May-Thurner syndrome (MTS) is a rare but serious medical condition. Also called iliac vein compression syndrome or Cockett's syndrome, it affects two blood vessels in the pelvic region. It may or may not produce symptoms initially, but it does increase your risk of deep vein thrombosis (DVT) in your left leg.
At Dallas Vein Institute and Texas Vascular Institute, interventional radiologist Dr. Dev Batra and his team handle all manner of blood vessel problems, including May-Thurner syndrome and DVT. Because many of our patients in the Dallas and Hurst, Texas, areas aren’t familiar with either condition, we’ve put together this guide about signs and symptoms so you’ll know when to get medical help.
Your circulatory system serves two important functions: it transports oxygen and nutrients to the tissues to keep them healthy and returns the depleted blood to the heart. To accomplish this, your heart regularly contracts, pushing oxygenated blood out through the arteries and deoxygenated back through the veins.
Veins, though, have the harder job because they have to fight gravity’s pull. To overcome this force, your thigh and calf muscles contract and squeeze the veins, forcing the blood upward. The veins also contain one-way valves that close once the blood passes and prevent it from flowing backward.
Valves become damaged, though, usually due to trauma or high blood pressure. That means they don’t close fully, and blood can flow backward, pooling around the damaged valves. That is called venous insufficiency, and it’s the first stage of vein disease. It can cause varicose veins, edema, and skin ulceration, among other problems.
It’s normal for arteries and veins to sometimes cross each other’s paths. However, with MTS, that crossing becomes a problem.
MTS involves your right iliac artery — the main artery transporting blood into your right leg — and the left iliac vein — the main vein transporting blood from your left leg back to your heart.
With MTS, the right iliac artery pushes on the left iliac vein as they cross in your pelvic region. Blood slows as it moves through the left iliac vein due to the pressure, like water does when you step on a hose.
When blood flows sluggishly, it’s more likely to pool and clot, increasing the risk of developing DVT. Unlike superficial clots, DVT clots, which form in the deep leg veins, are a significant health risk.
First, the presence of the clot further restricts blood flow in the leg. Second, the clot (or a piece of it) may detach from the vein, traveling to the lungs. If it becomes lodged in the lung, it’s called a pulmonary embolism — a life-threatening condition.
Most people with MTS don’t experience symptoms unless they develop DVT. However, because MTS leads to inefficient blood flow, it’s possible to experience symptoms without developing DVT.
Symptoms occur primarily in the left leg and can include any combination of the following:
Women may also develop another pelvic-area condition that needs to be ruled out for an MTS diagnosis. Pelvic congestion syndrome is a case of varicose veins in the pelvis instead of the legs. The main symptom is pelvic pain.
MTS treatment options focus on improving blood flow in the left iliac vein, which also lowers your risk for DVT. Some procedures include:
Dr. Batra inserts a small catheter with a balloon at the end into the vein. He inflates the balloon to open the vein, then places a stent (small mesh tube) to keep it open. Then, he deflates and removes the balloon, leaving the stent in place.
Dr. Batra uses a graft to reroute blood around the compressed part of the vein, restoring flow.
Dr. Batra moves the right iliac artery behind the left iliac vein to relieve pressure. In some cases, he may place tissue between the left iliac vein and the right artery to “pad” the area.
If you’ve developed DVT, treatment includes blood thinners, clot-busting medications, or placing a vena cava filter that prevents clots from traveling to the lungs.
If you’re noticing any of the symptoms of May-Thurner syndrome, it’s time to come to Dallas Vein Institute and Texas Vascular Institute for an evaluation by Dr. Batra. Give us a call at either location or book your appointment online.