What is May-Thurner Syndrome?
May-Thurner Syndrome is a congenital anatomical anomaly of the left iliac vein in the pelvis. This anomaly is present in up to 20% of the population. THe anatomic variation leads to the left common iliac vein being compressed abnormally by the overlying right common iliac artery. It was first identified in 1908 and today is frequently picked up through imaging with CT scans and MRI. May-Thurner Syndrome is most commonly seen in females bewtwwen the second and fourth decades of life, although it does affect men and women of all ages. This narrowing can lead to diminished blood flow within the venous system of the left pelvis and left leg. The condition is also referred to as Iliac Vein Compression Syndrome and Cockett Syndrome.
Symptoms of May-Thurner Syndrome
Symptoms can vary widely from person to person. Many individuals with the condition do not develop any symptoms or any complications during their lifetime. This has been determined by autopsy studies. Other individuals with May-Thurner Syndrome may develop discomfort chronic symptoms in the left leg or pelvis. Symptoms can include swelling, aching, pressure, heaviness, fatigue, and general discomfort. Other symptoms can include asymmetry of the legs, where the left leg is visibly larger than the right. Skin changes and dermatitis may occur in the lower leg, ankle, and foot that often looks brown or tan in color (hyperpigmentation). Varicose veins and skin ulcers around the lower leg and ankle can also form. This occurs due to chronic elevated venous pressure in the legs in people with the condition.
Other people with May-Thurner Syndrome can present with blood clots, with no other warning signs before the blood clots occur. Blood clot can occur in the pelvis or the leg and can even extend into the vena cava, the largest vein in the body. These severe and potentially life-threatening complications are called deep venous thrombosis. If the clots dislodge and float they can result in pulmonary embolism (blood clots traveling to the lungs that can lead to sudden death from cardiac arrest).
May-Thurner Syndrome Diagnosis
The diagnosis of May Thurner Syndrome is made through the use of diagnostic imaging studies. Traditionally this was done inclusively with catheter venogram. But with the advances in technology, now most cases are identified with the use of specialized CT or MRI studies (referred to as CT venogram / CTV and MR venogram / MRV). CT scans are also referred to as CAT scans. Catheter venogram and intra-vascular ultrasound (ie IVUS) is also very useful in confirming the diagnosis and providing additional anatomic detail. External imaging with conventional ultrasound has significant limitations in being able to see the condition, although it is very useful in following patients that have had stents inserted to treat May-Thurner Syndrome.
Diagnostic imaging studies are typically performed to assess for this condition if someone presents with blood clots in their legs or pelvis, especially when the clots are left-sided. Blood clots, known as Deep Venous Thrombosis (ie DVT) or Superficial Venous Thrombosis (ie SVT) can be precipitated by surgery, trauma, or medications (such as hormone replacement therapy or birth control medication). There also may be an underlying clotting disorder referred to as a hypercoagulable disorder present. If any of these other precipitating factors are present it will increase the risk that a patient with May-Thurner Sydrome will develop a blood clot. Patient that present with blood clots in their lungs (pulmonary embolism) will often be assessed for May-Thurner Syndrome as well. These are most common diagnosed by CT scan as well.
Other reasons that a physician may order diagnostic studies to check for May-Thurner Sydrome is due to a clinical suspicion based on presenting complaints in the legs or pelvis. Someone may come to the doctor reporting chronic pain or discomfort in their pelvis or leg. If unexplained swelling and discomfort is occurring in the pelvis or leg then May-Thurner Syndrome is a potential cause.
Treatment of May-Thurner Syndrome
The optimal treatment will depend on how a person presents. Patients without symptoms or complication may be managed with medications such as blood thinners or with compression stockings on their legs. Some patients may not need to be treated with medication or interventions. Patients that have active blood clots or prior blood clots will all require some type of medical therapy and often interventional therapy. Patients with chronic pain or swelling symptoms in the leg or pelvis are more likely to be treated with interventional therapies.
Interventional therapy by a vascular surgeon to resolve the narrowing of the vein if often indicated. The procedure involves placing a metal nitinol stent into the iliac vein to resolve the May-Thurner Syndrome narrowing. This vein stent procedure is done through a minimally-invasive approach through a catheter inserted into the groin / leg. The stent is guided into the body in a collapsed position and then expanded when it reaches its target. It is guided with the use of live x-tray images, referred to as fluoroscopy. A small skin puncture is all that is required. The procedure is done as an outpatient, with the patient leaving the hospital on the same day that the procedure is performed.
If active blood clots exist is the veins, then additional procedures in addition to the vein stent may be recommended. This may include placement of a vena cava filter, which is a small metal filter that captures clots and prevents them from moving or traveling to the lungs. Stronger catheter-based blood thinner medications that are directly infused into the blood clot under x-ray guidance may also be recommended by your surgeon. One example of such treatment is the infusion of a drug called tPA (tissue plasminogen activator).
Austin Vein Specialists | May Thurner Syndrome Experts
Our Vein Specialists are experts in the diagnosis and management of May-Thurner Syndrome. Our physicians are board-certified in Vascular Surgery and Endovascular Surgery by the American Board of Surgery. Dr. Gotvald has been performing venous stent procedures since 2005, with 15 years of experience in the diagnosis and management of May Thurner Syndrome. One of his areas of clinical interest in the management of deep venous thrombosis and May-Thurner Syndrome. He has extensive vascular experience in catheter-based interventional venous treatments for May-Thurner Syndrome utilizing stents.
Dr. Gotvald completed his fellowship in vascular interventional therapies at Baylor University Medical Center in 2006. He has been active in the clinical practice of vascular surgery and in the management of venous disease since that time. He has obtained additional certification in Phlebology by the American Board of Venous and Lymphatic Medicine (ABVLM). He is a distinguished Fellow of the Society For Vascular Surgery. He is a Fellow the the American College of Surgery, having completed a 5-year residency in surgery followed by a fellowship to specialize in vascular and vein interventions.
If you are interested in a consult for May-Thurner Syndrome, contact Austin Vein Specialists at (512) 339-9100.