- Risk Factors
- Signs & Symptoms
What is May-Thurner syndrome?
May-Thurner syndrome (MTS), also known as Cockett’s syndrome or iliac vein compression syndrome, is a rare medical condition that occurs when the right iliac artery compresses the left iliac vein. The left iliac vein carries blood from the pelvis and legs to the heart. This compression causes a narrowing of the vein and a decrease in blood flow from the leg, increasing the risk of blood clots in the leg veins, also known as deep vein thrombosis (DVT).
MTS is a relatively rare medical condition and is estimated to cause two to five percent of all DVT cases in the general population. The condition is more commonly diagnosed in women than men, and it is typically found in individuals between the ages of 20 and 40 years. However, MTS can occur in people of any age and gender.
What causes May-Thurner syndrome?
May-Thurner syndrome (MTS) is a condition where the left iliac vein gets compressed by the right iliac artery. This reduces blood flow and may lead to clot formation.
The exact cause of MTS is not known; however, it is believed to be caused by various reasons, including:
- Anatomical variation: Some genetic anatomical variations that cause the left iliac vein to be positioned differently increase the chance of compression.
- Prolonged sitting: People who sit for prolonged periods, such as long-distance travelers, office workers or those who have a sedentary lifestyle are more likely to develop MTS.
- Obesity: Obesity can increase the pressure on the veins and arteries and cause compression.
- Trauma: Trauma to the pelvis or abdomen can lead to the development of MTS.
- Pregnancy: During pregnancy, the uterus may put pressure on the left iliac vein, increasing the risk of MTS.
- Tumors: Rarely, tumors or abnormal growths in the pelvis can compress the left iliac vein, causing MTS.
What are the risk factors for May-Thurner syndrome?
The exact cause of May-Thurner Syndrome (MTS) is not known, but certain risk factors may increase the probability of developing the condition, which includes:
- Gender: Women are more prone to developing MTS than men. This may be due to hormonal factors that affect blood clotting. Certain high-risk conditions contribute to the development of MTS, such as postpartum, multiparity, and the use of oral contraceptives.
- Age: MTS is more commonly diagnosed in individuals between the ages of 20 and 40.
- Family history: There may be a genetic component to MTS, and individuals with a family history of the condition may be at increased risk.
- History of blood clots: Individuals with a history of deep vein thrombosis or pulmonary embolism may be at an increased risk of developing MTS.
- Other medical conditions: Certain medical conditions, such as cancer, heart failure, and inflammatory bowel disease, can increase the risk of blood clots and MTS.
What are the symptoms of May-Thurner syndrome?
Not all individuals with May-Thurner syndrome (MTS) experience symptoms, and many remain asymptomatic; however, in some cases, the compression of the left iliac vein can cause symptoms, such as:
- Leg pain, tenderness, or swelling of the affected leg
- Leg fatigue or heaviness, especially after prolonged standing or sitting
- Dark-red or purple discoloration of the skin on the affected leg
- Ulcers or sores on the leg
- Varicose veins
- Deep vein thrombosis (DVT)
- Pulmonary embolism
DVT, pulmonary embolism (a blockage in the lungs), and post-thrombotic syndrome, which can cause chronic pain, swelling, and skin changes in the affected leg, are serious complications that arise in untreated MTS.
How is May-Thurner syndrome diagnosed?
After noting down thorough medical history and symptoms, the doctor performs a physical examination to look for abnormal signs. To make a confirmed diagnosis, the person will be subjected to various imaging studies, including:
- Ultrasound: With ultrasonic sounds, the images of the insides of the body are seen on a screen. These images can help visualize the blood flow in the veins and arteries and detect signs of compression or blood clots.
- CT scan: This can provide detailed images of the veins and arteries, which can help identify any blockages or abnormalities.
- MRI: This can provide detailed images of the veins and arteries and can be particularly useful in identifying the extent of the compression and the presence of any blood clots.
- Venography: An imaging test that involves injecting a dye into the veins and using X-rays to visualize the blood flow. This test can help identify the location and severity of the compression.
