May-Thurner Syndrome Treatment - Iliac Vein Stenting

May-Thurner syndrome treatment involves relieving compression of the left iliac vein through stenting.

What is May-Thurner Syndrome?

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May-Thurner Syndrome (MTS), also known as iliac vein compression syndrome, is the compression of the left common iliac vein between the right common iliac artery and the lumbar vertebra (L5).

History:

• 1851: Virchow first described it
• 1957: May and Thurner detailed anatomical study
• Modern era: Treatment with stenting

Anatomy

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Right Common Iliac Artery
        ↓
        X ← Compression point
        ↓
Left Common Iliac Vein
        ↓
      L5 Vertebra

Pathophysiology:

1. Mechanical compression
2. Chronic trauma → Intimal hyperplasia
3. “Spur” formation
4. Venous stasis and thrombosis risk

Epidemiology

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May-Thurner Syndrome Symptoms

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Symptom Spectrum

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Asymptomatic:

• Anatomical variant only
• Incidental finding

Symptomatic:

• Left leg swelling
• Chronic venous insufficiency
• Acute DVT

Clinical Findings

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Chronic Presentation:

• Unilateral (left) leg swelling
• Pain and heaviness
• Varicose veins
• Leg fatigue
• Venous ulcer (advanced stage)

Acute Presentation:

• Sudden leg swelling
• Severe pain
• Iliofemoral DVT
• Phlegmasia (rare)

Risk Factors

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• Female gender
• Pregnancy/postpartum
• Prolonged immobilization
• Oral contraceptive use
• Pelvic surgery/trauma
• Hyperlordosis

May-Thurner Syndrome Diagnosis

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Imaging Methods

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Doppler Ultrasonography:

• First-line screening
• DVT detection
• Limited assessment at iliac level

CT Venography:

• Iliac compression imaging
• Anatomical assessment
• DVT extent

MR Venography:

• Non-invasive
• Soft tissue detail
• Contrast-free protocols possible

Conventional Venography:

• Reference standard
• “Smiley face” appearance (compression sign)
• Treatment planning

Gold Standard: IVUS

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Intravascular Ultrasound (IVUS):

• Most sensitive diagnostic method
• Lumen area measurement

• 50% stenosis diagnostic criterion

• Stent sizing

IVUS Advantages:

• True stenosis degree
• Intimal spur detection
• Optimal stent placement
• Intra-procedural assessment

Iliac Vein Stenting

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Indications

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Definite Indications:

• Symptomatic MTS
• Chronic post-DVT obstruction
• Post-thrombotic syndrome

Relative Indications:

• Recurrent DVT
• Asymptomatic but >70% stenosis
• DVT prophylaxis

Pre-procedure Preparation

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• Planning with IVUS/Venography
• Anticoagulation assessment
• General condition evaluation

Stenting Technique

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Access:

• Femoral vein (retrograde)
• Popliteal vein (antegrade)
• Jugular vein (rarely)

Procedure Steps:

1. Venous access (US-guided)
2. Diagnostic venography
3. IVUS assessment
4. Lesion crossing (guidewire)
5. Pre-dilation (balloon angioplasty)
6. Stent placement
7. Post-dilation
8. Control IVUS/venography

Stent Selection

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Stent Sizing:

• Diameter: 10-20% larger than reference vein
• Length: Completely covering the lesion
• May extend to iliocaval junction

Combined Approach in Acute DVT

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Pharmacomechanical Thrombectomy + Stenting:

1. Thrombus clearance with CDT or PMT
2. Underlying MTS detection
3. Same-session stenting
4. Optimal outcome

Treatment Outcomes

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Primary Stenting (Without DVT)

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Post-thrombotic Stenting

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Villalta Score Improvement

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Post-Procedure Care

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Anticoagulation

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In Acute DVT:

• At least 3-6 months anticoagulation
• Continuation decision based on risk factors

In Primary Stenting:

• Antiplatelet therapy (clopidogrel + aspirin)
• 3-6 months dual therapy
• Then aspirin monotherapy

Follow-up Program

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Compression Therapy

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• Below-knee compression stockings
• Class II (20-30 mmHg)
• Daytime use
• 2 years recommended duration

Complications

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Intraprocedural

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Early Period

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• Leg pain: Common, transient
• Superficial thrombophlebitis: Anticoagulation
• Early thrombosis: Thrombolysis/aspiration

Late Period

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• In-stent restenosis: 5-10%
• Stent fracture: Rare
• Stent migration: Very rare

Special Situations

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May-Thurner in Pregnancy

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• Pregnancy worsens MTS symptoms
• High DVT risk
• Anticoagulation (LMWH)
• Stenting usually postpartum

Bilateral Iliac Compression

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• Right iliac vein compression rare
• Cockett syndrome
• May require bilateral stenting

Recurrent DVT

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• Underlying MTS should be investigated
• Stenting prevents recurrence
• Long-term anticoagulation

Prognosis

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If Untreated:

• High recurrent DVT risk
• Post-thrombotic syndrome development
• Chronic venous insufficiency
• Poor quality of life

If Treated:

• Excellent symptom control
• Minimized DVT risk
• Normal quality of life
• Long-term stent patency

Frequently Asked Questions

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Appointment and Contact

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To schedule an appointment for May-Thurner syndrome evaluation and iliac vein stenting:

📍 Avrasya Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul, Turkey

📞 Phone: +90 212 665 50 50 (Extension: 4012)

This content has been prepared by Assoc. Prof. Habib Çil for informational purposes only. Please consult a cardiology specialist for accurate diagnosis and treatment.

Related Venous Interventions

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Other services related to May-Thurner syndrome treatment:

• Acute DVT Treatment - Deep vein thrombosis
• Chronic DVT Treatment - Post-thrombotic syndrome
• Iliac Artery Treatment - Arterial interventions
• Varicocele Treatment - Pelvic vein embolization