Have you had a blood clot in the left leg, or recurrent blood clots without a known cause? Do you notice swelling of the left leg? If so, you may be considered for evaluation of May-Thurner Syndrome, which can be a hidden cause for left leg swelling and DVTs. May-Thurner Syndrome is a condition where the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. This causes narrowing of the vein in the pelvic region, sort of like a bottle-neck. The narrowing of the vein makes the blood flow more sluggish and prone to blood clots and leg swelling. This variant has been shown to be present in over 20% of the population.
What Is May-Thurner Syndrome?
The iliac arteries originate from the largest artery in the body, the abdominal aorta. They split at the spine to form the left and right iliac arteries, which feed blood to the pelvis and legs. The right iliac artery is supposed to lie over the left iliac vein, but with this syndrome this artery is compressing the vein. As a result of this compression, the iliac vein narrows and constricts, sometimes scarring. This narrowing results in increased risk of developing blood clots or deep vein thrombosis in that extremity.
Why Do I Have May-Thurner Syndrome?
This condition is congenital but not hereditary and is more common in women than men. It shows up more frequently in young women taking birth control medication, as women age or as they gain weight. Many people may be unaware that they have this disorder, because many may only have some degree of compression of the iliac vein. Only a small number of individuals have severe compression of the iliac vein, resulting in symptoms, namely blood clots in the deep veins of the leg.
How Is May-Thurner Diagnosed?
Diagnosis is achieved by a combination of physical examination and diagnostic testing. Diagnosis may also occur when patients present with symptoms of a deep vein thrombosis (DVT- please see this section of venous conditions) and further testing is completed.
Tests to confirm diagnosis include:
- Duplex ultrasound
- Computed tomography scan (CT)
- Intravascular ultrasound
What Are My Treatment Options for May-Thurner Syndrome?
What Are My Treatment Options for May-Thurner Syndrome?
The goal of treatment is to reduce symptoms as well as reduce the risk of further complications.
- Anticoagulant therapy: These medications thin your blood and prevent the current clot from increasing in size, as well as prevent new clots from forming. These medications do not dissolve the clots that you have. You may be on IV heparin for several days or an injection called Lovenox that is given in the abdomen once daily for 5 to 7 days. You will be started on a medication called warfarin (Coumadin), which is an anticoagulant pill. It can take about 3 days for this medication to have effect, so during that time you may be on both warfarin and heparin. You may be on this medication for up to 6 months, during which time routine blood tests are required to ensure your blood is at the appropriate thinness to prevent clots from forming.
- Catheter-directed Thrombolytic Therapy: During this procedure, a thin flexible tube called a catheter is inserted into a puncture in the skin and guided into the affected blood vessel of the lung. A thrombolytic drug is injected which dissolves the clot over a period of time. There is a much higher risk of bleeding as well as stroke with this therapy, compared to anticoagulants.
- Angioplasty and stenting: Once the clot has been removed from the vein, this procedure is performed to widen the compressed vein. A thin flexible tube called a catheter is inserted in a puncture over a vein in the leg. A small balloon at the tip of the catheter is inflated to stretch the iliac vein open, increasing blood flow to the leg. A small metal mesh tube called a stent is inserted through the catheter and guided to the ballooned area of the iliac vein. The stent will help hold the compressed area open and will remain in the vein permanently.
- Inferior Vena Cava (IVC) filter: During this procedure, a thin flexible tube called a catheter is inserted through a vein in your leg, arm, or neck. The vascular surgeon passes a small special metal filter through the catheter and places it in the inferior vena cava, which is a large vein in your abdomen that carries blood back to the lungs. This filter traps clots that break away from leg veins, preventing them from travelling to your lungs. This is done if the patient cannot tolerate anticoagulation therapy.
Can May-Thurner Syndrome (MTS) Be Prevented?
Can May-Thurner Syndrome (MTS) Be Prevented?
Since May-Thurner Syndrome (MTS) increases risk of deep vein thrombosis (DVT) and complications associated with DVT, such as pulmonary embolism, prevention of these risks progressing to clinical events is prudent.
In the absence of DVT and for patients with only mild symptoms of left leg swelling or pain, conservative measures of prevention are used, specifically, compression stockings. These are also used if the severity of MTS requires more aggressive invasive interventions. Venous ultrasound imaging is helpful in ruling out more severe manifestations of MTS, such as DVT.
