Do you have swelling of your left leg?  Have you had a blood clot in the left leg, or recurrent blood clots without a known cause? Are you struggling to get a correct diagnosis?  If this sounds like something you or a loved one is experiencing you may want to consider an evaluation for a rare condition called May-Thurner syndrome, which can be a hidden cause for left leg swelling and deep vein thrombosis (DVT).

What is May-Thurner Syndrome? 

May-Thurner syndrome is a condition where the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. This causes narrowing of the vein in the pelvic region, sort of like a bottle-neck. The narrowing of the vein makes the blood flow more sluggish and prone to blood clots and leg swelling. It is estimated that this condition is present in over 20 – 30% of the population with unprovoked left-side DVT.  It is more commonly observed in women than in men and typically manifests between the ages of 20 to 50, but it can occur at any age.

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“Think of this “bottle-neck” as the backup on the 5 fwy on Friday night rush hour,” said Kim Marshall, DPT, CLT co-owner of Progressive Physical Therapy and Rehabilitation. “When the venous system gets backed up, it impacts the ability of the lymphatic system to get rid of lipids, proteins and waste products. This in turn causes the lymph system to spill over into the surrounding tissue which becomes thick and heavy leading to diseased fatty tissue called hypertrophy.  The only way to really get rid of it is with a lipectomy that removes the fat through suction. Complete decongestive therapy (CDT) can help with the swelling, but lymph-sparing lipectomy may be indicated to remove excessive fatty tissue.

“In fact, any time an individual has swelling or pain in the left leg without a known cause, May-Thurner syndrome is something that should always be discussed with a health care provider,” she added. “More importantly, for any person with swelling in any body part and unable to get relief, they should consider an evaluation with a vascular surgeon and subsequently with a certified lymphedema specialist to better assess their situation, provide advanced treatments and appropriate referrals when warranted.”

How is May-Thurner Treated?

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Not all patients will need surgical intervention for May-Thurner Syndrome, but for those that do, a certified lymphedema specialist can work closely with your vascular surgeon or plastic surgeon to develop a personalized care plan both pre and post-op. This includes complete decongestive therapy and manual lymph drainage, along with compression stockings and bandaging to reduce leg swelling as much as possible before the procedure.

Following surgery, treatment is focused on reducing swelling and smoothing out lumps and any unevenness that results to ensure the best possible looking result. Continued use of compression stockings and bandaging further aid in the reduction of the leg swelling. Education on wound and skin care also plays a vital role in the recovery process.

According to Kim, when it comes to any sort of swelling in an arm, leg or other body part, early diagnosis is the key to avoiding progression of the condition to a point where advanced surgical procedures are needed. This includes individuals who have diabetes or other vascular issues and can go on to develop edema and any cancer patient male or female that is at risk for lymphedema, especially with lymph node removal or involvement.

What are the symptoms of May-Thurner Syndrome? 

  • Leg swelling: Swelling, known as edema, may occur in the affected LEFT leg. The swelling is usually localized to the calf, ankle, or foot. The affected leg may feel heavier or appear visibly larger than the other leg.
  • Leg pain: Pain in the affected leg, typically in the calf or thigh region, is a frequent symptom. The pain may be described as aching, cramping, or throbbing and can be persistent or intermittent.
  • Deep vein thrombosis (DVT): May-Thurner syndrome can predispose individuals to the development of blood clots in the deep veins of the leg. DVT can cause pain, swelling, warmth, and redness in the affected leg.
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  • Skin discoloration: In some cases, the skin over the affected leg may show signs of discoloration. It may appear reddish or bluish, indicating compromised blood flow.
  • Varicose veins: May-Thurner syndrome can contribute to the development of varicose veins in the affected leg. These are enlarged, twisted veins that may be visible beneath the skin’s surface.

It’s important to note that these symptoms can vary in severity and may be attributed to other conditions as well. If you suspect you may have May-Thurner syndrome or are experiencing any of the aforementioned symptoms, it’s advisable to consult a vascular surgeon for an accurate diagnosis and appropriate treatment.

How is May-Thurner Diagnosed?

Vascular surgeons or interventional radiologists generally diagnosis this condition or a certified lymphedema specialist can also provide an evaluation and referral to an appropriate health care professional for further diagnostic studies.

May-Thurner syndrome is typically diagnosed through a combination of clinical evaluation, imaging studies, and diagnostic tests. Here are some common methods used to diagnose it:

  • Medical history and physical examination
  • Imaging studies using a Doppler Ultrasound, Venography or Magnetic Resonance Venography (MRV) to better view the veins and visualize the venous anatomy to look for blockages or compression of the iliac vein.
  • Intravascular Ultrasound (IVUS) to obtain a detailed view of the venous structures. This detailed visualization of the venous structures and can help assess the degree of compression and guide treatment decisions.

The choice of diagnostic tests may vary depending on the specific circumstances and preferences of the healthcare provider. It’s important to consult with a vascular specialist, lymphedema surgical specialist or healthcare professional experienced in diagnosing and treating May-Thurner syndrome to determine the most appropriate diagnostic approach for your situation.

How is May-Thurner Treated?

The treatment options for May-Thurner syndrome depend on the severity of symptoms, presence of DVT and individual patient factors. Below are some common treatment approaches:

  • Anticoagulation therapy with blood-thinning medications to help prevent the clot from worsening and reduces the risk of new clots forming.
  • Thrombolysis: Medications or catheter-directed techniques to dissolve or break down the clot and restore blood flow in the affected vein.
  • Angioplasty and stenting: In some cases, the compressed iliac vein may be treated with angioplasty and stenting to widen the narrowed vein and reduce the risk of future clot formation.
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  • Surgical bypass: In rare instances when other treatments are not feasible or effective, surgical bypass may be considered. This involves creating a new pathway for blood flow by surgically connecting the blocked or compressed vein to a nearby healthy vein.
  • Physical Therapy with a Certified Lymphedema Specialist: Complete decongestive therapy and manual lymph drainage to help reduce swelling along with compression stockings, bandaging and education.

It is important to note that the choice of treatment depends on individual factors and should be determined by a healthcare professional specializing in vascular and/or lymphatic conditions. They will evaluate your specific situation and recommend the most appropriate treatment approach for you.

May-Thurner Syndrome is Treated Exclusively in our Garden Grove Clinic

If you have been diagnosed with May-Thurner’s Syndrome or have unexplained swelling or puffiness in your left leg consider an evaluation by a health care professional. If you feel you are not getting answers or are not seeing a reduction in swelling and want another opinion please reach out and schedule an evaluation. Kim Marshall, DPT, CLT has more than 20 years of experience as a certified lymphedema specialist and is in expert in this field.  Our Garden Grove clinic is conveniently located by the 22/5/57 freeways. Please call us at 714.643.9012.

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