May-Thurner diagnosis and management

May-Thurner syndrome, known for decades as a unique pathology, has been included recently with other pelvic compression maladies in the S-V-P CEAP (symptoms-varicespathophysiology, clinical-etiology-anatomy-pathophysiology) classification sponsored by the American Venous and Lymphatic Society as part of several anatomic lesions in the abdominopelvic region that have variable clinical presentations. This classification will fully characterize and accurately describe a particular lesion; also, it will facilitate clinical interaction and precise treatment and in the long term the development of patient-reported outcome measures and clinical trials. In the interim, epidemiologic data reported so far have been questioned recently because of the lack of adequate clinical trials. The pathophysiology originally described is still currently accepted, and the clinical presentation is better known. The noninvasive vascular armamentarium (ultrasound, computed tomography, and magnetic resonance imaging) is very reliable, and the invasive methods (venography, intravascular ultrasound) allow us to assure the diagnosis and evaluate treatment. Endovascular treatment is the preferred approach to dissolve a thrombus should one be present, with then treatment of the underlying compression via stent placement. The stent most used globally is probably the Wallstent because of its results, and the dedicated nitinol venous stents are tending to show good results in long-term follow-up. There is no consensus on optimal anticoagulants given post stenting; however, the newer oral anticoagulants are used in patients with a history of thrombosis. So far, May-Thurner syndrome is underdiagnosed, but probably overtreated. That is why reviews like this are useful to avoid it. Finally, I believe that the term May-Thurner syndrome will continue to be used, alongside the new classification.