May-Thurner Syndrome
May-Thurner Syndrome is also known as Iliac Vein Compression Syndrome. It is a condition caused by the compression of the left common iliac vein by the right iliac artery resulting in narrowing of the vein. Iliac veins can also be compressed externally by the overlying arteries at different points, pelvic tumour or ovarian cyst.
Patients may develop pain, swelling, heaviness, skin hyperpigmentation and ulcers in the leg. Deep Vein Thrombosis (DVT) may occur with complete obstruction of iliac vein. Unfortunately, blood clot may break free and travel to your lungs, leading to life-threatening complications (Pulmonary embolism).
- Pain, especially worse with walking and prolonged sitting or standing
- Leg swelling
- Varicose veins
- Eczema
- Deep vein thrombosis (DVT)
Treatment
Angioplasty and stenting
This is a common intervention for May-Thurner Syndrome. Angioplastyand stenting is a nonsurgical treatment method used to increase the calibre of a narrowed or blocked vein. The procedure is performed with the use of advanced medical imaging system and intravascular ultrasound (IVUS) to accurately identify the exact location of vein blockage or narrowing and guide placement of stents. During angioplasty, a balloon at the tip of the catheter is inflated to stretch the vein. A stent (a metal mesh tube) is often placed as a scaffold to keep the vein open
In patients with acute DVT
In patients with acute DVT due to iliac vein compression, the following procedures may be required, in addition to angioplasty and stenting, depending on the symptoms and risk factors:
- Catheter Directed Thrombolysis- A catheter that delivers a clot busting medicine directly to the site of blood clot
- Percutaneous Mechanical Thrombectomy- This is a minimally invasive procedure uses specialized equipment to remove clot from the vein under X-ray guidance.
- Placement of Vena Cava Filter in patients who are not suitable for anticoagulation/blood thinner or at risk of pulmonary embolism. The filter serves to trap any blood clots dislodged from the vein, thus preventing the clots from reaching the lungs.
