What Is May-Thurner Syndrome?
May-Thurner syndrome is a thrombotic disorder, a condition that interferes with the normal flow of blood. In this condition, the right iliac artery constricts the iliac vein which causes narrowing and sometimes scarring as a result. An individual with May-Thurner syndrome is at increased risk for developing deep vein thrombosis (DVT), a potentially serious blood clot that can completely obstruct the circulation of blood in that vein. Such an individual may also develop venous insufficiency as a result of the deep vein thrombosis, known as post-thrombotic syndrome.
What Causes May-Thurner Syndrome?
May-Thurner syndrome is the result of the left iliac vein compressed by the right iliac artery. The anatomical variant responsible for the syndrome is congenital, but not hereditary, and more common in women than men. The syndrome shows up more frequently in young women taking birth control medication, and as women age or gain weight. While a high percentage of the population has some degree of compression of the iliac vein, only a small number of individuals have severe compression resulting in symptoms.
May-Thurner Syndrome Symptoms
Since May-Thurner syndrome must be diagnosed through testing, most patients are unaware that they have the condition, even when the iliac vein is extremely compressed unless they develop a deep vein thrombosis. While DVT alone is not life-threatening, there is a significant danger that the blood clot may break loose and travel through the body, resulting in the danger of a potentially fatal pulmonary embolism.
Symptoms of deep vein thrombosis may include any or all of the following conditions in the affected leg:
- Swelling, pain or tenderness
- Increased warmth
- Redness or discoloration of the skin
- Enlargement of the veins
What parts of the body do May-Thurner syndrome affect?
May-Thurner syndrome affects the blood vessels that carry blood through the legs and pelvis back to the heart. Without sufficient blood flow, symptoms can occur in the legs. In May-Thurner syndrome, it is the left leg that is affected an at risk of developing a blood clot known as DVT.
Is May-Thurner syndrome painful?
Yes. The compression on the vein often causes persistent low back pain. This may localize or may shoot from the low back to the groin area. People with May-Thurner syndrome may also experience pain in the left leg after sitting for long periods. Because this pain is usually subtle, it is often overlooked.
Diagnosing Of May-Thurner Syndrome
The majority of patients are not diagnosed with May-Thurner syndrome until they develop DVT. Diagnosis may include the following:
- Physical examination
- Complete family history
- Ultrasound, CT scan or MRI scan
- Venography with contrast dye
- Intravascular ultrasound
How can I prepare for treatment?
The doctor prescribes treatment based on the severity of the condition, the patient's medical history, and other factors. Patients who are prescribed anticoagulant medication will have different pre-treatment recommendations that patients who undergo angioplasty and stenting. When treatment is discussed, the doctor will provide clear instructions regarding how to adequately prepare.
May-Thurner Syndrome Treatment Options
There are several treatments for May-Thurner syndrome. All are focused on reducing symptoms and the risk of complications. Treatment options for May-Thurner syndrome may include:
Anticoagulants are medications to thin the blood. If blood thinners are prescribed, the patient must be carefully monitored since there is a danger of excessive bleeding.
Catheter-Directed Thrombolytic Therapy
Catheter-directed thrombolytic treatment involves inserting a catheter into a vein in the leg and threading it through the circulatory system to the site of the blood clot. At the location of the clot, the catheter dispenses a thrombolytic drug. This procedure is performed using X-rays and ultrasound scans to ensure precision.
Angioplasty And Stenting
After a blood clot has been successfully dissolved, angioplasty is sometimes performed to widen the blood vessel. When the clot has been removed, the compressed iliac vein is opened with the use of a stent.
Vena Cava Filters
Vena cava filters are a viable treatment option for patients unable to take anticoagulant medications. Vena cava filters are inserted in the vena cava, the largest vein in the body, during a surgical procedure. Once the filter is inserted, it can trap clots as they travel through the body, before they reach the lungs.
The prognosis for patients with May-Thurner syndrome is usually good, particularly if the syndrome is diagnosed and treated in its early stages.
Is recovery involved after treatment?
Patients may have a short recovery period after certain treatments. For example, patients who undergo angioplasty and stenting may need a week or two off work. They may perform light activities but should avoid anything strenuous. After this procedure, patients may need to take medication for comfort and also to facilitate optimal circulation. Like preparation steps, the doctor will provide clear instructions regarding aftercare based on the type of treatment the patient's needs
Can I get May-Thurner syndrome again after treatment?
Treatment for May-Thurner syndrome is intended to make it easier for blood to flow through the iliac vein. None of our current treatment options can eliminate the factors involved in vein compression, but some do "open" the vein using a stent. Treatment is successful in most cases and does not need to be repeated. However, there is a small chance that the compression that caused symptoms could recur. The doctor can discuss anticipated treatment outcomes and the prognosis for long-term efficacy after performing a thorough medical history and examination.
What happens if May-Thurner syndrome goes untreated?
The primary concern of untreated May-Thurner syndrome is DVT. Deep vein thrombosis is a blood clot that forms in a deep vein, usually in the leg. This condition may cause symptoms like aching or a sense of heaviness in the affected leg. However, DVT can also occur without any symptoms. The complication of DVT is that the blood clot could break loose and travel to the lungs. Pulmonary embolism is an emergency situation that requires immediate medical care.
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