention may benefit from diagnostic workup for lymphedema and treatment. More research is needed on the co-occurrence of lymphedema with MTS and its pathophysiology.