Can you have May Thurner Syndrome without any symptoms?

Not exactly. It’s not uncommon for a patient to get a CT or MRI for something unrelated to May Thurner Syndrome (MTS) and then receive a radiology report diagnosing them with MTS. Since many medical professionals are not familiar with MTS, this can cause a lot of anxiety in a patient, leading them to seek multiple opinions, invasive testing, and sometimes a stent when nothing was ever really needed.

So what is the compression on CT or MRI if it’s not MTS?

MTS is a clinical diagnosis NOT an imaging one. MTS is a syndrome and in order to have a syndrome, you need to have symptoms. In one study, more than 25% of subjects had no symptoms of MTS but had over 50% compression of the left common iliac vein on imaging¹. Should all of these patients get a stent if they do not have any symptoms? NO!!!!

If a patient is incidentally noted to have compression of the left common iliac vein on imaging, it is often referred to as “May Thurner physiology” or just “iliac vein compression”. Many well-meaning diagnostic radiologists will diagnose the patient as having MTS and state this in the radiology impression when they in fact, have never seen the patient. Instead, it would be better for the radiologist to say “If this patient has symptoms of left leg swelling/DVT or chronic pelvic pain, than May Thurner syndrome should be considered.” By wording it this way, the radiologist provides the treating physician a clue as to a potential diagnosis but does not definitively label the patient as having MTS.

If a patient has no symptoms at all than no treatment or follow-up is needed in most cases. BUT…..what is needed is education about the risk factors, signs, and symptoms of deep vein thrombosis (DVT). If compression of the iliac vein is seen on imaging in a patient without symptoms and who has never had a DVT, there is no evidence that placing a stent prophylactically will reduce their future risk of DVT.

1. Kibbe MR, Ujiki M, Goodwin AL, Eskandari M, Yao J, Matsumura J. Iliac vein compression in an asymptomatic patient population. J Vasc Surg. 2004;39(5):937–943