In advanced MTS that demonstrates signs and symptoms of advanced chronic venous insufficiency, such as limb swelling, pain, and skin discoloration, prevention of disease progression aims to reduce stenosis of the vein(s) using angioplasty and stents in the affected segments(s). Angioplasty alone results in a high recurrence rate. Thereafter, compression stockings are used.
In advanced MTS that results in venous thromboembolism (VTE), full anticoagulation therapy is begun (unless contraindicated by pre-existing coagulopathy). Catheter-directed or pharmaceutical thrombolysis is useful in eliminating the clots that may migrate. DVT requires anticoagulation according to the guidelines used in VTE prophylaxis.
Rarely, when more conservative or interventional measures are unsuccessful or contraindicated, an open cut-down may be necessary to evacuate the clot.
Prevention and follow-up utilize periodic venous ultrasound imaging.
OUR PATIENTS SAY
Dr De Young is personable and thorough in his explanations. Exceptional.
I am pleased to recommend La Jolla Vein & Vascular. I am in the process of receiving treatment there. The entire medical staff are super friendly, welcoming and very helpful. Everyone is courteous, including the physicians. I’ve had one doctor follow my case. He’s the one who always treats me at appointments and closely follows my health. I am very comfortable going there. Would go again if needed and encourage anyone who’s thinking of making an appointment to do so asap. You’ll see what a wonderful experience it is. It’s the people who make it so special!
From my greeting at the front desk to the ultrasound and visit with the doctor, I received excellent care. It’s clear they care about their patients and all the staff couldn’t have been nicer or more helpful. I also appreciate how much time the doctor spent with me to explain the results and the next steps. I would definitely recommend this office to friends with vein issues.
We were early and didn’t have to wait at all. The tech that did my husband’s ultrasound, Monica, was very accommodating with my husband’s Parkinson’s. Doctor Lucas whom we hadn’t seen before, came to us instead of making my husband walk down to another office. She spent a lot of time getting caught up on Steve’s background issues/conditions. I was impressed by this medical group before, so I was surprised that the staff was even better this time around; I honestly didn’t think there was room for improvement!
I have been having leg treatments for several months now La Jolla Vein Care. Every time I go to an appointment; the staff is so friendly and takes such good care of me; always informative; not in a rush and always friendly (especially Alejandra & Anna to name a few). Of course Dr. Lucas is amazing. The treatments have changed my life. Overall this has been an incredible experience.
Beautiful facility! I walked in without an appointment and they took me right away! It was even the end of the day…I was so grateful…Every single person was soooo pleasant! Super impressed ❤️
Highly recommend! Entire staff are warm& friendly, professional and accommodating. The doctor took the time to thoroughly explain everything and encouraged me to ask questions. I never felt rushed. Significantly better experience than the other 2 vein clinics I’ve been to on the east coast. I wish I could’ve just come here from the beginning.
The staff kept you informed as to when you would be seen and the wait was not too long. Emily took care of my ultrasound and was very accommodating giving me an extra pillow and playing a video to watch. The office is very courteous and professional- Nadia answered our questions and offered us a bottle of water. I have been seeing Dr. Bunke, but now Dr. Lucas and will continue coming to La Jolla Vein Care!
I had the best experience at La Jolla Vein Care. Dr.Bunke is an amazing doctor with the best bedside manners, she truly cares about her patients, she explained everything to me. My procedures where so easy I was impressed how painless and fast my appointments. Anna M was very helpful scheduling my treatments and checking on me to make sure all of my questions were answered. I am very pleased thank you !!! I truly recommend La Jolla Vein Care!
Everyone here is so nice! Usually front desk medical personnel are so rude. The front desk ladies Alejandra, Anna, and I think her name is Liz, went above and beyond to take care of me and my insurance issues. The techs are great too! Rachel and a male technician assisted me…both of them implemented different techniques to make me feel more at ease during an uncomfortable and painful process. These procedures were rough…and I am grateful everyone was so sweet to me. Thanks again.
When I arrived for the first time, I could barely walk. My legs were red and swollen. After my treatments, I can now walk again. I’m so thankful to the doctor and his staff. They are caring, supporting and knowledgeable about my issues. Five Stars all the way!!!!
La Jolla Vein care has the best staff ever. They are so nice, accommodating and professional!! Dr. Bunke is the best doctor that I ever seen. She is so friendly upfront and has the best bed side manner. I thank this office for letting me be their patient. 💜. Plus they are so careful with COVID which I really appreciate!!!