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May-Thurner Syndrome

In 2010, at age 26, NASCAR driver Brian Vickers was on a trip to Washington DC when he began to experience chest pain. At the time, Vickers was on a meteoric rise as one of the premier drivers in NASCAR. But a condition known as May-Thurner Syndrome was about to put Vickers’ career on hold.

Vickers was taken to the hospital where experts found multiple areas of blood clots in the veins of both Vickers’ legs and lungs. The source of these clots was found to be from a pinched vein in the pelvis. This phenomenon, known as May-Thurner Syndrome, is also referred to as Cockett Syndrome.

May-Thurner syndrome occurs when the main vein draining blood from the left leg, called the left common iliac vein, becomes narrowed by an overlying structure (such as the iliac artery) or scar tissue in the pelvis. This narrowing of the iliac vein can cause the blood flow through the vein to become obstructed resulting in blood clotting in the pelvis or in the left leg.

Statistically, May-Thurner phenomenon is much more prevalent in women than in men, and it also occurs in otherwise healthy young patients.

Occasionally clots from this area can travel with the flow of blood into the lung circulation creating a life-threatening phenomenon known as a pulmonary embolism, or PE. More commonly though, this condition can cause significant swelling, varicosities, ulcerations and/or sensations of heaviness and fatigue in the left leg since venous blood flow drainage from the extremity is compromised. Most commonly, May-Thurner Syndrome presents as a clot in the leg, known as a DVT- or, deep venous thrombosis.

Early recognition and aggressive treatment of May-Thurner phenomenon can be limb or even life-saving. Usually this diagnosis is confirmed with venous ultrasonography or venography.

Treatment is usually initiated with medications including anticoagulation and or antiplatelet agents. However, the current standard of care centers around treatment of the underlying compression of the left common iliac vein.

Balloon angioplasty and/or stenting of the compressed vein segment is the treatment of choice. Additionally, if extensive clotting is involved, treatment may also include removal or dissolution of any existing clot (thrombectomy or thrombolysis). These maneuvers can be accomplished through minimally invasive techniques with catheters as opposed to conventional, open surgical procedures. Usually, most patients can be treated in an outpatient setting.

In the case of Brian Vickers, his treatment was successful. Vickers returned to the NASCAR circuit in 2011 and enjoys a very active lifestyle. (www.brianvickers.com)

 

John A. Pietropaoli Jr., MD, FACS, RPVI

Fellowship-trained at the Mayo Clinic, John A. Pietropaoli Jr., MD, FACS, RPVI comes to The Vascular Experts with 20 years of practice experience in vascular and endovascular surgery.   Read more»

 

Dr. Pietropaoli practices at the Middletown and Manchester offices of The Vascular Experts.