written by

Annie Collum, BSN, RN

Annie Collum, BSN, RN is the RIA Manager, Physician Liaison in Denver, Colorado

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April 6, 2021,

What is May-Thurner syndrome?

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 nonsurgical, 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?

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 nonthrombotic iliac vein lesions, which can occur in both the right and left iliac veins, as well as multiple, other venous segments. Many people do not know they have May-Thurner syndrome, but it is discovered when they present with a blood clot. Patients should seek treatment for symptoms, which include pelvic pain, swelling pain or tenderness in the leg, feeling of increased warmth in the leg, redness or discoloration of the skin, and 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 postthrombotic 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.

What are the treatment options for May-Thurner syndrome?

May-Thurner syndrome treatment options 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 pharmacomechanical 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 prevent blood clots. There are several drugs available; when use of blood thinners is indicated, you will be carefully monitored to ensure that you have the right dosage.

Catheter-directed thrombolytic therapy – This nonsurgical treatment uses medications called thrombolytics to dissolve blood clots. The thrombolytic is delivered via a catheter to break up and dissolve the blood clot.

Angioplasty – Patients with May-Thurner syndrome may require an angioplasty of the iliac vein. Angioplasty is a nonsurgical treatment option performed by an interventional radiologist and 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 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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