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May-Thurner Syndrome: Causes, Symptoms, and Treatment

May 5, 2023 1:15:22 PM Dr. Andrew Cha, DO, FACS
May-Thurner Syndrome: Causes, Symptoms, and Treatment

May-Thurner Syndrome is a condition that impacts blood flow and occurs when the right iliac artery compresses the left iliac artery. According to medical research, it affects 14-32% of the general population. Despite the high prevalence, it can remain clinically silent in most patients and is quite challenging to diagnose, in part due to it being asymptomatic unless they develop deep vein thrombosis (DVT). Some other names for May-Thurner syndrome (MTS) are Cockett syndrome or Iliac vein compression syndrome. 

MTS develops through three stages, starting with asymptomatic left iliac artery compression, which leads to the formation of a venous spur, the second stage. The last stage is the formation of a left lower extremity, such as DVT. However, some people can live with MTS for years without developing DVT. 

Causes of May-Thurner Syndrome 

May-Thurner Syndrome is caused by the right iliac artery being on top of the left iliac artery and putting pressure on it. It is unsure why this happens since it has no symptoms or warning signs. However, according to a 2015 study, 2-3 percent of people with DVT can attribute it to May-Thurner Syndrome. A 2018 study also found that the condition occurs twice as often in women as in men. Additionally, most cases involve people between the ages of 20 and 40


Since most people with May-Thurner Syndrome don't develop symptoms, it may take a long time to detect this condition. Your doctor will ask about your medical history and give you a routine physical examination. Imaging tests are required to narrow in on your left iliac artery. Some examples of imaging tests that can be used to diagnosis this condition include:

  • Ultrasound 
  • CT scan 
  • MRI scan 
  • Venogram 
  • Intravascular ultrasound 
  • Catheter-based venogram 

Treatment and Management 

The goals of treatment are to treat any clots you already have and prevent new clots from forming. The standard primary treatment is angioplasty and a stent, where a small balloon is used to expand the left iliac vein. Then a tiny metallic container called a stent is installed so blood can flow normally.

Blood thinners and other anticoagulants are also used to prevent the formation of new clots in the veins and keep the existing clots from getting larger. Other treatment and management options include:

  • Compression stockings- You may not need treatment if your symptoms are mild. Wearing tight stockings puts pressure on your lower leg, thus reducing swelling and improving blood flow. 

  • Surgical thrombectomy- This procedure involves the removal of large clots in the vessels to prevent further tissue damage. 

  • Clot busters- Doctors only use this treatment to treat large clots. It involves using a thin tube or catheter to send medication to the clot to break it down. The drug can take a few hours or days to work. 

  • Bypass Surgery- This procedure builds a new path for blood flow and is only used when the vessels have suffered irreversible damage or when the heart needs urgent blood flow. 

  • Vena cava filter- It involves placing a filter in your vena cava to catch larger blood clots from reaching the lungs. Doctors mainly consider this option if the blood thinners don't work. 

Symptoms of May-Thurner Syndrome 

Most people with this condition don't experience the symptoms until they develop deep vein thrombosis. However, since MTS makes it harder for blood to circulate back to the heart, some people may suffer from the symptoms without developing DVT. The symptoms mainly occur in the left leg. They include:

  • Leg swelling 
  • Feeling heaviness in the leg 
  • Leg pain when walking 
  • Enlarged veins in the leg 
  • Skin discoloration 
  • Leg ulcers 

Contact The Cardiovascular Care Group for Effective Diagnosis, Treatment, and Management 

Consider visiting us for a venogram if you notice any of the above mentioned symptoms. This test lets your doctor see your left iliac artery on an X-ray, allowing them to make the correct diagnosis. Our board-certified vascular physicians utilize several treatment options to reduce pressure on the left iliac artery and prevent new clots from forming. 

Schedule an appointment with us today! 

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