<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1646-706X</journal-id>
<journal-title><![CDATA[Angiologia e Cirurgia Vascular]]></journal-title>
<abbrev-journal-title><![CDATA[Angiol Cir Vasc]]></abbrev-journal-title>
<issn>1646-706X</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Angiologia e Cirurgia Vascular]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1646-706X2021000300278</article-id>
<article-id pub-id-type="doi">10.48750/acv.412</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[May-Thurner syndrome: the importance of ivus in the diagnostic and therapeutic algorithm]]></article-title>
<article-title xml:lang="pt"><![CDATA[Síndrome May-Thurner: importância do ivus no algoritmo diagnóstico e terapêutico]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Machado]]></surname>
<given-names><![CDATA[Marta]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Machado]]></surname>
<given-names><![CDATA[Miguel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Matos]]></surname>
<given-names><![CDATA[Arlindo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Machado]]></surname>
<given-names><![CDATA[Rui]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital CUF Viseu  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>09</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>09</month>
<year>2021</year>
</pub-date>
<volume>17</volume>
<numero>3</numero>
<fpage>278</fpage>
<lpage>282</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S1646-706X2021000300278&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S1646-706X2021000300278&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S1646-706X2021000300278&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  May Thurner Syndrome (MTS) is a clinical condition as a result of an anatomical compression of the left common iliac vein by the fifth lumbar vertebra posteriorly, and by the right common iliac artery anteriorly associated with symptomatology. Affirming the diagnosis can be difficult and intravascular ultrasonography (IVUS) can help in the definitive decision.  Clinical Case:  A 43 years old man with a past history of a deep venous thrombosis of the left lower limb presented at our clinical appointment with a 5 months history of left limb edema and inability to stand up for long periods of time, disabling him from working. A venous-CT scan was obtained to diagnose the condition but was inconclusive. It was proposed to the patient to carry out a phlebography and an IVUS to eliminate the doubt and increase the diagnosis acuity, which was accepted. A phlebography and IVUS confirmed a significant compression of the left common iliac vein (image 1). The patient was treated by endovenous placement of an Abre 16/80 medtronic stent followed by dilatation with a 16/40 balloon Boston scientific. The phlebography and IVUS control showed complete resolution of the compression. (Image 2)  Discussion/Conclusion:  The diagnosis of MTS can be difficult and implies a high degree of clinical suspicion. The TC scan alone may not be diagnostic. The phlebography, and especially the more recent IVUS technology increases the accuracy of the diagnosis. Emergence of endovascular surgery revolutionized the treatment of obstructive venous disease, and became the gold standard of treatment. However, the implantation of stents in a young population implies additional cautions due to the lack of knowledge about their behavior over the long term. In this clinical case, the IVUS allowed us to reach the diagnosis and to increase the therapeutic accuracy of the ilio-cava stenting. We recommend the routine use of IVUS in the management of MTS.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  A síndrome de May Thurner (SMT) é uma condição clínica resultante da compressão anatómica da veia ilíaca comum esquerda pela quinta vértebra lombar posteriormente e pela artéria ilíaca comum direita anteriormente associada a sintomatologia. Afirmar o seu diagnóstico pode ser difícil e a ultrassonografia intravascular (IVUS) pode ajudar na decisão definitiva.  Caso Clínico:  Homem de 43 anos com história de trombose venosa profunda do membro inferior esquerdo recorre à consulta com história de edema do membro inferior esquerdo com agravamento desde há cinco meses associado a incapacidade de ficar em pé por longos períodos , facto que o impedia de realizar a sua atividade laboral. Realizou flebo-TC no enatnto este foi inconclusivo. Foi proposto ao paciente a realização de flebografia e IVUS para eliminar as dúvidas e aumentar a acuidade diagnóstica. A flebografia e o IVUS confirmaram a compressão significativa da veia ilíaca comum esquerda pela artéria ilíaca comum direita (imagem 1). O paciente foi tratado através da implantação endovascular de um stent Abre 16/80 da Medtronic, seguido da dilatação com um balão 16/40 da Boston Scientific. A flebografia e o IVUS de controle mostraram a resolução completa da compressão. (Imagem 2)  Discussão/Conclusão:  O diagnóstico do SMT pode ser difícil e implica alto grau de suspeita clínica. O veno-TC pode não ser diagnóstico e ser necessário flebografia e IVUS. A cirurgia endovascular revolucionou o tratamento da doença venosa obstrutiva, tornando-se o gold standart terapêutico. No entanto, o implante de stents numa população jovem implica cuidados acrescidos devido ao desconhecimento de seu comportamento a longo prazo. Neste caso, o IVUS permitiu aumentar o grau de certeza diagnóstica e aumentar a qualidade do controle terapêutico do stenting ílio-cava. Nós recomendamos o uso do IVUS de forma rotineira na abordagem do SMT.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Cockett Syndrome]]></kwd>
