A review into the management of May-Thurner syndrome in adolescents

J Vasc Surg Venous Lymphat Disord. 2020 Nov;8(6):1104-1110. doi: 10.1016/j.jvsv.2020.05.006. Epub 2020 May 28.


Objective: To investigate the presentation, etiology, management and outcomes of May-Thurner syndrome (MTS) in adolescents aged under 18.

Methods: We searched electronic bibliographic databases to identify published reports of MTS in patients under 18 years of age. We conducted our review according to the PRISMA statement standards.

Results: Ten studies encompassing 22 patients treated for MTS in adolescent cases were identified. The mean age of patients was 15 years (range, 10-18 years). Of the 22 patients, 12 (55%) were confirmed to have proximal deep vein thrombosis as the primary indication for intervention. Treatment methods included catheter-directed thrombolysis and iliac vein stenting (41%), pharmacomechanical thrombolysis and iliac vein stenting (18%), iliac vein stenting alone (27%), open surgery (14%), catheter-directed thrombolysis (5%), and anticoagulation alone (5%). Complications were infrequent. All studies reported subjective improvements in clinical symptoms with only two studies using validate outcome measures. In total, 9 of 22 patients (41%) had addition risk factors that may precipitate thrombosis.

Conclusions: As in adults, the most common form of treatment seen in the literature is a combination of catheter direct thrombolysis, followed by iliac vein stenting with subsequent anticoagulation. Complications from interventions were low. It is unclear how these interventions affect symptomology and the long-term sequalae associated endovascular surgery and stenting in adolescents. Further research is needed in well-designed studies with adequate follow-up.

Keywords: May-Thurner syndrome; Pediatrics; Thrombosis; Venous stenting thrombolysis.

Publication types

  • Systematic Review

MeSH terms

  • Adolescent
  • Age Factors
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use*
  • Child
  • Constriction, Pathologic
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / instrumentation
  • Female
  • Humans
  • Iliac Vein / diagnostic imaging
  • Iliac Vein / physiopathology
  • Iliac Vein / surgery*
  • Male
  • May-Thurner Syndrome / diagnostic imaging
  • May-Thurner Syndrome / physiopathology
  • May-Thurner Syndrome / therapy*
  • Stents
  • Thrombolytic Therapy* / adverse effects
  • Treatment Outcome
  • Vascular Surgical Procedures* / adverse effects


  • Anticoagulants