Methods Of Treating May-Thurner Syndrome
May-Thurner syndrome is a condition where a major vein in the left leg called the iliac vein is squeezed by its companion artery, or the left iliac artery, increasing the risk of blood clots in the left leg. The condition is sometimes asymptomatic until the patient discovers they have a deep vein thrombosis, which is a blood clot deep in a large vein. Other individuals find their leg swells, is tender or painful, and feels warm to the touch. The skin may be red, and they may see veins in their leg that look varicose. It is important for May-Thurner syndrome to be treated because the blood clot in the vein may break off and travel to the lungs, leading to a life-threatening pulmonary embolism. Here are some ways to treat May-Thurner syndrome.
Vena Cava Filters
Vena cava filters are inserted into the body to catch any clots that might have broken off in the patient's leg and are traveling toward the lungs. They get their name because they are inserted into the vena cava, the largest vein found in the body. The patient is given a physical examination before the surgery, and the doctor may tell them to stop using blood thinning medication or other kinds of drugs or supplements. The patient usually fasts the night before the surgery. The operation is typically performed while the patient is under IV sedation or general anesthesia. The doctor uses X-ray or ultrasound to guide a catheter into a vein in the patient’s neck or the upper part of their leg, and then threaded to the vena cava. When the catheter is in place, the filter is passed through it and into the vein. When it’s in place, it is released and allowed to expand. Many vena cava filters are removable.
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Balloon Angioplasty
Another way to treat May-Thurner syndrome is through balloon angioplasty, which is very much like the procedure to insert a vena cava filter, but the doctor inserts a balloon instead of a filter. Also, it's inserted not to prevent a clot from traveling to the lung but is installed after a clot has been dissolved. The balloon forces the vein open and allows the blood to flow through it more easily. A stent is often inserted along with the balloon. The stent also expands and holds the vein open. Once the stent is placed correctly, the doctor deflates the balloon and carefully draws it out of the vein. The stent is permanent.
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Blood Thinners
Blood thinners, also called anticoagulants, are another way to treat a patient with May-Thurner syndrome. Blood thinners work by reducing the body’s production of thromboxane, a chemical that causes blood platelets to stick together. They also inhibit other compounds that cause the blood to clot including vitamin K. The body can’t form blood clots without this vitamin, so these types of anticoagulants are called coumarins or vitamin K antagonists. They are especially helpful for individuals in danger of developing a deep vein thrombosis or pulmonary embolism. Sometimes, the doctor introduces the medication surgically, in a method called catheter-directed thrombolytic therapy. The doctor puts the medication directly into the blood clot via a catheter, causing the clot to dissolve. This therapy is often used along with angioplasty.
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Right Iliac Artery Repositioning
Some doctors recommend May-Thurner syndrome be treated aggressively to remove the risk of blood clots. One way to do this is through right iliac artery repositioning, a surgery in which the doctor creates a sling made out of tissue to raise the right iliac artery, and put some space between it and the artery compressing it. Surgeons can also move the right iliac artery to just behind the left iliac vein to take the pressure off of it the way a tissue sling does. Some surgeons perform what is called a Palma crossover. This is a type of bypass surgery where a part of the patient’s saphenous vein is used to reroute the blood from around the affected part of the left iliac vein. The saphenous vein is a large vein found in the leg.
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Compression Socks
Some patients have mild cases of May-Thurner syndrome, and in these cases, doctors typically recommend they wear compression socks. These socks look like normal socks but are made out of fabric that wraps tightly around the leg, especially at the ankle. Because of this, excess fluid is forced up the leg so blood can flow more freely through the blood vessels and not pool or clot. Compression socks are best put on first thing in the morning and not taken off until bedtime. They are easily found in pharmacies as well as online, can be laundered, and should be replaced every four months or so.