<kwd lng="en"><![CDATA[May Thurner syndrome]]></kwd>
<kwd lng="en"><![CDATA[Iliac vein stentig]]></kwd>
<kwd lng="en"><![CDATA[Compression syndrome]]></kwd>
<kwd lng="en"><![CDATA[Stenting]]></kwd>
<kwd lng="en"><![CDATA[IVUS]]></kwd>
<kwd lng="pt"><![CDATA[Síndrome Cockett]]></kwd>
<kwd lng="pt"><![CDATA[Síndrome May thurner]]></kwd>
<kwd lng="pt"><![CDATA[Síndrome compressão da veia ilíaca]]></kwd>
<kwd lng="pt"><![CDATA[Stenting]]></kwd>
<kwd lng="pt"><![CDATA[IVUS]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Machado]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Machado]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[May thurner syndrome associated with nutcracker syndrome: clinical case and literature review]]></article-title>
<source><![CDATA[Angiol Cir Vasc]]></source>
<year>2017</year>
<volume>13</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>52-7</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[McMurrich]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The occurrence of congenital adhesions in the common iliac veins and their relation to thrombosis of the femoral and iliac veins]]></article-title>
<source><![CDATA[Am J Med Sci]]></source>
<year>1908</year>
<volume>135</volume>
<page-range>342-6</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ehrich]]></surname>
<given-names><![CDATA[WE]]></given-names>
</name>
<name>
<surname><![CDATA[Krumbhaar]]></surname>
<given-names><![CDATA[EB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A frequent obstructive anomaly of the mouth of the left common iliac vein]]></article-title>
<source><![CDATA[Am Heart J]]></source>
<year>1943</year>
<volume>26</volume>
<page-range>737-50</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Patel]]></surname>
<given-names><![CDATA[NH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome]]></article-title>
<source><![CDATA[J Vasc Interv Radiol]]></source>
<year>2000</year>
<volume>11</volume>
<page-range>1297-302</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[May]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Thurner]]></surname>
<given-names><![CDATA[J.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins]]></article-title>
<source><![CDATA[Angiology]]></source>
<year>1957</year>
<volume>8</volume>
<page-range>419-48</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cockett]]></surname>
<given-names><![CDATA[FB]]></given-names>
</name>
<name>
<surname><![CDATA[Thomas]]></surname>
<given-names><![CDATA[ML.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The iliac compression syndrome]]></article-title>
<source><![CDATA[Br J Surg]]></source>
<year>1965</year>
<volume>52</volume>
<page-range>816-21. 7</page-range></nlm-citation>
</ref>
<ref id="B7">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[O&amp;apos;Sullivan]]></surname>
<given-names><![CDATA[GJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Endovascular management of iliac vein compression (MayThurner) syndrome]]></article-title>
<source><![CDATA[J Vasc Interv Radiol]]></source>
<year>2000</year>
<volume>11</volume>
<page-range>823-36</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Shebel]]></surname>
<given-names><![CDATA[ND]]></given-names>
</name>
<name>
<surname><![CDATA[Whalen]]></surname>
<given-names><![CDATA[CC.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnosis and management of iliac vein compression syndrome]]></article-title>
<source><![CDATA[J Vasc Nurs]]></source>
<year>2005</year>
<volume>23</volume>
<page-range>10-7</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hurst]]></surname>
<given-names><![CDATA[DR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnosis and endovascular treatment of iliocaval compression syndrome]]></article-title>
<source><![CDATA[J Vasc Surg]]></source>
<year>2001</year>
<volume>34</volume>
<page-range>106-13</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wolpert]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Magnetic resonance venography in the diagnosis and management of May-Thurner syndrome]]></article-title>
<source><![CDATA[Vasc Endovascular Surg]]></source>
<year>2002</year>
<volume>36</volume>
<page-range>51-7</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ley]]></surname>
<given-names><![CDATA[EJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Endovascular management of iliac vein occlusive disease]]></article-title>
<source><![CDATA[Ann Vasc Surg]]></source>
<year>2004</year>
<volume>18</volume>
