Understanding the Basics of May-Thurner Syndrome

Do you have a history of deep vein thrombosis or persistent pain and swelling in your lower extremities? Have you or a loved one undergone hip or knee surgery but continue to experience leg swelling and difficulty walking. Have you had your veins treated without any resolution of your symptoms, or have the symptoms returned and are worse than ever? Do you have varicose veins in other places besides your lower extremities? Do you have pelvic pain or fullness and have been diagnosed with endometriosis, but the treatments that have been offered are not helping? If so, you may have May-Thurner syndrome. Also known as iliac vein compression, this condition can inhibit the flow of blood in your lower extremities

Diego Hernandez, MD, of Bloomfield Vein & Vascular in Bloomfield Hills, Michigan, a Board Certified Vascular Surgeon, is an expert in vein conditions, and he can diagnose and treat not only deep vein thrombosis, but also the underlying causes, such as May-Thurner syndrome.

What is May-Thurner syndrome?

Arteries are blood vessels that carry oxygen-rich blood from the heart to the rest of your body. Veins carry oxygen-depleted blood back to the heart where it is then distributed back to the lungs to obtain oxygen again and circulate through the body in a cycle. In your pelvis, the area of your lower abdomen, the blood vessels that accomplish these functions are known as the iliac arteries and the iliac veins. The iliac veins are responsible for taking all of the venous flow from your lower extremities and help to distribute it back to your heart. We all have one iliac vein on each side of our body, draining the corresponding lower extremity. May-Thurner syndrome most commonly involves the right iliac artery and the iliac vein draining the left lower extremity, but we often see involvement of the right lower extremity, as well, and/or involvement of both lower extremities. 

Arteries and veins parallel each other throughout our bodies. However, in the pelvis, the right iliac artery crosses over the left iliac vein (and sometimes the right iliac vein as well), creating a situation where the pressure in the iliac artery compresses the iliac vein. It resembles stepping part way down on a garden hose, which prevents the blood from flowing as freely through the iliac veins

The result of this reduced blood flow through the iliac veins is that it can lead to swelling, achiness, heaviness, varicose veins, leg pain when walking or exercising and, under the right circumstances, can increase your risk of developing deep vein thrombosis (DVT, blood clot). Deep vein thrombosis not only blocks the blood flow in the affected lower extremity, which can be very painful, but a part of the clot can also break off and go to your lungs. That is called a pulmonary embolism or PE, and it can be life-threatening.

What are the symptoms of May-Thurner syndrome?

Although May-Thurner syndrome can happen to anyone, we tend to see it more commonly in women. The problem with May-Thurner syndrome is that you may not know you have it until you develop a deep vein thrombosis. That’s why researchers aren’t certain how frequently this condition occurs. In a study of patients with DVT, 46% had May-Thurner syndrome as the underlying cause; our experience at Bloomfield Vein & Vascular over the last several years treating hundreds of patients with this condition, has led us to believe that everyone who develops a DVT has May-Thurner syndrome as the underlying cause of it

Symptoms, when a DVT is not present, usually include pain and swelling in the lower extremities, difficulty walking or exercising caused by the failure of the blood to drain from the legs, thigh discomfort and/or achiness when sitting for too long, and varicose veins. Some early, subtle symptoms include a feeling of tightness in the lower extremities that is better in the morning and gets worse with activity. This can also cause you to feel as if your shoes fit tighter, particularly in the evening. 

In more advanced stages, this condition can lead to skin discoloration and ulcerations — or sores on the skin — typically on the inner aspect of either ankle. It is not uncommon, however, that the first symptoms that you experience are related to the development of a deep vein thrombosis. 

Diagnosis and treatment

An initial clinical examination may suggest a diagnosis of May-Thurner syndrome, but diagnosing this condition requires imaging to properly visualize the compression of the iliac veins. At Bloomfield Vein & Vascular, we have an extensive experience in diagnosing May-Thurner syndrome prior to it causing DVTs, with a team of talented ultrasound technicians who have developed specific protocols to help diagnose this problem. 

Once diagnosed, treatment for May-Thurner syndrome involves placing a stent within the iliac veins. This helps protect the veins from being compressed by the artery and restores flow. If a DVT has developed as a result of May-Thurner syndrome, we can often help remove some of the clot that is present and then treat the underlying compression by insertion of a stent. After intervention, we often use blood thinners, or anticoagulants, to ensure that flow remains adequate, due to the increased risk of development of another DVT when anticoagulants are not used. 

We now have specially designed venous stents that are indicated for this condition. These stents are metal cylinders that are inserted into the iliac veins through a small puncture in the lower extremity. The procedure is minimally invasive and is performed as an outpatient intervention. Placement of these stents will keep the iliac veins open and allow blood to flow freely. Our experience in treating May-Thurner syndrome in Southeast Michigan is unparalleled. Not everyone is properly trained to place stents and experience helps in order to avoid serious complications. 

If you have symptoms associated with May-Thurner syndrome or DVT, it’s important to contact us as soon as possible since complications can be life-threatening. If you have any of the symptoms described above, such as leg swelling, achiness, tiredness, heaviness, varicose veins, difficulty walking or exercising due to leg pain, book an appointment online or over the phone with Bloomfield Vein & Vascular today. You will be glad that you did. 

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