What is May-Thurner Syndrome?
May-Thurner syndrome is caused by a blockage of the left leg vein, or iliac vein, as it goes through the pelvis. The left leg vein gets squeezed between the right iliac artery and the spinal column which causes the blockage. The continued pulsation of the artery as it crosses over the vein and compresses it, causing inflammation and scarring in and around the vein. This narrows and blocks the outflow of the leg.
May-Thurner syndrome is a thrombotic disorder. Thrombotic disorder interferes with patient’s normal flow of blood. A high percentage of the population has some degree of compression occurring in the iliac vein. Of that percentage, only a small number of those individuals will have severe compression that will result in symptoms. May-Thurner is caused by an anatomical variant that is congenital but not hereditary.
If diagnosed with May-Thurner syndrome patients have an increased risk of developing deep vein thrombosis or DVT. As a result of DVT patients may also develop venous insufficiency which is known as post-thrombotic syndrome.
May-Thurner Syndrome was previously thought to be very rare but we have found that it was just rarely diagnosed due to lack of technology. As technology advances, we have discovered more information about May-Thurner. Blockages can also occur on the right side of the body in addition to the left. There are also three commonly compressed areas on each side of the body. The following are common symptoms to look out for when concerned about May-Thurner Syndrome.
- Leg pain such as heaviness, aching, restlessness, throbbing, or tenderness
- Leg swelling, discoloration or inflammation
- Pelvic, hip and back pain
- Varicose veins in the upper inner thigh, on or underneath the buttock, in the groin area, and lower body
- Vein Enlargement
The veins from the pelvic organs, uterus, ovaries, bladder, rectum and gluteal muscles all drain into the leg veins, this blockage can affect these parts of your body as well. Since May-Thurner presents itself most commonly in women this can lead to pelvic congestion syndrome (PCS) – pelvic pain, urgency to urinate, fullness in the rectum, hemorrhoids, and buttock pain, and possibly pain or aching after sex.
May-Thurner Syndrome Treatment
There are several treatment options for May-Thurner syndrome. These treatments focus on reducing the symptoms as well as the complications. If diagnosed in the early stages the prognosis for patients with May-Thurner syndrome is usually good. Treatment options include the following.
- Anticoagulants. This medication is used to thin the blood. If prescribed, the patient must be carefully monitored since there is a danger of excessive amounts of bleeding.
- Catheter-Directed Thrombolytic Therapy. This treatment involves inserting a catheter into a vein in the leg and moving it through the circulatory system to the blood clot site. Once the catheter is at the location of the clot, it dispenses a thrombolytic drug. This procedure is performed using X-rays and ultrasound scans.
- Angioplasty and Stenting. After successfully dissolving the blood clot, an angioplasty is occasionally performed to widen the blood vessel. Once the clot has been removed, the compressed iliac vein is opened using a stent.
- Vena Cava Filters. If patients are unable to take anticoagulant medications for other medical reasons this is an alternative option for them. A surgical procedure is performed where the vena cava filters are inserted into the vena cava, the largest vein in the body. Once the filter is inserted, it can trap clots that are traveling through the body. This will prevent the clots from reaching the lungs.
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Diagnosing May-Thurner Syndrome
May-Thurner syndrome can only be diagnosed through testing. The majority of patients are even unaware that they have the condition until they develop a deep vein thrombosis. DVT along is not life-threatening but there is a danger that the blood clot can become loose and travel through your body. If this occurs it can result in a potentially fatal pulmonary embolism. The following are two of the ways you can test for May-Thurner.
Abdomen and Pelvis Ultrasound
This test is difficult to perform accurately and requires special training. In order to receive a proper diagnosis through this method, it should be performed by a vein specialist.
Intravascular Ultrasound (IVUS)
IVUS is the newest state of the art technology to diagnose May-Thurner. A long catheter, that contains a tiny ultrasound probe on the tip, is inserted into the patient’s veins. This allows precise images and videos of the veins to be obtained. If there is a blockage of more than 50% The Vein Specialists of the Carolinas will address the best route of treatment. This will most likely include venoplasty and stenting.
At Vein Specialists of the Carolinas we have the cutting edge technology to diagnose and treat this problem in our accredited office based surgical suite. Dr. Draughn has studied with the world’s pioneers and leading experts learning to diagnose and treat May-Thurner Syndrome.