May-Thurner syndrome is also known by the name of iliac vein compression syndrome – a name far more revealing. It means that the iliac vein gets compressed, which leads to pain, usually left leg swelling and general discomfort in the left leg, but in more serious cases, it can result in deep venous thrombosis which can be life-threatening. The condition is rather rare, which makes it even more difficult to detect.
The issue happens when the left common iliac vein gets pressed under the right common iliac artery. There have been examples of May-Thurner syndrome affecting the right leg, but it is far less common. The reason for this is that both iliac veins are connected to the inferior vena cava. While the right common iliac vein reaches the inferior vena cava going almost vertically towards it, the left common iliac vein travels diagonally, going under the mentioned right common iliac artery. The compression occurs between the mentioned artery and the lumbar spine. This is why May-Thurner syndrome is usually felt in the left leg.
When this happens it usually causes stasis of blood, which is creating a small pool. This is suitable for development of blood clots. However, clots do not always form, but pain, swelling and discomfort are all pretty common symptoms.
How common is May-Thurner syndrome
It is thought that between 2% and 5% of all patients with venous disorders in the lower extremities actually suffer from May-Thurner syndrome and most people who suffer from it are between 10 and 40 years old.
Women seem to suffer from the iliac vein compression far more than men. There is no conclusive data regarding this, since the syndrome is often misdiagnosed and unrecognized, but experts estimate that it is about three times more common for women than men.
It was demonstrated that patients who suffer from thrombophilia (a state where a change in blood coagulation leads to an increased possibility of developing thrombosis) and have no clear reason for it often actually suffer from May-Thurner syndrome. Before diagnosing a patient with May-Thurner syndrome due to thrombophilia, it is important to rule out other possible causes. In order to do this, a series of tests is needed, including checking factor V Leiden, proteins C and S and antithrombin.
The same goes for patients who suffer thrombosis in the left leg.
In case May-Thurner syndrome leads to deep venous thrombosis, it will often accentuate the mentioned symptoms. However, in case the blod clot gets detached and goes to the lungs, it can cause pulmonary embolism which can result in death.
May-Thurner syndrome treatment
The treatment greatly depends on the severity of the condition and symptoms. First of all, the initial symptoms (most often pain and swelling of the left leg) need to be addressed and evaluated by vascular specialists. In order to be certain of the diagnosis, some sort of imaging is necessary. Venography is always the first choice, but it may often be insufficient, since the vein compression may remain undetected. This is why more advanced imaging methods are necessary. These include intravascular ultrasound, magnetic resonance venography and venogram.
Treatment of the mild cases of May-Thurner syndrome may be limited to improving flow by non-intrusive methods, such as wearing compression stockings.
More severe cases can call for procedures such as the following:
Thrombolysis – breaking blood clots down within the blood vessels. It is usually performed using medication, but there are risks to this procedure.
Angioplasty – widening the vein which is narrowed or obstructed. A catheter with a deflated balloon gets inserted into the vein which needs the treatment. When the guide wire with the catheter reaches the desired spot, the balloon is inflated. It makes the vein expand and also push the muscular wall. This improves the blood flow.
Stent – Stenting usually comes after or even with angioplasty. It is used to prevent future compression which would lead to recurrence of the condition. Stent is a tube inserted into the vein which prevents it from getting compressed again.
Aside from dealing with decluttering of the left common iliac vein, patients also usually need something to treat the accompanying pain and relieve other symptoms. Many of them use painkillers, but they are not the best option, mostly due to the side effects that occur. Moreover, they can have negative interactions with other medication used, including the drugs used for thrombolysis.
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