May Thurner Syndrome

May-Thurner syndrome, sometimes called iliac vein compression syndrome or Cockett’s syndrome, is a common but often undiagnosed circulatory condition. It occurs when the vein carrying blood out of the left leg becomes compressed by an overlapping artery. The compression slows normal blood flow, which can cause a buildup of blood in the left leg, in turn causing pain, swelling and a high risk of blood clots including deep vein thrombosis (DVT).

Once identified, May-Thurner syndrome can be treated effectively with a variety of methods. However, the condition often goes unnoticed until a DVT develops. Many patients receive treatment for a DVT without discovering that May-Thurner syndrome was the cause. This leads to the possibility of symptoms and a DVT returning in the future.

At Owensboro Hear & Vascular, our experienced cardiologists can provide relief from May-Thurner syndrome. Drs. Vora will help you identify whether May-Thurner syndrome is the underlying cause of your concerns, and can then provide the safe and effective treatments you need for a long-lasting solution. Learn more below, or contact us today to schedule an appointment.

What is May-Thurner Syndrome?

All of the blood vessels in the lower body come together in the pelvic area, as the veins and arteries in the legs join with the body’s other major blood vessels. Two blood vessels — the vein that carries blood out of the left leg, and the artery that carries blood into the right leg — overlap one another at this junction. Specifically, the artery, called the right common iliac artery, crosses on top of the vein, called the left common iliac vein. These vessels intersect in everyone’s body, but about 20 percent of people have a slightly different positioning that can cause May-Thurner syndrome.

In May-Thurner syndrome, the left common iliac vein becomes pinched between the right common iliac artery and the lower spine. In some cases, the compression is mild and has few noticeable symptoms. When compression is severe, however, blood flow through the vein slows significantly. This causes blood and fluid buildup that can lead to swelling and pain and is likely to cause a DVT in the left leg.

May-Thurner Syndrome Symptoms

Many individuals live with May-Thurner syndrome and do not experience significant symptoms. They may have some occasional discomfort or swelling, particularly if they spend long periods of time without moving or if they sit or stand in a way that makes the vein compression worse. The discomfort will typically go away once they move around and restore blood flow.

However, symptoms may become severe if someone with May-Thurner syndrome becomes pregnant, has a long period of immobility due to injury or illness, or experiences blood vessel weakness due to age. In particular, these risk factors often cause an individual with May-Thurner syndrome to develop a DVT in the left leg, which includes warning signs such as:

• Swelling
• Skin discoloration
• Redness
• Pain
• Tenderness
• Skin warmth
• Leg cramps

Symptoms of a DVT, whether caused by May-Thurner syndrome or not, should not be ignored. If left alone, a DVT blood clots can travel through the body and into the lungs, where they can result in a potentially fatal blockage called a pulmonary embolism. It is important to speak to your healthcare provider if you are noticing pain or swelling in your leg that does not go away.

May-Thurner Syndrome Diagnosis

A patient with a DVT caused by May-Thurner syndrome should get treatment for a DVT, but may not receive a correct diagnosis. Doctors will frequently attribute a patient’s DVT to other possible causes, such as a sedentary lifestyle, being overweight, aging, or otherwise. They will treat the patient by eliminating the blood clot and recommending a course of action to combat clotting, such as regular exercise or medication.

A doctor may test for May-Thurner syndrome if an otherwise healthy patient develops a DVT in the left leg, or if a patient has recurring symptoms of a DVT in the left leg despite other treatments. May-Thurner syndrome can be identified with imaging tests such as x-ray venography, an MRI, a CT scan or an ultrasound.

May-Thurner Syndrome Treatments

Treating May-Thurner syndrome typically begins with treatment for a DVT. This involves dissolving the blood clot using either blood-thinning medications or a catheter inserted into the vein to break up the clot. Severe clots may require surgical intervention. After a DVT is eliminated, May-Thurner Syndrome can be identified, and corrective treatment can be provided. Some options for May-Thurner syndrome treatment include:

Angioplasty. Angioplasty is a nonsurgical procedure that uses a tiny balloon to “reinflate” the compressed left common iliac vein. The flat balloon is moved through the blood vessels attached to a catheter until it reaches the compressed area, where it is then inflated to widen the vein. Angioplasty is typically accompanied by the placement of a stent. This is an outpatient procedure where you can return home the same day.

Insertion of a stent. A stent is a small mesh tube placed inside a blood vessel to clear blockages and prevent the vessel from collapsing. In May-Thurner syndrome, a stent placed in the left common iliac vein ensures that pressure from the right common iliac artery does not interfere with blood flow. This is an outpatient procedure where you can return home the same day.

Use of blood-thinning medications. Blood thinners, also called anticoagulants, are medications that prevent blood cells from sticking together to form clots. If a May-Thurner syndrome patient does not have significant compression on their left common iliac vein, a blood thinner may be all that is needed to reduce their chances of a recurring DVT.

Surgery. Surgical options for May-Thurner syndrome include bypass surgery to route blood flow around the compressed vein; surgery to move the right common iliac artery behind the left common iliac vein; and surgery to place a cushioned “sling” that prevents the artery from pressing on the vein. Though more intensive than other options, surgery can offer very reliable and permanent results for patients with severe vein compression.

Owensboro Medical Practice proudly provides cardiovascular services, including the diagnosis and treatment of May-Thurner syndrome, in the western Kentucky and southern Indiana area. Please contact us today to schedule an appointment with one of our experienced providers.