May-Thurner Syndrome

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What Is May-Thurner Syndrome?

May-Thurner Syndrome, also known as iliac vein compression, occurs when the left iliac vein is compressed by an artery. It is a rare and underdiagnosed vascular disorder that occurs predominantly in individuals in the 20-40 age group and affects women twice as much as men.

The left iliac vein is the large vein that moves blood up the left leg and pelvis to the heart. A nearby artery can compress the iliac vein, restricting the flow of blood, and narrowing or scarring the vein. The artery may also compress the right iliac vein or both veins.

Complications of May-Thurner Syndrome

May-Thurner Syndrome can increase the risk of deep vein thrombosis (DVT), a life-threatening situation caused when a blood clot forms in the deep veins of your body. If the blood clot breaks off and travels to your brain, heart, or lungs, it can result in a stroke, heart attack, or pulmonary embolism, which blocks blood flow to the lungs, potentially leading to death. DVT is responsible for nearly 600,000 hospitalizations in the United States each year.

Symptoms

Some people with May-Thurner Syndrome are asymptomatic, while others report a swelling, pain, redness, heaviness, or tenderness in the leg; pigmentation changes on the leg; venous sores and ulcers that don’t heal; and varicose veins in the pelvic area.

The disorder is reported more frequently in women in the 20-40 age group, after pregnancy or a long period of immobilization.

Diagnosing May-Thurner Syndrome

Your doctor will perform a physical examination and review your medical history and symptoms. Common diagnostic tests for May-Thurner Syndrome include:

  • Doppler ultrasound
  • CT venography
  • Helical abdominal computed tomography (CT)
  • Magnetic resonance venography (MRV)
  • Intravenous ultrasound (IVUS)
  • Conventional venography 

If the results of imaging tests show compression of the iliac vein, and there is also a presence of lower extremity pain, swelling, and other symptoms, May-Thurner Syndrome can be confirmed. From there we have treatment options.

Treating May-Thurner Syndrome

Your doctor will recommend suitable treatment based on your symptoms and risk factors. Blood thinners may be prescribed to prevent the formation of blood clots.

Thrombolytic therapy is a non-surgical treatment for May-Thurner Syndrome. Clot-dissolving medications, called thrombolytics, are delivered through a catheter to dissolve the blood clot.

After the blood clot has been removed, angioplasty and stenting may be performed to open the compressed vein and maintain it in place.

A thin catheter with a balloon at its end is guided towards the faulty vein using intravascular ultrasound, which uses sound waves to see inside blood vessels. The balloon is inflated to force the vein open and restore blood flow. A small tube of metal mesh, known as a stent, is placed to keep the vein open and provide support like a scaffold.

Results from Treatment

The outcome of May-Thurner Syndrome treatment is generally excellent. Symptoms can be fully resolved if the disorder is detected and treated before or soon after the deep vein clot has set in.

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