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How is May Thurner Syndrome diagnosed?

This question was asked in Griffin, Indiana and has 3 answer(s) as of 06/17/2015.
I have had two bouts of DVTs in my left leg, the first from groin to ankle with PEs also in 2007, and chronic pain in groin and acute above the knee in 2015. The pain also extends up into my lower left abdomen and the worse it gets, the "fuller" that side feels. I have never been checked for May Thurner Syndrome, but have read about it. For example, I read about one woman who carried a clot several inches long in her abdomen that went undetected for two years until she was diagnosed with M-T. I am just wondering if this is something I should be checked for? What are the main symptoms of May Thurner Syndrome and how is it diagnosed?

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Doctors Answers (3)

The clinical scenario you describe might be a result of iliac vein compression or obstruction caused by old thrombosis (clotting) in the iliac and femoral veins. Symptoms may include leg pain and swelling, pelvic or hip pain, and some women experience deep pelvic pain with intercourse. Some patients also experience chronic low back pain. The workup varies depending upon the skills at local facilities. We prefer to evaluate with abdominal/pelvic venous color duplex ultrasound studies. Others prefer CT or MR venography. The final diagnostic study may be venography with intravascular ultrasound (IVUS). IVUS involves passing a small catheter through the veins in question while imaging the veins with ultrasound from the catheter. Vascular surgeons and interventional radiologists, generally, are the physicians most experienced in evaluation of this problem.

You have described the symptoms of May Thurner Syndrome, so yes you should have it checked out. It is diagnosed by utilizing intravascular ultrasound, with measurements of pressure gradients across the iliac vein in question. Be sure to see a board certified vascular surgeon. Vascular Surgery is the specialty recognized by the American board of medical specialists, in which the trainees receive formal training in diagnosis and treatment of venous disease. No other recognized specialty can make that claim.

After several episodes of Deep Venous Thrombosus (DVT blood clot) it would be reasonable to order specific labs to check antithrombin, protein C, protein S, factor V Leiden, and prothrombin G20210A to evaluate for a hypercoagulable condition. If these labs do not reveal a cause for your clots then an evaluation for possible May Thurner Syndrome (MTS) also called iliac vein compression syndrome may be required. With MTS the left common iliac vein lies under the right common iliac artery, which may restrict flow by compressing the vein against the lumbar spine. A Venography will demonstrate the blood flow in this region to diagnosis MTS. Management of MTS depends on the severity and frequency of the symptoms. Severe MTS may require an angioplasty and stenting of the iliac vein (similar to what is done for coronary blockages).

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