May-Thurner Syndrome: What is it?
It may go by many names, but the potential harm caused by this vein disease can be life threatening. May-Thurner syndrome is also known as Cockett’s syndrome or iliac vein compression syndrome. It primarily attacks a pair of vessels that carry blood in and out of your legs.
The condition places pressure on one of the veins, cutting down on the blood flow. The resulting slow blood flow makes you more likely to suffer from a deep vein thrombosis (DVT) in your left leg.
A Problem With the Blood Vessel
Blood vessels are the interstate highway systems of your body. They carry blood from the heart to every part of your body and back again. The oxygen carried by the circulatory system is what keeps each cell in your body alive. If there is a blockage, a opening, or some other reason that blood cannot reach a cell, that cell will die. This is what happens in deadly strokes and heart attacks.
The arteries are responsible for moving blood away from your heart, and the veins return it. In some spots in the body, your arteries and veins will cross paths. This is typically not a situation that causes any concern. That is unless you have suffer from May-Thurner syndrome.
Swollen Right Iliac Artery
May-Thurner syndrome is characterized by a swollen right iliac artery. The right iliac artery and the left iliac vein cross in your pelvis. The right iliac artery transports the oxygen rich blood to your right leg and the left iliac vein carries the blood back out of your left leg toward your heart.
In cases of May-Thurner syndrome, the right iliac artery swells up and compresses against the left iliac vein in the pelvis. The exterior pressure placed on the left iliac vein, makes it harder for the blood to freely flow out of the legs. It is similar to pinching a straw while trying to drink from it. You can get a small about of beverage through the reduced opening, but it takes more time and effort.
What will my Doctor do to Properly Diagnose my May-Thurner syndrome?
In order to properly diagnose May-Thurner syndrome, your doctor will likely want to:
- Inquire into your medical history and
- Ask about your symptoms.
- Give you a complete physical exam. He or she will examine the area and test your general health (blood pressure, etc.)
- Employ an imaging test (an ultrasound, echogram, MRI, or venogram) to confirm a suspected diagnosis.
May-Thurner syndrome – clotting in your left leg
The conditions produced by the limited flow of blood is conducive to clotting in your left leg. As the blood is moving more slowly, it will spend more time in contact with the adjacent blood cells and vein walls making it easier to form a bond.
Individuals with this condition are more likely to develop a deep vein thrombosis (DVT) in their left leg. A DVT clot can be quite serious. Not only can these types of clots cause damage by blocking the regular blood flow in your leg, if they break loose, they can become life-threatening.
When a DVT breaks loose, it will travel through the circulatory system and can find another place to become lodged. If it reaches your lungs, it can cause a life-threatening blockage in the lungs called a pulmonary embolism.
May-Thurner Syndrome: Causes and Risk Factors
May-Thurner syndrome can affect anyone. There do not appear to be any genetic links associated with May-Thurner syndrome. It is not something that is passed in the genes from generation to generation. Females are more likely to suffer from May-Thurner syndrome because of the stress that pregnancy puts on the pelvis. It is not something that you can get from your parents. Remember that the crossing of the blood vessels is natural. Some times, however, they are situated in such a way that the right iliac artery pushes the left iliac vein back into the spine. The additional pressure causes the vein to collapse leaving a narrower opening. It is similar to what happens when you step on a garden hose. If the contact with the spine is abrupt, it can injure the vein, causing scarring. The scars will make the interior of the vein even narrower.
You are at a higher risk to get May-Thurner syndrome if you:
are a woman
have been diagnosed with another medical condition that causes your blood to clot easily
recently had a baby
have given birth to more than one child
use oral birth control
suffer from scoliosis
May-Thurner Syndrome: Symptoms
Unfortunately, there are very few warning signs for May-Thurner syndrome. Many people do not realize that they have the condition unless they develop a deep vein thrombosis. Some people report a general pain or slight swelling in the leg, but typically, there are not any warning signs.
There are recognizable symptoms for a deep vein thrombosis. Pay special attention if you notice any of the following:
The skin on your left leg may appear red or purple
You leg feels heavy or tender
Throbbing in the leg
Swelling in the leg
Skin becomes warm to the touch
Tight pain similar to a cramp or charley horse
Veins swell in size
If a DVT breaks loose and becomes lodged in your lungs, your situation will deteriorate quickly. Call 911 immediately if you have any of these symptoms.
