Iliac vein spur

The importance of the iliac vein spur in its hemodynamic significance was first described in 1956 by the Viennese surgeons May and Thurner. In 1965, Cockett and Thomas again described this clinical constellation with the name "iliac vein compression syndrome".

Pathologically and anatomically, the pelvic vein spur is an intravascular tissue structure of loose connective tissue of the left V.iliaca communis (left pelvic vein). The spur is structured differently and ranges from a strip-like protrusion to scene-like sail structures.

According to the investigations of May et al. on 430 corpses, this intravascular spur was found in 22% of the cases.

The origin of the pelvic vein spur is attributed to a chronic irritation of the vein wall. It results from an anatomical peculiarity. The right pelvic artery lies in front of the left pelvic vein and crosses it. The arterial pulsations of the iliac artery compress the pelvic vein between the artery and the spinal column; this leads to a disturbance of the venous hemodynamics.

As a rule, the venous spur does not trigger any clinical symptoms. It is suspected in recurrent left-sided pelvic vein thrombosis. Due to this anatomical situation, pelvic vein thro mbosis or venous thrombosis on the left leg is twice as frequent as on the right leg.

Sonographically, the iliac vein spur is difficult to detect. More effective is the phlebographic or tomographic (angio-MRI) detection.

Treatment of the pelvic vein spur is recommended for recurrent pelvic vein thrombosis. Interventional vascular dilatation with the application of a stent implant is suitable for this purpose.

1. Fernando RR et al(2013) May-Thurner syndrome in a 68-year-old woman after remote abdominal surgery. Tex Heart Inst J 40:82-87.
2. Wölfle KD et al (2001) Endovascular therapy in pelvic vein track. Kongressbd Dtsch Ges Chir Kongr 118:482-485.
3. Woo EJ et al (2016) Iliac vein compression syndrome from anterior perforation of a pedicle screw. J Surg Case Rep doi: 10.1093/jscr/rjw003.
4. Yin M et al (2015) The effect of stent placement for May-Thurner syndrome combined with symptomatic superficial venous reflux disease. J Vasc Surg Venous Lymphatic Disord 3:168-172.