May-Thurner Syndrome: Symptoms, Treatment


May-Thurner syndrome (MTS), also named Iliac Vein Compression Syndrome, describes the
condition where the left iliac vein is compressed by the right iliac artery. When
compression is severe, deep venous thrombosis (DVT), a type of blood clots, may
form in the blood vessels. These clots can eventually break away from the vein,
leading to serious health conditions and even death.

About 1 in 5 people have developed MTS. Women are more likely to be affected than men. Moreover, the condition is more common in young females aging between 20 and 50.


MTS is caused by the right iliac artery
being on top of and putting pressure on the left iliac vein in your pelvis.
However, doctors are not sure why this happens. You are at higher risk of
getting this disease if you:

  • Are a female between 20 and 40 years old
  • Just have a baby
  • Take birth control pills
  • Are dehydrated
  • Had blood clots once
  • Are inactive for a long period of time
  • Have trauma or injury once
  • Are overweight

Some experts think that MTS is a congenital
condition, which may cause an aberration in the arrangement of the left common
iliac vein and the right common iliac artery. But this opinion has not been
proved and agreed yet.


In the early stage, MTS may cause no
symptoms. But over time, you may experience signs and symptoms like:

  • Swelling and pain in the leg
  • Warmth and tenderness in the leg
  • Redness or dislocation of the skin
  • Bleeding from the affected area
  • Venous ulcers or sores that do not heal on your leg
  • Varicose veins

In severe cases, MTS can cause DVT, a blood
clot in the vein deep below your skin. If a blood clot breaks away and travels
to your lungs, heart, or brain, it can lead to serious, even life-threatening
issues like:

  • Stroke
  • Heart attack
  • Pulmonary embolism, a blood clot in your lung, causing shortness of breath, fast heartbeat and chest pain


It is hard to diagnose MTS because it is
symptom-free in most cases. To make a diagnosis, your doctor will start by
giving you a physical exam. In the exam, they will look closely at your leg and
check for typical signs of the disease. He or she may also use some of the
following imaging tests to help confirm the diagnosis:

  • Ultrasound
  • CT scan
  • MRI scan
  • Venogram, a type of X-ray that uses a special dye to show the veins
    in your leg


Usually, the goals of treatment for MTS are
to treat blood clots already have and prevent new ones from forming.

Blood thinners are the most effective medications to treat DVT. They can prevent new clots and keep ones you already have from getting bigger. Accompanying this type of medicine, a clot-busting medication can be delivered via a catheter directly into the vein near the clot.

Other invasive surgical procedures that can help treat MTS include:

  • Balloon angioplasty and stenting

This is a common treatment for MTS. First,
your doctor uses a small balloon to expand the left iliac vein. Then, you get a
device called a stent. It’s a tiny cylinder, made of metal mesh, that keeps the
vein open wide so blood can flow normally.

  • Bypass surgery

In this procedure, a bypass graft is used
to reroute the blood around the compressed part of the vein.

  • Repositioning the right iliac artery

This is done by removing the right iliac
artery behind the left iliac vein, so it doesn’t put pressure on it.

  • Vena cava filter

You might get this if you can’t take blood
thinners or if they don’t work well for you. Your doctor places a filter in
your vena cava, a large vein in your belly. The filter will catch clots from
your legs, so they don’t reach your lungs. It can’t stop new clots from

  • Compression stockings

If your symptoms are mild, your doctor may suggest you wear these tight stockings that go from toes to knee. They put pressure on your lower legs that eases swelling and improves blood flow.

Keywords: May-Thurner syndrome (MTS); MTS; Iliac Vein Compression Syndrome.

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