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E1964. May The Flow Be With You: An Anatomical and Radiological Review of May-Thurner Syndrome
Authors
  1. Ricardo Declet-Bauzó; Louisiana State University Health Sciences Center
  2. Jane Ball; Louisiana State University Health Sciences Center
  3. Raman Danrad; Louisiana State University Health Sciences Center
Background
It is widely known that deep vein thrombosis (DVT) can be a life-threatening medical condition. For this reason, a low threshold for diagnostic test acquisition of patients with multiple risk factors is generally accepted in the medical community. However, healthy patients without predetermined risk factors can have anatomical variants that predisposes them to DVT development. May-Thurner Syndrome (MTS) is an anatomical variant that has been shown to be present in over 20% of the population (1,2). Surprisingly, despite a relative high incidence, established MTS-related DVT cases only account for approximately 2-3% of overall DVT diagnosis (3). This may be attributed to missed cases in settings where alternative risk factors, such as gender, obesity, immobility, oral contraceptives (OCPs) and malignancy among others, are present concomitantly, creating a sense of clinician fulfillment which results in ceasing further diagnostic work up.

Educational Goals / Teaching Points
This educational exhibit aims to review the pelvic vascular anatomy and identify the variants commonly seen with MTS. A discussion regarding the available diagnostic imaging studies, including a brief comparison of their individual benefits and draw-backs, will be held. We will go in depth behind the pathophysiological mechanism responsible for DVT formation, but more importantly their characteristic appearance as reflected on imaging findings. Additional topics include an introduction into multiple therapeutic interventions, associated complications and adequate follow up imaging, as clinically indicated. To conclude, common and uncommon cases of MTS from our institution will be portrayed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
MTS consists of an anatomical variant that produces venous outflow obstruction. The normal anatomical course of the left common iliac vein requires traversing posterior-medially between the right common iliac artery and vertebral spine prior to its iliocaval confluence. As a result of anatomical variants in this region, diminished venous return and altered laminar blood flow result from extrinsic venous compression by the arterial system and adjacent vertebra. Chronic venous stasis can ensue, producing a pro-thrombotic environment that accounts for a wide variety of presentations, from the more benign such as non-thrombotic left lower extremity swelling to more sinister outcomes like left iliac vein rupture.

Conclusion
This educational exhibit would provide a concise review of MTS directed towards all levels of education (radiologists, radiologists-in-training, interested residents and/or medical students). It would not only be informative but would continue to raise awareness of a relative common predisposition of a possibly fatal medical condition.