- Duplex ultrasound: This test combines traditional ultrasound with Doppler ultrasound to provide information about the direction and speed of blood flow in the veins and arteries.
In some situations, the condition is discovered during an imaging test done for another condition.
What are the stages of May-Thurner syndrome?
May-Thurner syndrome (MTS) is typically classified into three stages based on the severity of the condition and the presence of symptoms. These stages are as follows:
- Stage 1: The individual is asymptomatic and imaging studies may only show mild compression of the left iliac vein.
- Stage 2: The compression of the left iliac vein is more significant and symptoms may begin to appear. These symptoms can include leg swelling, pain, or varicose veins.
- Stage 3: In this stage, deep vein thrombosis (a blood clot) has formed in the left leg due to the severe compression of the left iliac vein. The blood clot can travel to the lungs (pulmonary embolism) and become life-threatening.
Not all individuals with MTS will progress through these stages, and some may only experience mild symptoms or none at all.
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What is the most common treatment for May-Thurner syndrome?
May-Thurner syndrome (MTS) is a rare medical condition caused by compression of the left iliac vein by the right iliac artery, which hinders the blood flow from the left iliac vein to the heart. The goal of treatment for MTS is to improve blood flow in the affected leg and prevent the formation of blood clots.
Treatment options for MTS
- Blood thinning medications: Medications such as warfarin, heparin, or direct oral anticoagulants, can help prevent the formation of blood clots and reduce the risk of DVT and pulmonary embolism.
- Compression stockings: These can help improve blood flow and alleviate symptoms such as leg swelling and pain. They are usually worn during the day and removed at night.
- Thrombolysis: A minimally invasive procedure where a catheter is inserted into the affected vein, and medication is used to dissolve the blood clot. This procedure can help restore blood flow in the affected leg.
- Angioplasty and stenting: A minimally invasive procedure where a balloon is inserted into the narrowed vein and is inflated to widen the compressed area. A stent is placed to keep the vein open.
- Surgery: In rare cases, surgery may be necessary to remove the blood clot or correct the compression of the left iliac vein through bypass surgery.
- Lifestyle changes: Making lifestyle changes, such as quitting smoking, losing weight, and exercising regularly, can help improve blood flow and reduce the risk of complications.
The treatment depends on the severity of the condition, presenting symptoms, and overall health of the individual. With prompt and effective treatment, many individuals with MTS can experience significant improvement in their symptoms and a reduced risk of complications.
Can May-Thurner syndrome be cured?
May-Thurner syndrome (MTS) can be treated, but it is not always possible to cure it completely. The treatment approach for MTS depends on the severity of the condition and the presence of symptoms.
In some cases, MTS may be asymptomatic, and no treatment may be necessary. However, if symptoms are present or if there is a risk of developing blood clots, treatment may be recommended. The goals of treatment are to improve blood flow, prevent blood clots from forming and alleviate symptoms.
As the condition may not be cured completely, individuals with MTS need ongoing treatment and monitoring to prevent the development of blood clots and manage symptoms.
Can May-Thurner syndrome be reversed?
Although treatment can be effective in managing symptoms and preventing complications of May-Thurner syndrome (MTS), it may not reverse the underlying anatomical abnormality of the compression of the left iliac vein by the right iliac artery.
Treatment can improve blood flow and prevent the formation of blood clots. Various treatment options are available to reduce the severity of the condition and prevent the risk of further complications.
It is essential to consult a doctor if you experience any symptoms suggestive of MTS, such as leg pain, swelling, or skin discoloration.
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May-Thurner syndrome: a not so uncommon cause of a common condition: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377287/
May-Thurner Syndrome: https://www.webmd.com/dvt/may-thurner-syndrome
May-Thurner Syndrome: https://www.ncbi.nlm.nih.gov/books/NBK554377/#:~:text=May%2DThurner%20syndrome%20develops%20through,without%20ever%20having%20a%20DVT.
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