May-Thurner Syndrome

May-Thurner Syndrome  Look at that!

May-Thurner syndrome is a pelvic condition in which the right common iliac artery compresses the left iliac vein, pressing it against the spine. This may cause discomfort, swelling and-or blood clots. Interventional radiologists provide non-surgical, minimally invasive interventions for May-Thurner Syndrome.

The condition increases the risk of deep vein thrombosis (DVT). DVT is a blood clot that may partially or completely block blood flow through the vein.

What are the symptoms of May-Thurner Syndrome?Hispanic woman in park with bike

Symptoms of May–Thurner syndrome are more common in the left leg,  as the right iliac artery overlaps the left iliac vein.

However, the definition of May–Thurner syndrome includes non-thrombotic iliac vein lesions which can occur in both the right and left iliac veins as well as multiple other named venous segments.

Manypeople do not know they have May-Thurner syndrome, but is discovered when they present with a blood clot. Patients should seek treatment for symptoms, including:

  • pelvic pain
  • swelling
  • pain or tenderness in the leg
  • feeling of increased warmth in the leg
  • redness or discoloration of the skin
  • enlargement of the veins in the leg

Even though DVT itself is not life-threatening, the blood clot has the potential to break free and travel through the bloodstream, where it can become lodged in the blood vessels of the lung (known as a pulmonary embolism). This can be a life-threatening condition.

DVT can also lead to complications in the legs referred to as chronic venous insufficiency (also known as post-thrombotic syndrome). This condition is characterized by pooling of blood, chronic leg swelling, increased pressure, increased pigmentation or discoloration of the skin, and leg ulcers. These leg ulcers are called venous stasis ulcers.

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How common is May-Thurner Syndrome?May Thurner Syndrome

While May–Thurner syndrome often goes unrecognized and undiagnosed, it thought to represent between 2 and 5 percent of lower-extremity venous disorders. It is estimated that this condition is three times more common in women than in men, and generally occurs in individuals from 20 years of age through the 40’s.

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How does one get the condition?

The condition is thought to be related primarily to a congenital condition, which may cause an abnormality in the arrangement of the left common iliac vein and the right common iliac artery. It may also develop as a result of trauma, age or extreme weight gain.

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How is May-Thurner Syndrome diagnosed?young couple

May-Thurner Syndrome is diagnosed through imaging studies of the lower back and pelvic area. Most people are unaware of this condition. It is often identified when they have a blood clot called deep vein thrombosis, or DVT. Patients are generally seeking treatment for symptoms such as leg swelling, pain or tenderness, an increased feeling of warmth in the leg, skin redness or discoloration, or the appearance of enlarged leg veins.

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Is May-Thurner Syndrome serious?

When compression is severe, blood flow within the vein is compromised and clots can form. The danger is that the blood clot can possibly break free and travel through the bloodstream, where it can become lodged in the blood vessels of the lung (known as a pulmonary embolism). This is a life-threatening condition. As well, DVT can lead to complications in the legs referred to as chronic venous insufficiency (post-thrombotic syndrome). This condition is characterized by pooling of blood, chronic leg swelling, increased pressure, increased pigmentation or discoloration of the skin, and leg ulcers known as venous stasis ulcer.

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What are the treatment options for May-Thurner Syndrome?May-Thurner Syndrome

Treatment options used for May-Thurner Syndrome are aimed at resolving the symptoms and risks associated with DVT.  Stenting of the iliac vein is often important in the treatment of May-Thurner Syndrome. If there is a clot, that is the first course of action using pharmaco-mechanical thrombolysis or catheter-directed thrombolytic therapy.

Once the blood clot is removed from the vein (usually by thrombolysis), the compressed vein is forced open with angioplasty and the structure is maintained with the use of a stent.

  • Pharmacomechanical thrombolysis – Blood-thinning medications may help to prevent blood clots. There are several drugs available; when use of blood thinners is indicated, you will be carefully monitored to insure that you have the right dosage.
  • Catheter-directed thrombolytic therapy-  This nonsurgical treatment uses clot-dissolving medications, called throbolytics, to dissolve blood clots. The anti-thrombolytic, or clot-busting, medicine, is delivered via a catheter to break up and dissolve the blood clot.Woman in the park cycling
  • Angioplasty Patients with May–Thurner syndrome may require an angioplasty of the iliac vein. Angioplasty is a nonsurgical treatment option used to widen the affected vein after the blood clot has been dissolved. During angioplasty, a small balloon at the tip of the catheter is inflated to stretch the vein open and increase blood flowAngioplasty is a nonsurgical treatment option performed by an intervention radiologist. The procedure is used to widen the vein after a blood clot has been dissolved. In this procedure, a small balloon at the tip of the inserted catheter is inflated. This stretches the vein and increases the blood flow.
  • Stenting - A stent is often placed during the angioplasty procedure to keep the vein open. A stent is a small, metal mesh braided tube that acts as a scaffold.

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What are pre- and post-treatment options?

  • Thrombectomy – If the patient has extensive thrombosis, it may be appropriate to consider pharmacologic and-or mechanical thrombectomy (also known as pharmacomechanical thrombectomy) to decrease post-thrombotic syndrome.
  • Vena cava filters - While vena cava filters are not always used directly for May-Thurner Syndrome, the filter is often used to treat complications associated with the development of DVT. A vena cava filter may be a treatment option for patients who cannot take blood-thinning (anticoagulant) medications, or for those in whom clots continue to develop despite the use of anticoagulants. The filter can prevent blood clots from moving from the vein in the legs to the lung. A clot in the lungs, called a pulmonary embolism, can be life-threatening. This treatment can help reduce the risk of a pulmonary embolism.

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What outcomes can I expect from treatment?Physician With Patient

Treatment outcomes for May-Thurner syndrome are generally very good. If identified soon after a deep vein clot has formed, the syndrome can usually be treated with full resolution of symptoms.

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Consults. Referrals. Scheduling and Appointments.

Call RIA Endovascular at 720.493.3406.

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