May-Thurner syndrome (MTS) is also referred to as iliac vein compression syndrome or Cockett’s syndrome. It affects two blood vessels in the pelvic area, one of which goes into your legs and one of which runs out of your legs. While it may cause no symptoms initially, it may increase your risk of deep vein thrombosis (DVT) in your left leg.

At Texas Vascular Institute, located in Dallas and Hurst, Texas, interventional radiologist Dr. Dev Batra and his team handle all manner of blood vessel problems, including May-Thurner syndrome and DVT. Because many of our patients aren’t familiar with either condition, we’ve put together this guide to help you understand your risks.

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A brief guide to your circulatory system

Your circulatory system’s primary function is to transport oxygen and nutrients to the tissues to keep them healthy. To do that, your heart regularly contracts, pushing oxygenated blood through the arteries to every part of your body. Once the blood is depleted of nutrients, the veins return it to the heart to start the process over again.

In some ways, veins have the harder job because they have to fight the downward pull of gravity. To compensate, your thigh and calf muscles contract, squeezing the veins and forcing the blood along an upward course. In addition, the veins contain one-way valves that prevent blood from flowing backward.

However, if the valves become damaged, blood flow becomes sluggish, and it can pool around the damaged valves. That state is called venous insufficiency, and it’s often the first stage of vein disease. It can lead to varicose veins, which can also lead to further vein problems.

What happens in May-Thurner syndrome?

Arteries and veins sometimes cross over each other’s paths. Normally, that isn’t a problem. However, if you have May-Thurner syndrome, it becomes an issue.

MTS involves your right iliac artery — the main artery that transports blood into your right leg — and the left iliac vein — the main vein that transports blood from your left leg up toward your heart.

When you have MTS, the right iliac artery squeezes the left iliac vein as they cross in your pelvic region. Because of the pressure, blood slows as it moves through the left iliac vein like water does when you step on a hose.

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With sluggish flow, blood is more likely to pool and clot, increasing your risk for DVT. Unlike superficial clots, DVT clots are a significant health risk. First, the clot further restricts blood flow in the leg. Furthermore, the clot may detach from the vein, or a piece of it may break off and travel to the lungs. That is known as a pulmonary embolism — a life-threatening condition.

Most people with MTS don’t experience symptoms unless it causes DVT. However, because the syndrome leads to inefficient blood flow, some people may experience symptoms without DVT.

These symptoms occur mostly in the left leg and can include any combination of the following:

  • Pain
  • Leg pain with walking (claudication)
  • Swelling
  • A “heavy” sensation in the leg
  • Varicose veins
  • Skin discoloration (venous stasis dermatitis)
  • Leg ulcers

Women may also develop pelvic congestion syndrome, a case of varicose veins in the pelvis. The main symptom of PCS is pelvic pain.

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Treating MTS

Treating MTS focuses on improving blood flow in the left iliac vein, which can also lower your risk for DVT. That can be accomplished by:

Angioplasty and stenting

Our team inserts a small catheter with a balloon on its end into the vein. Dr. Batra inflates the balloon to open the vein, then places a small mesh tube (stent) to keep the vein open. Finally, he deflates and removes the balloon but leaves the stent in place.

Bypass surgery

Our team uses a bypass graft to reroute blood around the compressed part of the vein.

Repositioning the right iliac artery

Our team moves the right iliac artery behind the left iliac vein so it doesn’t put pressure on it. In some cases, Dr. Batra may place tissue between the left iliac vein and the right artery.

Treatment for DVT includes blood thinners, clot-busting medications, and a vena cava filter that prevents clots from traveling to the lungs.

If you haven’t had a vein checkup recently, it’s time to come into Texas Vascular Institute for an evaluation. Give us a call at either our Dallas or Hurst, Texas, location, or book your appointment online.

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Texas Vascular Institute | Dallas, TX

3500 Oak Lawn Ave, #760
Dallas, TX 75219


For Appointments: 972-798-4710
General Inquiries: 972-646-8346

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Texas Vascular Institute | Hurst, TX

809 West Harwood Rd, Suite 101,
Hurst, TX 76054


For Appointments: 972-798-4710
General Inquiries: 972-646-8346

Set Appointment