May-Thurner Syndrome
Clinical History
A 42 yo female with history of extensive left lower extremity DVT treated with pharmacomechanical thrombolysis with good result returns to the clinic with persistent leg swelling and negative duplex ultrasound study. She underwent diagnostic venography with IVUS (intravascular ultrasound) which revealed May-Thurner Syndrome. This was treated with primary stenting with excellent technical and clinical result.
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Case Discussion
May-Thurner remains an underdiagnosed phenomenon which contributes to significant morbidity throughout the world. Some clinical clues include persistent swelling after successful catheter directed treatment of DVT, persistent swelling after Treatment of varicose veins, or concomitant deep and superficial venous insufficiency on venous Doppler ultrasound studies.
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Peace and kindness.
Case Credits
Images and content graciously provided by:Jhimmelvir
Hello, thank you for this artical i was diagnosed with MTS. I was stented but i continue to swell. Often times i have pain with the sweeling only on the left side. I did not have DVT, I was tild i had a 90% blockage.
I have gone to my coordioligist on several occusions since March 9th 2017 when the stent was placed and nothing has changed. HELP ME, i want to live a normal life without swelling and often times pain.
Hi Marsha. I’m sorry you continue to suffer. Often times patients with MTS have chronic damage to the valves of the deep and superficial veins which can result in persistent swelling and pain even after the stenosis has been stented. Sometimes these problems can be addressed with additional procedures, but sometimes not. Unfortunately, most cardiologists are well trained in placing stents, especially in arteries, but lack comprehensive training in venous conditions such as MTS. This is true for many specialties that practice vein care. There are cardiothoracic surgeons, dermatologists, plastic surgeons and primary care physicians that all perform “vein” care because it can be very lucrative, particularly if it is cosmetic. In most cases, however, these specialists do not offer the type of comprehensive vein care that a patient such as you requires. There is currently no reliable method to determine which practitioners are best qualified to provide comprehensive vein care. My recommendation is that you seek out interventional radiologists or vascular surgeons near you and interview them about their experience with MTS, deep and superficial venous insufficiency, and EVLT, sclerotherapy and phlebectomy of varicose veins. If they don’t do it all, then thank them kindly for their time and move on. Word of mouth referrals may be your best bet. Best of luck!