Iliac vein compression syndrome: Clinical, imaging and pathologic findings

Figure 2 The appearance of May-Thurner syndrome on multiple imaging modalities from a single patient. A: Axial T1 fat-saturated magnetic resonance image following the administration of an intravascular contrast agent demonstrates > 50% narrowing of the left common iliac vein by the overlying right common iliac artery; B: Intravascular ultrasound with the transducer within the left common iliac vein (blue) demonstrates near complete obliteration of the vessel’s lumen due to compression by the right common iliac artery (red); C: Digital subtraction angiography with contrast injection from a vascular sheath in the left external iliac vein demonstrates an obliquely oriented silhouette of the right common iliac artery compressing the left common iliac vein (arrowhead); multiple left-to-right pelvic collaterals are also present, signifying that the compression is hemodynamically significant; D: Following the placement of an uncovered stent, the compression is resolved, and there is no longer filling of the cross-pelvic collaterals.