May-Thurner Syndrome

Your patient is back again for a DVT. Is there something you should think about this time? In this lecture from our ultrasound lecture series Dr. Matthew Tabbut, MD from the ED talks about a unique condition that predisposes patients to DVTs. This condition is called May-Thurner Syndrome.
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[@Pheobos]

I just want to say... as someone who has this syndrome... I was lucky enough to meet the one ER DR who also had the syndrome. And, coming from a patient standpoint, you have the right idea. But I WISH that the presenting symptoms would cause dr's to just do a simple ultrasound to check the Illiac system.... It would be the same as an ultrasound that would be done for a uterine scan for a pregnancy, but a whole three cm to the left.... I think that's why it's so unknown. Just saying.

[@annabelminard4829]

MTS isn't rare. Sure its 2-5% of all DVT but if your patient is under 50 and has left side iliofemoral DVT they have a ~25-50% chance of having MTS. Take their history and it'll become even more obvious. We often have pain in the lower back. Don't wait for a patient to come back, you have to diagnose them at the ER. I had one DVT, common iliac to distal femoral. Couldn't stand up straight, no hip flexion, leg became like a brick if trying to walk a small distance, no distance was comfortable to walk, I was disabled. I got discharged on DOACs and now my common and external iliac are chronically occluded. It sucks. Took 10 months to get a diagnosis. 6 months prior to the chronic occlusion I went to vascular to tell them for 5 years my legs have become increasingly heavy and achy, I felt something was wrong. They did an ultrasound of just the legs not the iliac and so missed the opportunity to diagnose MTS then as well. The fact this screening isn't routine pisses me off. Thanks for making the video.

[@ulycarrillo2425]

Do you have to follow up with vascular Dr. For the rest of your life after the Stent put on? Is it safe to have metal for life?

[@Floodland-bn3ol]

Can't you balloon to open up the iliac and do a wait and see rather than going right to the stent? Some patients are reporting of back pain from the stent.

[@nsas955]

Great discussion but this is usually occurs in right side and not the left side!!!

[@MetroHealthEmergencyUltrasound]

Thanks for the comment. MTS generally affects the left lower extremity by causing compression of the left common iliac vein by the right iliac artery.