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.