Endovascular and medical therapy of May-Thurner syndrome: Case series and scoping literature review.

INTRODUCTION: May-Thurner syndrome has been recognized as a cause of chronic venous insufficiency and a trigger for venous thromboembolism. There is no consensus about the definition, diagnosis, and therapeutic approach. We are aiming to describe its characteristics and a scoping literature review. METHODS: A retrospective review of patients with May-Thurner syndrome from March 2010 to May 2018 and scoping literature review were made. RESULTS: Seven patients were identified. All patients were female with a median age of 36 (20-60) years. The median time from the first symptom to diagnosis was 3.41 (0.01-9) years. The primary clinical presentation was post-thrombotic syndrome (4 patients). Six patients had at least one risk factor for deep venous thrombosis. All patients underwent angioplasty with stent; patients with acute deep venous thrombosis, furthermore mechanic thrombectomy with or without catheter-directed thrombolysis were done. There were three complications (one patient, lymphedema, and two venous stent thrombosis). Scoping review results were descriptively summarized. CONCLUSION: May-Thurner syndrome has a varied spectrum of clinical presentation, and clinical awareness is paramount for diagnosis. Its principal complication is the post-thrombotic syndrome, which is associated with high morbidity. There is no consensus on the antithrombotic treatment approach.

Two divergent paths: compression vs. non-compression in deep venous thrombosis and post thrombotic syndrome / Uso da terapia compressiva ou não compressiva na trombose venosa profunda e síndrome pós-trombótica: dois caminhos divergentes

Abstract Use of compression therapy to reduce the incidence of postthrombotic syndrome among patients with deep venous thrombosis is a controversial subject and there is no consensus on use of elastic versus inelastic compression, or on the levels and duration of compression. Inelastic devices with a higher static stiffness index, combine relatively small and comfortable pressure at rest with pressure while standing strong enough to restore the "valve mechanism" generated by plantar flexion and dorsiflexion of the foot. Since the static stiffness index is dependent on the rigidity of the compression system and the muscle strength within the bandaged area, improvement of muscle mass with muscle-strengthening programs and endurance training should be encouraged. Therefore, in the acute phase of deep venous thrombosis events, anticoagulation combined with inelastic compression therapy can reduce the extension of the thrombus. Notwithstanding, prospective studies evaluating the effectiveness of inelastic therapy in deep venous thrombosis and post-thrombotic syndrome are needed.

Resumo O uso da terapia de compressão para reduzir a incidência de síndrome pós-trombótica em pacientes com trombose venosa profunda apresenta controvérsias como o uso da compressão elástica versus inelástica, os níveis e a duração da compressão. Dispositivos inelásticos com índice de rigidez estática combinam uma pressão pequena e confortável em repouso com uma pressão forte o suficiente para restaurar o "mecanismo de válvula" gerado pela flexão plantar e dorsiflexão do pé. Uma vez que o índice de rigidez estática depende da rigidez do sistema de compressão e da força muscular dentro da área enfaixada, a melhoria da massa muscular com programas de fortalecimento e treinamento de resistência deve ser incentivada. Na fase aguda dos eventos de trombose venosa profunda, a anticoagulação acompanhada de terapia de compressão inelástica pode reduzir a extensão do trombo. Assim, são necessários estudos que avaliem a eficácia da terapia inelástica na trombose venosa profunda e na síndrome pós-trombótica.

Successful treatment of post thrombotic syndrome with sequential lumbar sympathetic block.

An underappreciated sequelae of deep venous thrombosis (DVT) is the pain associated with the blood clot in the peripheral extremity. Although most frequently acute in nature, DVT occasionally presents with chronic pain in the affected limb. Furthermore, many individuals suffering from prothrombotic states often have recurring pain from DVT. Thus far there has been a paucity in the medical literature in how to treat post thrombotic pain. Post thrombotic syndrome (PTS) can cause a significant decrease in quality of life in individuals who have had a history of a DVT. Symptoms will typically include edema, pain, heaviness of the affected limb, skin changes, ulcers, varicosities, and gait abnormality. An underappreciated approach to treating PTS is the utilization of lumbar sympathetic blocks (LSB). A 68-year-old male who had a history of recurrent right lower extremity deep venous thrombosis presented with complaints of excruciating pain, discomfort, and erythema in his right lower extremity, which was negatively affecting his quality of life and prohibiting him from mobility. The patient attributed his lack of mobility secondary to the thrombotic pain. Compression boot/stocking therapy was not combating the discomfort associated with the PTS, often increasing the severity of the patient's pain. Sequential right lumbar sympathetic blocks were performed, which nearly completely resolved the patient's symptoms and improved the patient's ambulatory status and ability to perform activities of daily living. Sympathetic nerve blocks should be considered as a treatment option for patients who suffer with pain from PTS.

Validation of upper extremity post-thrombotic syndrome outcome measurement in children.

Using the Manco-Johnson instrument in a derivation cohort of 107 children with or without a central venous catheter, upper extremity physical findings of post-thrombotic syndrome were absent, and the pain score was 0 in all but one child. Interrater reliability in an independent validation cohort (n = 38) of children with or without upper extremity deep venous thrombosis was 97%-100%.