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What is May Thurner Syndrome?
Written by Medicover Team and Medically Reviewed by Dr Sandeep Botcha , Vascular Endovascular Surgeon
May-Thurner Syndrome (MTS), also known as Cockett syndrome or iliac vein compression syndrome, is a vascular condition where the right iliac artery compresses the left iliac vein, disrupting normal blood flow from the left leg back to the heart. This compression can cause blood to pool in the leg, increasing the risk of deep vein thrombosis (DVT) and other complications.
While iliac vein compression is common (affecting nearly 1 in 5 people), many remain undiagnosed unless symptoms or DVT appear.
How Does May-Thurner Syndrome Affect the Body?
In a healthy circulatory system, arteries carry oxygen-rich blood from the heart, while veins return oxygen-poor blood back.In MTS, the right iliac artery crosses over and compresses the left iliac vein, similar to stepping on a hose, which slows or blocks blood return. This pressure can lead to:
- Blood pooling in the left leg
- Increased risk of DVT
- Pelvic congestion syndrome in some females, causing chronic pelvic pain
What Are the Common Causes of May Thurner Syndrome?
The exact cause of May Thurner Syndrome remains unclear. However, it is believed to result from anatomical variations and mechanical factors. The constant pulsations of the right iliac artery against the left iliac vein can cause chronic trauma to the vein's walls, leading to scarring and narrowing.
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Get Second OpinionWhat are the Symptoms of May Thurner Syndrome?
Many people with MTS have no symptoms unless DVT develops. When symptoms are present, they usually affect only the left leg.
Common Symptoms
- Swelling or heaviness in the leg
- Pain, tenderness, or throbbing
- Discolored or reddish-blue skin
- Visible varicose veins
- Open sores (ulcers) in severe cases
DVT-Specific Symptoms
- Sudden leg pain and swelling
- Warmth or redness
- Difficulty walking or bearing weight
How is May-Thurner Syndrome Diagnosed?
Diagnosis begins with a detailed medical history and physical exam, followed by vascular imaging tests to confirm vein compression and assess blood flow.
Common Diagnostic Tools
- Ultrasound/Doppler scan: This non-invasive test uses sound waves to evaluate blood flow in the veins. It helps detect blockages, clots, or abnormal vein function without the need for radiation.It helps evaluate vein function and identify areas of poor circulation.
- CT or MR Venography: These advanced imaging techniques provide detailed views of the vein structure using CT or MRI technology. They are especially useful for identifying deeper vein abnormalities or obstructions.
- Traditional Venogram: In this procedure, a special dye (contrast agent) is injected into the veins, making them visible on X-ray images.It offers a clear view of vein blockages or malformations.
- Intravascular Ultrasound (IVUS): IVUS uses a tiny ultrasound probe inserted through a catheter into the vein to capture real-time, high-resolution images from within. It helps assess the vein's condition and guide precise treatment.
Complications Associated with May Thurner Syndrome
If left untreated, May Thurner Syndrome can lead to severe complications, including:
- Deep Vein Thrombosis (DVT): The most common complication, DVT can cause pain, swelling, and other severe issues if the clot dislodges and travels to the lungs, causing a pulmonary embolism.
- Chronic Venous Insufficiency: Prolonged compression can damage the vein valves, leading to chronic venous insufficiency, where blood pools in the legs, causing swelling and skin changes.
- Venous Ulcers: Chronic venous insufficiency can result in venous ulcers, which are difficult to heal and can lead to infections.
What Are the Treatment Options for May-Thurner Syndrome?
The goal of treatment is to relieve compression, restore blood flow, and prevent DVT or pulmonary embolism (PE).
Minimally Invasive Procedures
- Balloon Angioplasty and Stenting: A balloon is inflated to open the vein, followed by stent placement to keep it open.
- Catheter-Directed Thrombolysis: Delivers clot-dissolving medication directly to a DVT.
Surgical Options (if endovascular methods fail)
- Vein Bypass Surgery: Creates a new pathway around the compressed vein.
- Iliac Artery Repositioning: Moves the artery or inserts tissue to reduce compression on the vein.
When to See a Doctor May-Thurner Syndrome?
Seek medical attention if you experience:
- Unexplained swelling in one leg
- Persistent leg pain or discomfort
- Skin color changes or varicose veins
- Shortness of breath with leg swelling (urgent)
MTS can become life-threatening if a clot travels to the lungs. Prompt diagnosis is essential.
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Risk Factors for May Thurner Syndrome
Several risk factors can increase the likelihood of developing May Thurner Syndrome, including:
- Gender: Women are more commonly affected by MTS than men.
- Age: MTS is often diagnosed in young to middle-aged adults.
- Pregnancy: The increased blood volume and pressure during pregnancy can exacerbate the compression of the iliac vein.
- Sedentary Lifestyle: Prolonged periods of inactivity can contribute to the development of DVT and MTS.
How Can I Reduce My Risk of May-Thurner Syndrome and DVT?
While MTS cannot always be prevented, certain habits can lower the risk of complications:
Prevention Tips
- Avoid prolonged sitting (especially during travel or recovery)
- Stay hydrated
- Exercise regularly (especially walking, stretching, and aerobic workouts)
- Manage health conditions like hypertension or diabetes
- Quit smoking
- Wear compression stockings if recommended by your doctor
Our Experience Treating May-Thurner Syndrome
At Medicover, our vascular experts and interventional radiologists specialize in diagnosing and treating May-Thurner Syndrome with advanced imaging and minimally invasive endovascular techniques. From accurate diagnosis to personalized treatment and long-term follow-up, we ensure that patients receive holistic vascular care to prevent complications and restore quality of life.
