How May Thurner's Syndrome Affects Pelvic Health

Have you ever heard of the quote from Phineas and Ferb? More like an idiom. It goes "If I had a nickel for every time [insert situation here], I'd have two nickels. Which isn't a lot, but it's weird that it happened twice." That was the exact thing I thought about when I encountered a patient with May Thurner Syndrome. Two patients! Which isn't a lot, but it's weird that it happened twice within a short span of time between me doing an initial evaluation for each patient.

If you're wondering what May Thurner Syndrome is, you are not alone. It was not a condition I encountered previously, in either my studies or with patients I had seen thus far. I underwent a crash course in understanding the condition with my first patient, then after the initial eval, looked up studies for more information so I could help that patient further. That flurry of research helped quite a bit when I saw my second patient.

Definition

May Thurner affects blood flow, usually compression of a vein causing venous insufficiency in the left leg. This may lead to deep vein thrombosis (DVT), or otherwise known as blood clots.

What causes it

This condition is usually caused when the right iliac artery compresses the left iliac vein. This compression usually occurs where the common iliac artery and iliofemoral junction cross in the lower body near the groin and top of the leg. "The pulsations of the overriding artery compress the vein against the lower lumbar vertebrae, injure the venous endothelium, and promote the formation of endovenous fibrous bands or spurs." This may lead to blood clots, and accounts for 2% to 5% of all blood clot occurrence. May Thurner tends to be underdiagnosed in people.

Who may have it

May Thurner can be asymptomatic and people may not realize they even have it, especially if they do not develop any blood clots. This condition is more common in women and people assigned female at birth, though men can develop this, too. About one-third of those who are diagnosed with this condition are men. This condition is more common in adults between the ages of 20 to 50.

What are the symptoms

It's entirely possible for someone to have May Thurners and not know it due to being asymptomatic, as mentioned above. If you're not having symptoms, you won't know you have it unless it was discovered by accident when you are getting imaging done for something else.

If you are symptomatic, the symptoms that get people to see their provider are for blood clot symptoms. These symptoms can be feelings of heaviness in legs, pain, swelling, and skin color changes. Typically, this condition presents with swelling in the left leg, though the swelling can also be in the right leg or both, depending on where the obstruction is located.

How it gets diagnosed

Your provider would be the one to diagnose if you have this condition. This is done usually due to a concern, whether from the patient or your provider, regarding blood clots. A doppler ultrasound is used to reveal venous insufficiency or a blood clot in your leg/groin. If that imaging does not reveal anything useful, then a computed tomography (CT) or a magnetic resonance venography is recommended to get a more detailed look into the area of concern. CT venography has greater than 95% sensitivity and specificity to detect compression of the iliac vein, as well as providing differential diagnosis to exclude lymphadenopathy, malignancy, and hematoma.

Treatment and Management

While there is no cure, there are treatments available that can help a patient manage their symptoms. Conservative treatments are compression garments as well as elevating that leg.

If surgery is indicated, having an angioplasty and venous stenting is a medical management option. The stenting allows for the blood to pass through without getting compressed. However, if you are allergic to nickel, stenting will not be an option for you, as most stents are made from nickel or a nickel mixture.

It is rare for surgical resection of that anatomy to occur.

Another medical management treatment is anticoagulation medication, such as heparin, warfarin, or aspirin.

What physical therapy can do for it

There are physical therapists who specialize in lymphedema, who can assist with the swelling and pain aspect of May Thurners. They can also help you with compression garments.

Sometimes May Thurners may lead a patient to also have pelvic congestion syndrome, which is chronic pain caused by varicose veins within the pelvis. Physical therapy treatment would include the above, as well as any deficiencies that affect your pain.

Other presentations that may occur due to May Thurner include lower limb swelling, post-thrombotic syndrome, and venous claudication.

Management of condition in pregnant patients 

While there is not a lot of literature out there regarding pregnant patients with May Thurners, there are case studies about the management and outcomes in patients. The study Management of May Thurner Syndrome in Pregnant Patients reviews five pregnancies from four patients. The treatment for each patient was similar. Either the patient had a stent placed at their left common iliac vein or became pregnant prior to that procedure. Low molecular weight heparin was administered for the rest of pregnancy. The patients also had other medication prescribed, usually aspirin or rivaroxaban. The patients continued to wear compression stockings. Each patient had a vaginal delivery without complications.

If you have May Thurner Syndrome and, and are thinking of becoming pregnant, talk with your provider to help minimize risks during pregnancy.

It was a lot of fun researching this condition in order to help my patients navigate through their signs and symptoms. I hope it helps you!

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References

May-Thurner Syndrome: Causes, Symptoms & Treatment

Ahmad AS. May-Thurner Syndrome, an Often Overlooked Cause of Deep Vein Thrombosis: A Case Report. Oman Med J. 2021;36(3):e269. Published 2021 May 31. doi:10.5001/omj.2021.33

Kuo CH, Martingano DJ, Saadat Cheema O, et al. Pelvic Congestion Syndrome. [Updated 2025 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK560790/

Mangla A, Hamad H. May-Thurner Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 11, 2024.

Schrufer-Poland TL, Florio K, Grodzinsky A, Borsa JJ, Schmidt L. Management of May Thurner Syndrome in Pregnant Patients. J Cardiovasc Dev Dis. 2022;9(12):410. Published 2022 Nov 23. doi:10.3390/jcdd9120410