EP06: Shedding Light on May-Thurner Syndrome

Werfen is committed to Powering Patient Care and raising global awareness about thrombosis to improve overall health outcomes.
In this episode, we focus on May-Thurner Syndrome, a relatively underdiagnosed condition that typically affects adults aged 20 to 50. Bringing attention to this syndrome is a crucial, as DVT is often mistakenly seen as primarily affecting the elderly.

Shedding Light on May-Thurner Syndrome

Werfen is committed to Powering Patient Care and raising global awareness about thrombosis to improve overall health outcomes.

In this episode, we focus on May-Thurner Syndrome, a relatively underdiagnosed condition that typically affects adults aged 20 to 50. Bringing attention to this syndrome is crucial, as DVT is often mistakenly seen as primarily affecting the elderly.

Etiology and Epidemiology

May-Thurner Syndrome (MTS), also known as iliac vein compression syndrome or Cockett's syndrome, occurs when the right iliac artery compresses the left iliac vein, restricting blood flow and causing it to pool in the leg. This compression disrupts normal blood flow, leading to various complications, including DVT. 

While the prevalence of the disorder is unknown, this condition is found in 2–5% of patients undergoing evaluation for lower extremity venous disorders and often affects young women. 

Symptoms and Risk Factors

The clinical presentation of MTS is highly variable. Many individuals remain asymptomatic due to venous collaterals that preserve blood flow. Some patients experience a gradual progression of venous insufficiency, while others may have an acute onset.

Thrombotic events often occur when risk factors such as stasis, injury, or pregnancy are concomitant, and symptoms can be subtle until advanced. In severe cases, if a clot breaks off and travels to the lungs, it can cause PE, a medical emergency requiring immediate attention.

Diagnosis and Treatment

Diagnosing MTS typically involves a combination of physical examinations and imaging tests. Common diagnostic methods include Doppler ultrasonography and imaging techniques such as CT or MRI.

The primary goals of MTS treatment are to alleviate symptoms, prevent new clot formation, and manage existing clots. Interventional management like thrombolysis or stenting is considered on a case-by-case basis. Anticoagulation is always required, with patients typically receiving therapeutic heparin and discharged on warfarin.

Prognosis and Management

With appropriate treatment, individuals with MTS can manage their symptoms and reduce the risk of complications. Consistent follow-up with a healthcare provider is essential to monitor their condition and adjust treatment as needed. 

Residual stenosis from MTS poses a risk for recurrent DVT. While warfarin remains the anticoagulant of choice for managing MTS, recent reports indicate successful treatment with DOACs, generally better tolerated by younger individuals. 

Collaborative Healthcare Efforts

Diagnosing MTS necessitates a high level of clinical suspicion and a collaborative approach among healthcare professionals to ensure timely and appropriate testing, leading to better outcomes. The care team for MTS patients often includes interventional radiologists, vascular surgeons, wound care specialists, and hematologists.

Coordination among professionals facilitate prompt diagnosis and intervention, enhancing long-term outcomes and quality of life. Educating patients on daily practices, medications, and warning signs is essential to reduce morbidity.

Conclusions and Outlook 

Understanding the causes, symptoms, and risk factors of MTS is crucial for timely diagnosis and effective treatment. With appropriate management, patients can reduce the risk of complications and improve their quality of life. Continued research and awareness efforts are vital to better understand and address this condition, ultimately leading to improved patient outcomes.