Since May-Thurner Syndrome (MTS) increases risk of deep vein thrombosis (DVT) and complications associated with DVT, such as pulmonary embolism, prevention of these risks progressing to clinical events is prudent.
In the absence of DVT and for patients with only mild symptoms of left leg swelling or pain, conservative measures of prevention are used, specifically, compression stockings. These are also used if the severity of MTS requires more aggressive invasive interventions. Venous ultrasound imaging is helpful in ruling out more severe manifestations of MTS, such as DVT.
In advanced MTS that demonstrates signs and symptoms of advanced chronic venous insufficiency, such as limb swelling, pain, and skin discoloration, prevention of disease progression aims to reduce stenosis of the vein(s) using angioplasty and stents in the affected segments(s). Angioplasty alone results in a high recurrence rate. Thereafter, compression stockings are used.
In advanced MTS that results in venous thromboembolism (VTE), full anticoagulation therapy is begun (unless contraindicated by pre-existing coagulopathy). Catheter-directed or pharmaceutical thrombolysis is useful in eliminating the clots that may migrate. DVT requires anticoagulation according to the guidelines used in VTE prophylaxis.
Rarely, when more conservative or interventional measures are unsuccessful or contraindicated, an open cut-down may be necessary to evacuate the clot.
Prevention and follow-up utilize periodic venous ultrasound imaging.