May Thurner Syndrome Treatment

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May-Thurner Synrome (MTS), also known as Cockett’s Syndrome or Iliac Vein Compression Syndrome, is a condition caused by the compression of the left common iliac vein by the right iliac artery and the presence of venous disease symptoms. In most cases, the right common iliac artery compresses the left common iliac vein against the lumbar vertebrae, causing it to narrow and induce blood clotting1. This condition increases the risks of deep vein thrombosis or DVT in the left leg. A blood clot may prevent the blood from flowing freely through the vein. This may cause serious complications if not treated promptly.

Anatomy of MTS

The right common iliac artery (the artery that goes to the right leg) normally lies on top of the left common iliac vein (the vein coming from the left leg). Since arteries are more muscular than veins, the artery tends to compress the vein or “pinch” it, which reduces venous blood flow. Since the left common iliac vein drains blood from the left leg, reduced blood flow through the vein causes blood in the left leg to pool or stagnate. Slowly moving blood tends to form clots, which is why left leg DVT is associated with May-Thurner Syndrome.

Risks

May-Thurner Syndrome occurs most commonly in young and middle-aged women, between the ages of 20 and 503. The narrowing of the vein may lead to deep vein thrombosis, especially if the patient has a clotting disorder, is using contraceptives, or is pregnant.

Patients with DVT suffer from a range of symptoms, including:

  • Increased warmth in the leg
  • Pain, swelling, and tenderness in the leg
  • Enlargement of the veins in the leg
  • Discoloration of the skin

Early detection and treatment is important to reduce the symptoms and avoid more severe complications. Doctors may recommend different treatment options depending on the severity of the condition. Modern procedures, such as stenting, are now becoming the standard in treating this type of venous disease.

Diagnosing May-Thurner Syndrome

Most people are not aware that they have May-Thurner Syndrome because the symptoms do not appear until iliac vein compression is advanced4. Moreover, the first sign of the syndrome is usually a deep vein thrombosis. Since May-Thurner Syndrome is not one of the more common causes of DVT, doctors may not consider it as a possible cause initially.

Ultrasound imaging is one of the most common methods to detect a DVT. Unfortunately, the blood clot that occurs in May-Thurner Syndrome is usually much higher up in the leg than in normal DVT, so ultrasound may not show the clot5. Other diagnostic options include CT scan, MRI, intravascular ultrasound (IVUS), and contrast venography. Each procedure has its own advantages and disadvantages.

VENITI is committed to developing products that will help physicians treat venous disease faster and easier. Our team of medical professionals and scientists are working hard to find ways to improve the design and functionality of our products.

Treatment Options

Blood-Thinning Medication

Doctors may recommend the use of anticoagulants to prevent blood clots in the vein. Blood thinning medications by themselves are not a suitable treatment for May-Thurner Syndrome, because the iliac vein compression will persist if not treated directly6. On the other hand, blood-thinning medications are extremely helpful after thrombectomy and/or venous stent placement7.

Catheter-Directed Thrombolysis

In this minimally invasive procedure, a long, slender tube called a catheter is inserted into the vein until it is near the clot. Then the physician infuses a clot-dissolving medication directly onto the blood clot. More recently, this approach is being combined with venoplasty and stenting7.

Surgery

A surgery may be necessary to prevent the right common iliac artery from pressing the left common iliac vein against the spine. During the procedure, the doctor moves the artery behind the affected vein. This helps prevent further compression, allowing the vein to recover gradually. A follow up procedure may be necessary to achieve the best result. Another surgical approach is to place a tissue sling between the right iliac artery and the left common iliac vein. This procedure creates space between the vessels, thus reducing the pressure placed on the narrowed iliac vein.

Venoplasty and Stenting

Venoplasty is a procedure used to widen the vein after dissolving and removing the clot. Doctors inflate a small balloon inside the affected vein to stretch it open and increase blood flow. In addition to using the balloon to open the vein, the doctor may place a small metal mesh tube, called a stent, to keep the vein open.

Some of the traditional methods of treating May Thurner Syndrome are not commonly used today, as stenting has become the main treatment option. More doctors are using stenting because of the high patency rate achieved in most procedures. VENITI, an industry leading medical device company, developed a system that uses a stent to treat May Thurner Syndrome and its complications.

The ability of doctors to provide the procedure, along with clinical experience, suggests that stenting is an ideal option for many patients. Results, however, may vary from patient to patient, depending on the severity of the case. A thorough examination and proper monitoring are necessary to determine how a patient can maximize the benefits of iliac stent placement procedures.

The Role of VENITI

As a premier medical device company, VENITI strives to improve the lives of patients and provide innovative technologies and treatment solutions for doctors. Our team continues to find ways to improve our existing products and create new ones. We are committed to serving the needs of physicians and patients.

As part of our campaign towards making Venous Disease a more manageable disease, we partner with doctors and investors to grow our network and improve the quality of service we offer. Providing physicians with the tools and technologies they need and helping improve patients’ quality of life are among our primary goals.

Involving Doctors and Patients

We know we cannot make things happen without the help of our clients. We build a community of medical practitioners to establish strong relationships and create a collaborative environment. Members of The Confluence, the private, physicians-only portal we provide, interact with one another to gain insight and discuss matters concerning the research, diagnosis, and treatment of venous disease. We encourage doctors to join our growing community and participate in conversations.

Contact VENITI by calling our office or by filling out an online form if you have questions about our company and everything we do.

 References 

  1. Butros SR, Liu R, Oliveira GR, et al. Venous compression syndromes: clinical features, imaging findings and management. Br J Radiol. Oct 2013;86(1030):20130284.
  2. Mousa AY, AbuRahma AF. May-Thurner syndrome: update and review. Ann Vasc Surg. Oct 2013;27(7):984-995.
  3. Patel NH, Stookey KR, Ketcham DB, et al. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome. J Vasc Interv Radiol. Nov-Dec 2000;11(10):1297-1302.
  4. Oguzkurt L, Ozkan U, Ulusan S, et al. Compression of the left common iliac vein in asymptomatic subjects and patients with left iliofemoral deep vein thrombosis. J Vasc Interv Radiol. Mar 2008;19(3):366-370; quiz 371.
  5. Fazel R, Froehlich JB, Williams DM, et al. Clinical problem-solving. A sinister development–a 35-year-old woman presented to the emergency department with a 2-day history of progressive swelling and pain in her left leg, without antecedent trauma. N Engl J Med. Jul 5 2007;357(1):53-59.
  6. Comerota AJ, Throm RC, Mathias SD, et al. Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life. J Vasc Surg. Jul 2000;32(1):130-137.
  7. Husmann MJ, Heller G, Kalka C, et al. Stenting of Common Iliac Vein Obstructions Combined with Regional Thrombolysis and Thrombectomy in Acute Deep Vein Thrombosis. European Journal of Vascular and Endovascular Surgery. 2007;34(1):87-91.