May-Thurner syndrome: assessment and treatment in a specialist unit
Table of contents
Assessment
Assessment of iliac venous compression
May-Thurner’s syndrome is a common cause of venous obstruction in the pelvis which can lead to persistent swelling of one leg, a feeling of heaviness or episodes of deep vein thrombosis.
At the Abdominal Compression Syndromes and Venous Thrombosis Unit at the Publio Cordón Memorial Hospital, a specialised assessment is carried out to determine whether there is compression of the iliac vein and whether this condition is significantly affecting the return of blood from the leg to the heart.
In this condition, the right iliac artery compresses the left iliac vein. When this compression is significant, venous flow is impeded and may contribute to the development of thrombosis or persistent venous symptoms.
The aim of the examination is to determine whether this compression requires treatment. In many cases, an accurate diagnosis allows the condition to be corrected using minimally invasive techniques, leading to a marked improvement in symptoms.
Specialist management in the Compression Syndromes Unit
The management of May-Thurner syndrome requires expert assessment of the deep venous system, as it is not simply a matter of identifying a thrombosis when it occurs, but of detecting the underlying cause.
The Unit combines clinical assessment, vascular imaging and endovascular treatment, enabling it to manage both the early stages and the more advanced forms of the condition.
This approach enables a personalised assessment of whether venous compression needs to be treated and what the best option is in each individual case.
Do you need specialist advice on symptoms related to venous compression?
Diagnosis of iliac vein compression
The aim of the diagnosis is to confirm whether compression of the vein is affecting blood flow.
The first step is usually a venous Doppler ultrasound, which allows the blood flow in the veins of the legs to be analysed.
When compression in the pelvis is suspected, more advanced imaging tests such as CT angiography or venous MRI are used, which allow the anatomy of the veins and their relationship with the arteries to be visualised.
In some cases, the investigation is supplemented with intravascular ultrasound (IVUS), a technique that allows the vein to be examined from the inside and the degree of narrowing to be measured accurately.
When to treat May-Thurner syndrome
Treatment depends on the degree of venous compression, the presence of thrombosis and the symptoms. In mild cases, clinical monitoring and medical treatment may be sufficient.
Where compression is significant or has led to deep vein thrombosis, it is usually advisable to restore venous flow to prevent further complications and improve symptoms.
Assessment of venous compression and treatment options
A vascular scan makes it possible to confirm the presence of compression and to determine whether endovascular treatment is advisable.
Treatment: iliac vein angioplasty and stenting
The most commonly used treatment is the endovascular approach, a minimally invasive procedure that allows the vein to be treated from the inside without the need for open surgery.
A catheter is inserted through a puncture site — usually in the groin — and guided to the compressed vein. Once there, angioplasty is performed (dilating the vein using a balloon) and a venous stent — a small metal mesh designed to keep the vein open — is then placed.
By correcting the compression, blood flow is restored and venous return from the leg is improved, thereby reducing symptoms and lowering the risk of further thrombosis.
Follow-up and recovery
Following treatment, clinical and ultrasound monitoring is carried out to assess the progress of the venous system and the improvement in symptoms.
In some cases, anticoagulant treatment is recommended for a specific period, along with measures to promote venous return.
Most patients experience a gradual improvement in swelling and heaviness in the leg, and are able to resume their normal activities within a short period of time.
Deciding on treatment at the right time
May-Thurner syndrome may go undiagnosed unless a specific examination of the deep venous system is carried out. A specialist assessment enables the compression to be identified, its actual impact to be assessed and a decision to be made as to whether treatment is indicated.
When treated appropriately, it is possible to improve venous symptoms and reduce the risk of further complications.
