A Comprehensive Review of May-Thurner Syndrome: Pathophysiology, Clinical Manifestations, and Advanced Therapeutic Approaches

May-Thurner Syndrome (MTS), also referred to as iliac vein compression syndrome, is an underrecognized vascular condition characterized by the extrinsic compression of the left common iliac vein by the overlying right common iliac artery. This mechanical obstruction predisposes patients to venous stasis, significantly increasing the risk of deep vein thrombosis (DVT) and chronic venous insufficiency. Although the precise prevalence of MTS remains uncertain due to its often asymptomatic presentation, the condition accounts for a considerable proportion of DVT cases in younger individuals, particularly women. This review aims to elucidate the pathophysiological mechanisms underpinning MTS, its clinical manifestations, diagnostic strategies including advanced imaging modalities, and both traditional and evolving therapeutic options. Emphasis will be placed on the use of endovascular techniques, such as stenting and catheter-directed thrombolysis, as well as the role of conservative management. Through a thorough analysis of current literature, this article will explore the long-term outcomes associated with different treatment approaches and the emerging role of precision medicine in tailoring therapies for patients with MTS.