What Causes May-Thurner Syndrome to Develop?

What Causes May-Thurner Syndrome to Develop?

May-Thurner syndrome (MTS) is a rare but serious medical condition that affects two blood vessels in the pelvic region. And while it may not produce symptoms initially, it increases your risk of deep vein thrombosis (DVT), a significant vascular condition, in your left leg.

At Dallas Vein Institute and Texas Vascular Institute, interventional radiologist Dr. Dev Batra and his team handle all types of blood vessel problems, including both May-Thurner syndrome and DVT. 

Because many of our patients in the Dallas and Hurst, Texas, areas aren’t familiar with these conditions, we’ve put together this guide about how the syndrome develops, as well as signs and symptoms you should look for so you’ll know when to get medical help.

The ins and outs of your circulatory system

Your circulatory system is a closed loop that serves two essential functions: it transports oxygen and nutrients to the body’s tissues and returns deoxygenated blood to the heart. To do this effectively, your heart contracts regularly, pushing oxygenated blood out through the arteries and deoxygenated back through the veins.

In many ways, veins have a harder task. That’s because they have to move the blood against gravity’s pull. To circumvent the problem, your thigh and calf muscles contract, squeezing the veins and forcing the blood upward. The veins also have one-way valves that close once the blood passes, preventing it from flowing backward.

Unfortunately, the valves can become damaged, either from injury or high blood pressure. That means they don’t snap shut fully, and blood is free to flow backward, pooling around the damaged area. This is called venous insufficiency (VI), and it’s the first stage of vein disease. VI can lead to varicose veinsedema, and skin ulceration, among other problems.

What causes May-Thurner syndrome?

Arteries and veins sometimes cross each other. However, with MTS, that crossing leads to a problem with blood flow.

MTS involves your right iliac artery — the main artery moving blood into your right leg — and the left iliac vein — the main vein moving blood from your left leg back to your heart.

With MTS, the right iliac artery crosses over the left iliac vein in your pelvic region, exerting pressure on it. Blood flow slows within the vein due to the pressure, like water does when you step on a hose.

When blood flow becomes sluggish, it’s more likely to pool and clot, increasing the risk of developing DVT. Unlike the superficial clots seen in varicose veins, DVT clots form in the deep leg veins, and they pose a significant health risk.

First, the clot further obstructs blood flow in the leg, leading to potentially more clots. Second, the clot (or a piece of it) can detach from the vein wall and travel to the lungs. If it becomes lodged there, it’s called a pulmonary embolism — a life-threatening condition.

Symptoms of May-Thurner syndrome

Most people with MTS don’t have noticeable symptoms unless they develop DVT. However, because MTS leads to venous insufficiency, it’s possible to experience symptoms without developing DVT.

Symptoms occur primarily in the left leg and can include one or more of the following:

Women can also develop pelvic congestion syndrome — the development of varicose veins within the pelvis instead of the legs. The main symptom is pelvic pain.

Treating MTS

MTS treatment focuses on improving blood flow in the left iliac vein, which also lowers the risk of developing DVT. Some procedures include:

Angioplasty and stenting

Dr. Batra inserts a small catheter with a balloon at the end into the compressed vein. He inflates the balloon to open the vein, then places a small mesh tube (stent) to keep it open. Finally, he deflates and removes the balloon, leaving the stent in place.

Bypass surgery

Dr. Batra uses a vein graft to reroute blood around the compressed vein, restoring normal blood flow.

Repositioning the right iliac artery

Dr. Batra moves the right iliac artery behind the left iliac vein, relieving the pressure. He may also place tissue between the left iliac vein and the right iliac artery to “pad” the area.

If you’ve developed DVT, treatment involves a combination of blood thinners, clot-busting medications, or placing a vena cava filter in the vein to prevent clots from traveling to the lungs.

If you’re experiencing any symptoms of vein disease, including those for May-Thurner syndrome, it’s time to come to Dallas Vein Institute and Texas Vascular Institute for a consultation with Dr. Batra. Give us a call at either location or book your appointment online.

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