<page-range>228-33</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rigas]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Vomyoyannis]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Tsardakas]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Iliac compression syndrome: report of ten cases]]></article-title>
<source><![CDATA[J Cardiovasc Surg]]></source>
<year>1970</year>
<volume>11</volume>
<page-range>389-92</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Taheri]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Taheri]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Schultz]]></surname>
<given-names><![CDATA[R.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Iliocaval compression syndrome]]></article-title>
<source><![CDATA[Br J Surg]]></source>
<year>1992</year>
<volume>40</volume>
<page-range>9-15</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gloviczki]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Cho]]></surname>
<given-names><![CDATA[JS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surgical treatment of chronic occlusions of the ilicaval veins. RB Rutherford]]></article-title>
<source><![CDATA[Rutherford&amp;apos;s vascular surgery]]></source>
<year>2005</year>
<page-range>2303-20</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Canales J]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Krajcer]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Intravascular ultrasound guidance in treating May Thurner Syndrome]]></article-title>
<source><![CDATA[Tex Heart Inst J]]></source>
<year>2010</year>
<volume>37</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>496-7</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Forauer]]></surname>
<given-names><![CDATA[AR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Intravascular ultrasound in the diagnosis and treatment of iliac vein compression (May-Thurner) syndrome]]></article-title>
<source><![CDATA[J Vasc Interv Radiol.]]></source>
<year>2002</year>
<volume>13</volume>
<page-range>523-7</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Montminy M]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A comparison between intravascular ultrasound and venography in identifying key parameters essential for iliac vein stenting]]></article-title>
<source><![CDATA[J Vasc Surg Venous Lymphat Disord]]></source>
<year>2019</year>
<volume>7</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>801-7</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Neglén]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Raju]]></surname>
<given-names><![CDATA[S.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Intravascular ultrasound scan evaluation of the obstructed vein]]></article-title>
<source><![CDATA[J vasc Surg]]></source>
<year>2002</year>
<volume>35</volume>
<page-range>694-700</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ye]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Long-term outcomes of stent placement for symptomatic nonthrombotic iliac vein compression lesions in chronic venous disease]]></article-title>
<source><![CDATA[J Vasc Interv Radiol.]]></source>
<year>2012</year>
<volume>23</volume>
<page-range>497-502</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Meng]]></surname>
<given-names><![CDATA[QY]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Endovascular treatment of iliac vein compression syndrome]]></article-title>
<source><![CDATA[Chin Med J (Engl)]]></source>
<year>2011</year>
<volume>20</volume>
<page-range>3281-4</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Raju]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Ward Jr]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Kirk]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A modification of iliac vein stent technique]]></article-title>
<source><![CDATA[Ann Vasc Surg]]></source>
<year>2014</year>
<volume>6</volume>
<page-range>1485-92</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mahnken]]></surname>
<given-names><![CDATA[AH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cirse standards of practice guidelines on iliocaval stenting]]></article-title>
<source><![CDATA[Cardiovasc Intervent Radiol]]></source>
<year>2014</year>
<volume>37</volume>
<page-range>889-97</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Shi]]></surname>
<given-names><![CDATA[WY]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Endovascular treatment for iliac vein compression syndrome with or without lower extremity deep vein thrombosis: a retrospective study on mind-term-in-stent patency from a single center]]></article-title>
<source><![CDATA[European Journal of Radiology]]></source>
<year>2020</year>
</nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Machado]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Machado]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Primary may-thurner syndrome, clinical and endovascular surgical results: Our experience]]></article-title>
<source><![CDATA[Angiol Cir Vasc]]></source>
<year>2018</year>
<volume>14</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>22-37</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
