May Thurner Syndrome

May-Thurner syndrome (MTS), also known as iliac vein compression syndrome or Cockett’s syndrome, is a condition that affects blood flow in the pelvis. It occurs when the right iliac artery, which carries blood to your right leg, compresses the left iliac vein, which drains blood from your left leg back to the heart. This compression can disrupt normal blood flow and increase the risk of blood clots (deep vein thrombosis) in the left leg.

Iliac arteries: These are the main arteries that supply blood to your legs. They branch off the aorta in your lower abdomen and divide into the right and left common iliac arteries.
Iliac veins: These are the main veins that drain blood from your legs. They also branch off, forming the right and left common iliac veins, which come together to form the inferior vena cava, the largest vein returning blood to your heart.

Symptoms

May-Thurner syndrome may not cause any symptoms in some individuals. However, when symptoms do occur, they can include:

Chronic pain, aching, or heaviness in the left leg, especially when standing or sitting for long periods
Swelling of the left leg or ankle
Varicose veins, particularly in the left leg
Discoloration of the skin on the left leg
A feeling of warmth in the affected leg

Causes

The exact cause of May-Thurner syndrome is unknown, but several factors may contribute:

Anatomical variations: Some people naturally have a pelvis that shapes the iliac vessels in a way that increases the chance of compression.
Hormonal changes: Pregnancy, childbirth, and hormonal therapy can increase the risk of May-Thurner syndrome.
Prolonged sitting or bed rest: This can slow blood flow and increase the risk of blood clots.
Obesity: Excess weight can put additional pressure on the iliac veins.

Diagnosis

Diagnosing May-Thurner syndrome can involve several tests, including:

Ultrasound: This painless test uses sound waves to create images of your blood vessels to check for blood clots and assess blood flow.
Venography: A contrast dye is injected into a vein, and X-ray images are taken to visualize the veins and identify any blockages.
Magnetic resonance imaging (MRI): This imaging test uses strong magnets and radio waves to create detailed images of your blood vessels and surrounding tissues.
Digital subtraction angiography (DSA): This minimally invasive X-ray technique provides a clear picture of the blood vessels by injecting a contrast material and subtracting background structures (Click here to read more on Digital subtraction angiogram)

Treatment

Treatment for May-Thurner syndrome focuses on preventing blood clots and managing symptoms. Options may include:

Blood thinners (anticoagulants): These medications help prevent blood clots from forming or growing larger.
Compression stockings: These garments apply gentle pressure to your legs to improve blood flow and reduce swelling.
Endovascular stenting: A small stent is placed in the left iliac vein to keep it open and improve blood flow. This procedure is typically performed using DSA guidance (Click here to read more on Angioplasty/ stenting)
Surgery (rare): In severe cases, surgery may be necessary to remove scar tissue or reposition the iliac artery to relieve compression on the vein.

Living With May-Thurner Syndrome

With proper diagnosis and treatment, most people with May-Thurner syndrome can live normal, active lives. Here are some tips for managing the condition:

Maintain a healthy weight.
Avoid prolonged sitting or standing.
Elevate your legs when resting.
Wear compression stockings as directed by your doctor.
Be aware of the signs and symptoms of blood clots and seek immediate medical attention if you experience them.

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May Thurner Syndrome