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May-Thurner syndrome: Trying but treatable
Omar P. Haqqani, MD
Midland Daily News
December 4, 2016
Swelling. Pain. Tenderness. Increased warmth. Redness. Skin discoloration.
If you find yourself experiencing any of the prior symptoms, you may be afflicted with May-Thurner syndrome (MTS), also known as iliac vein compression syndrome. While not life-threatening, this condition can lead to serious complications, including loss of limb, if untreated.
Even though MTS typically affects the left side of the body, there are other anatomic points in the venous system that can be compressed naturally by our anatomy resulting in symptoms. Thus the left, right or both legs may be affected in some cases of MTS.
Anatomically, the right iliac artery travels over the left iliac vein in all humans. MTS occurs when the left iliac vein is compressed by the right iliac artery in the pelvic region, similar to how a pair of shoelaces overlap when pulled tight. When compressed, the risk of deep vein thrombosis (DVT), swelling, pain and tenderness in the left leg increases. DVT is a blood clot that may partially or completely block blood flow through the vein.
DVT may lead to chronic venous insufficiency which can cause blood to pool in the extremity, resulting in chronic swelling, increased pressure, discoloration of the skin, and leg ulcers. When left untreated, in severe cases, amputation of the limb may be necessary.
MTS is congenital but not hereditary, meaning it is a birth trait, but not necessarily due to your family history. It is more commonly found in women than men, and shows up more frequently in young women taking birth control medication. Additionally, as women age or gain weight, their risk increases.
Many people have some form of compression between the iliac artery and vein, however only a small number of those afflicted have severe compression of the iliac vein and the attributed complications, namely blood clots, swelling or increased pressure in the deep veins of the leg. Many people may even be unaware that they have this disorder, due to having only a small degree of compression to the iliac vein.
A combination of physical examination and diagnostic testing are generally used to achieve a diagnosis of MTS. Tests used to confirm diagnosis include duplex ultrasound, computed tomography scan (CT), magnetic resonance imaging (MRI), intravascular ultrasound and outpatient venography.
You may also be diagnosed with MTS if you are present with symptoms of increased swelling, pain, discomfort or a deep vein thrombosis. These symptoms are usually in the left leg, though symptoms present in the either or both legs could lead to diagnosis, until further testing is completed.
The majority of treatments related to MTS are typically aimed at treating the DVT that is associated with the vein compression. The goals of treatment are to reduce symptoms and reduce the risk of complications. Your healthcare provider can direct the appropriate treatment option for you.
Treatment includes diagnosing the condition and placing a stent, a tubular support similar to a metal scaffolding, to keep the vein from being compressed by the iliac artery. The stent is then inserted through the catheter and guided to the ballooned area of the iliac vein. This helps hold the compressed area open and remains in the vein permanently.
Because the condition is congenital, not much can be done in terms of preventing MTS. MTS, however, is rather common, with some studies suggesting that MTS is present in 70 percent, or 7 out of 10, patients with deep venous thrombosis. What can be done, however, is taking measures to help prevent the associated blood clots that can cause complications.
These measures can include taking prescribed anticoagulants as directed, regularly exercising your lower leg muscles to improve circulation, avoiding sitting or lying in one place too long, and wearing compression stockings.
If properly managed, those afflicted with MTS stand a high probability of living their life free of complications from the disease.
Dr. Omar P. Haqqani, M.D., is the chief of Vascular and Endovascular Surgery at Vascular Health Clinics in Midland.
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