May Thurner Syndrome
May Thurners Syndrome(MTS)
May-Thurner syndrome (MTS), also known as iliac vein compression syndrome or Non Thrombotic Iliac Vein Lesion (NIVL).
Clinical Presentation
The most frequent presentation is chronic venous insufficiency. Patients complain of acute, intermittent, and progressive (activity-related) heaviness and swelling of left lower limb or venous claudication that is relieved with rest and leg elevation.
The progression of the chronic venous insufficiency—manifested as pain, venous claudication, varices, skin hyperpigmentation, and ulceration there by affecting quality of life (QOL).
Many times, patients after standard ablative treatment for varicose veins have increased tightness or discomfort with activity with poor medium- or long-term results and delay medical consultation.
Other less common presentation is acute, spontaneous, and painful leftleg swelling (Deep Vein Thrombosis) with no precipitating cause, or the disease may first present during or after pregnancy and a history of recent use of oral contraceptive pills. May-Thurners Syndrome prevalence is associated in 20% to 50% of cases of left lower-limb Deep Vein Thrombosis.
Diagnosis
Noninvasive diagnostic tests include Color venous duplex ultrasound and Cross-sectional imaging: CT/MR venography.
Endo Vascular Treatment of May Thurner’s Syndrome/NIVL
Management depends upon the presence of symptoms, severity, and whether or not DVT is present.
The gold standard for Confirmation of MTS and Intervention is venography plus Intravascular ultrasound.
- In patients with nonthrombotic iliac vein lesions (NIVL) who are symptomless or with mild symptoms (CEAP 1–3), conservative treatment with compression stockings is enough.
- In patients with nonthrombotic MTS with moderate to severe symptoms (CEAP 4–6), angioplasty and stenting is indicated.
MTS is underdiagnosed:
- Early diagnosis and adequate treatment are paramount.
- In patients with left-leg Deep Vein thrombosis, early treatment reduces the rate of Chronic leg complications Post Thrombotic Syndrome (PTS) by less than 10%.
- without treatment, the chances of venous claudication, varices, skin hyperpigmentation, and ulceration is 80% to 90%.
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Treatments for May Thurners Syndrome
Venaseal Glue Treatment
- Can be performed in the office/outpatient environment
- Is relatively painless?
- Very little bruising of the leg
- Minimal local anaesthetic required.
- Return to work within 24 hours.
Radiofrequency Vein Ablation
- Gold standard treatment of varicose veins (along with endovenous laser ablation)
- Keyhole treatment
- Relatively painless and return to work within 24 hours
- Useful in treating primary varicose veins
Closure Treatment
- Same day procedure
- Fast recovery – resuming normal activities within 1-2 days
- Minimal or no scarring
EndoVenous Laser Ablation
- Keyhole treatment
- All varicose vein sizes can be treated.
- Relatively painless with return to work within 24 hours
- Useful in treating primary and secondary varicose veins
Ultrasound – Guided Foam Sclerotherapy
- Keyhole treatment
- Useful in treating recurrent varicose veins
- Outpatient/office based treatment
- Compliments: laser and radio frequency treatment of varicose veins
- Relatively cheap
Vein Check-up
- At the Vein and Foot Clinic, we offer an early detection service for the potential risk of developing thread veins, varicose veins, pelvic varicose veins, and deep vein thrombosis (DVT).
Conditions We Treat
- Varicose veins
- Superficial Venous Thrombosis Phlebitis
- Thread / spider veins
- Swollen leg
- Deep vein thrombosis (DVT)
- May turners syndrome
- Varicose veins in pregnancy
- Varicose veins in obese patients
- Restless leg syndrome
- Varicose veins of the testicles
- Recurrent Varicose Veins
- Hidden Varicose Veins
- Hemosiderin Brown Stains
- Lipo dermatosclerosis (LDS)
- Venous Eczema
- Leg Ulcers
- Vaginal and Vulval Varicose Veins
- Pelvic Congestion Syndrome (PCS)
