Anatomical variant where the right common iliac artery compresses the left common iliac vein against the L5 vertebra. This chronic compression causes intimal proliferation (due to the transmitted pulses to the venous wall) as well as vein stenosis, that can lead to local thrombosis. This variant is usually revealed during investigation of a lower limb or pelvis thrombosis. Several cases have been reported in adolescent girls in association with an another risk factor for thrombosis: oral contraception, prolonged immobilization...

It can occur after a kidney transplant on the left side. The compression of the dural sac and/or the nerve roots by the congested veins unable to drain into the IVC can cause atypical lumbar pain.

Treatment in case of thrombosis: local or systemic thrombolysis followed by percutaneous endovascular angioplasty combined with placement of a stent in the vein..

Anesthetic implications:

thromboprophylaxis

References : 

• Whitman MC, Walker DM. 
  A case of lower extremity venous thrombosis in the pediatric emergency department: association with May-Thurner syndrome and isotretinoin use.
  Pediatr Emerg Care 2011; 27: 125-8.
• Campsen J, Bang TJ, Kam J, Gupta R. 
  May-Thurner syndrome complicating left-sided renal transplant. 
  Transplantation 2010; 89: 904-6.
• Fernando RR, Koranne KP, Fuentes F. 
  May-Thurner syndrome in a 68-year-old woman with remote abdominal surgery. 
  Tex Heart Inst J 2013; 40: 82-7.- Raffini L, Raybagkar D, Cahill AM, Kaye R, Blumenstein M, Manno C. May-Thurner syndrome (iliac vein compression) and thrombosis in adolescents. Pediatr Blood Cancer 2006; 47: 834-8.
• Sinderman M.
  Epidural injections contraindicated for lumbar radiculopathy in May-Thurner syndrome : a case report.
  A&A Case Reports; 2017; 9: 294-6

Updated: December 2017