Pain in the chest that is made worse when inhaling
Coughing up blood
Becoming short of breath or have other breathing problems
A racing heartbeat
All of these are signs of a serious life-threatening condition. Call 911 if you notice any of them.
May-Thurner Syndrome: Diagnoses
Your doctor will want to start by asking questions about your condition. He or she will want to know what symptoms you are noticing, under what conditions are they worse or better, and when you first noticed them. After he or she has a fuller picture of your situation, then the doctor will likely follow up with a full physical exam. He or she will touch different areas of your leg and pelvis identifying if you have common symptoms of a DVT. After that, he or she may order some imaging or lab tests. Your healthcare provider may ask for blood test, an echocardiogram, or other tests on the circulatory system. Imaging tests may include X-rays, sonogram or an MRI.
Due to the serious nature of a deep vein thrombosis clot, if it is discovered that you suffer from May-Thurner Syndrome you should start treatment immediately. Treatment will target two objectives. 1) To treat any current clots and 2) to keep new ones from developing. Your healthcare provider may discuss several different options with you. Those options are discussed in more detail below.
Angioplasty and/or a stent:
Many doctors favor using one or both of these methods to help normalize blood flow in patients suffering from May-Thurner syndrome. For angioplasty you will be given medication to relax you and a local anesthesia will be administered at the entry site (most likely in your groin.) A catheter is guided through a blood vessel to the area of the blockage. Once there, a balloon at the tip of the catheter is inflated. The balloon will push the plaque and stretch the artery open to boost blood flow to the heart. At this point a stent may be added. A stent is a tiny cylinder, made of metal mesh. It holds the vein open so that blood can flow more normally.
May-Thurner syndrome: Possible Complications
The primary complication of May-Thurner syndrome is deep vein thrombosis (DVT). By itself, DVT is not a grave concern. However, if a DVT clot breaks loose from the leg, it can move with the blood flow to the lungs. Once in the lungs it could lodge in a pulmonary artery, causing a life-threatening condition known as a pulmonary embolism.
Symptoms of a pulmonary embolism can differ greatly. The severity of the symptoms will vary based on many factors. Some of those are:
- the size of the area of the lung that is involved,
- the size of the clots themselves, and
- whether or not you have any underlying lung or heart disease.
Some of the most common signs and symptoms include:
- Quick onset of shortness of breath that always gets worse with physical exertion.
- Serious “heart attack like” chest pain that may become worse when you take deep breaths, cough, eat, stoop or bend over. Your pain will always get worse when you exert yourself but will not go away when you rest.
- A deep cough that may include blood.
Anticoagulants and other Blood thinners:
Drugs that reduce the blood’s ability to clot are frequently used to treat DVT. By “thinning” the blood, they lower the possibility of creating new clots and stop the growth of any clots you already have. There are many types of blood thinners on the market. Talk to your doctor about which one might be right for you. Blood thinners can have serious side-effects.
Iliac bypass surgery:
Your doctor can use a vein from your arm to create a detour along which the blood will flow.
A vena cava filter is a small device that is inserted in a large vein in your abdomen (called the inferior vena cava). Your doctor might opt for this approach if you cannot take a blood thinner due to another medical condition or if they they are ineffective for you. The filter will prevent blood clots from moving through your blood into your lungs. While the filter will not prevent the formation of clots, it will stop them so they do not end up in your lungs and cause a life-threatening pulmonary embolism.
If you have mild to moderate symptoms and your medical provider does not feel that you are in need of more treatment, he or she might simply suggest wearing a support hose (also called a compression stocking.) These tight stockings cover your legs from your knees to your toes and put constant pressure on your lower legs. The constant pressure will ease swelling and improve blood flow.
This is a type of surgery that removes the blood clot from inside an artery or vein. It is generally reserved for clots that are very large in size or those that are causing severe damage to the tissue. The surgeon will make an incision into a blood vessel. The clot is then removed, and finally the blood vessel is repaired.
Surgery to reposition the right iliac artery.
During this operation, the surgeon adjusts the position of the artery. He or she positions it so it sits behind the left iliac vein, no longer pressing on it.
Thrombolytic therapy (also called clot busters) are used by doctors to treat more serious clots. Your medical provider will use a catheter (a thin hollow tube) to apply medication directly to the site of the clot. These powerful drugs can break down a clot in anywhere from a few hours to a few days.
Tissue sling surgery:
During this procedure, the surgeon will place some extra tissue between the two blood vessels to act as a cushion between them.