May-Thurner syndrome (also known as Cockett syndrome or iliac vein compression syndrome) refers to a narrowing of the iliac vein, a vein in the lower back. The condition itself usually only leads to mild symptoms (slight swelling of the leg and a feeling of tightness). However, it increases the risk of thrombosis and life-threatening pulmonary embolisms. Early detection is therefore important.
Below you will find further information and selected May-Thurner syndrome specialists.
Experts also refer to May-Thurner syndrome as iliac vein compression syndrome. The iliac vein is located in the abdominal cavity at the level of the sacrum. It is where the blood from the legs, pelvis and buttocks comes together and flows back to the heart.
The iliac artery runs parallel to the iliac vein. On the left side, the artery briefly crosses the vein, exerting pressure on it. Due to its position directly on the spine, it cannot escape. This may result in a constriction in the vein.
If the pressure from the artery causes the vein to constrict, the vessel walls are particularly stressed at this point.
Frequent repairs cause the vein wall to thicken over time and the vessel becomes narrower and narrower. High blood pressure (hypertension) also promotes injuries and signs of wear and tear on the vessel walls.
Phlebologists are specialists in the diagnosis and treatment of patients with May-Thurner syndrome. They are experts in May-Thurner syndrome and other venous diseases. They are very familiar with the structure and health of blood vessels. If an operation is required, the phlebologists consult vascular surgeons.
May-Thurner syndrome is usually asymptomatic for a long time. The mere formation of a narrowing in the area of the sacral veins is not yet problematic. However, the inevitably increasing constriction makes it increasingly difficult for blood to flow out of the left leg over time.
The blood builds up in the veins. The body then tries to divert the blood to the vena cava via other vessels. However, these may also be damaged by the increased load.
At an advanced stage, Cockett's syndrome manifests itself as follows:
The worst consequence of iliac vein compression syndrome is deep vein thrombosis. The risk of thrombosis increases significantly due to blood congestion and other consequences of vein constriction: Due to the reduced flow rate, the blood can clot there and form a thrombus that blocks the entire vessel.
Around one in five patients with May-Thurner syndrome suffers from deep vein thrombosis. Doctors usually only recognize May-Thurner syndrome when a thrombosis occurs.
Symptoms of venous thrombosis are
In the worst case, a deep vein thrombosis can lead to a pulmonary embolism. This is when the blood clot detaches from the vessel wall and travels in the bloodstream to the lungs. Because the veins there are small and narrow, the clot gets stuck and causes shortness of breath and severe pain.
In deep vein thrombosis, the blood clot forms in one of the veins located deep in the muscle layers @ hriana /AdobeStock
In the early stages of May-Thurner syndrome, the symptoms are only mild as the vein is not yet too constricted. As it progresses, however, the flow capacity continues to decrease. The symptoms become acute and treatment becomes urgent.
A thrombosis or an (almost) complete vein occlusion is always a medical emergency. The entire tissue of the leg is at risk due to the blood congestion and pressure. In addition, a life-threatening pulmonary embolism can follow. Immediate action is therefore necessary.
Specialists can check for suspected narrowing of the iliac vein using an ultrasound scan. Venography is also often used. In this procedure, also known as phlebography, a doctor injects a strong X-ray contrast agent into the superficial veins. He then takes X-ray images of the leg. These show the course of the veins. Experts take several images at regular intervals to show existing constrictions.
Venography must not be used on adolescent, pregnant or kidney insufficiency patients due to the radiation exposure. In these patients, doctors perform an ultrasound or an MRI. These procedures are particularly suitable for large veins because they provide additional information about the condition of the tissue.
In the case ofmild vein-iliaca compression syndrome (slight swelling of the left leg), the treating doctor prescribes wearing a compression stocking. This prevents blood congestion in the leg and reduces the risk of thrombosis because the veins in the leg cannot dilate.
If thrombosis already exists and doctors diagnose May-Thurner syndrome, the focus is on treating the thrombosis. Special medication that inhibits blood clotting dissolves the so-called thrombus. If there is no longer any acute danger, the patient's medical history and how the thrombosis was able to develop is taken.
If the iliac vein is severely damaged or narrowed as part of Cockett's syndrome, there is a significantly increased risk of thrombosis. In the advanced stage of the disease, wearing compression stockings is no longer sufficient to prevent the veins from dilating.
To prevent the affected area from narrowing further, doctors perform an operation. During this operation, doctors insert so-called stents into the veins. The small tubes made of metal mesh support the vascular wall and ensure that they no longer constrict. They remain in the body for life and are generally not attacked as foreign bodies.
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Dilation possibilities of a constricted blood vessel in the leg @ Solarisys /AdobeStock
May-Thurner syndrome is a mild anatomical abnormality that can lead to severe damage over time. Doctors rarely recognize the condition at the first symptoms, but only when a thrombosis occurs. They can treat the constriction syndrome well with compression stockings and venous stents.
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