Can men get May-Thurner syndrome?

May-Thurner Syndrome in Men: Diagnosis and Implications

Yes, men can definitely get May-Thurner syndrome, though it is approximately twice as common in women than men with a female-to-male ratio of 2:1. 1

What is May-Thurner Syndrome?

May-Thurner syndrome (MTS) is an anatomical condition characterized by compression of the left common iliac vein by the right common iliac artery against the lumbar spine, causing venous outflow obstruction. This compression can lead to:

• Venous stasis
• Development of deep vein thrombosis (DVT)
• Lower extremity swelling and pain
• Potential pulmonary embolism

Gender Differences in May-Thurner Syndrome

While MTS affects both sexes, there are important gender-based differences:

• Prevalence: Women are affected twice as frequently as men (67.1% vs 32.9%) 1
• Age at presentation: Women present at a younger age (38.7 years) compared to men (46.2 years) 1
• Symptom differences:
  • Men report more leg swelling (92.7% vs 80.8%) and leg pain (88% vs 74.3%) 1
  • Women are significantly more likely to present with pulmonary embolism (9.9% vs 1.6%) 1

Clinical Presentation in Men

Men with MTS may present with:

• Left lower extremity pain and swelling
• Unprovoked DVT involving the left iliac, femoral, and popliteal veins
• Potential for pulmonary embolism
• In rare cases, left-sided varicocele that is refractory to standard treatments 2

Diagnostic Approach

When MTS is suspected in a male patient:

1. Initial evaluation: Doppler ultrasound of the lower extremity to detect DVT
2. Advanced imaging: CT venography or MR venography to visualize the iliac vein compression
3. Definitive diagnosis: Venography with intravascular ultrasound to confirm compression and assess the degree of stenosis

Treatment Options

Treatment for MTS in men follows the same principles as in women:

• Endovascular intervention is the preferred treatment approach (86.2% of cases) 1

  • Catheter-directed thrombolysis for acute DVT
  • Angioplasty and stenting of the compressed iliac vein
  • Temporary IVC filter placement in cases with pulmonary embolism

• Medical management with anticoagulation alone (7% of cases) 1

  • May be insufficient to prevent recurrence and post-thrombotic syndrome

• Open surgical procedures (6.8% of cases) 1

  • Associated with higher complication rates than endovascular approaches

Clinical Implications

Clinicians should maintain a high index of suspicion for MTS in men presenting with left-sided DVT, especially:

• Young males with no traditional risk factors for DVT 3
• Patients with recurrent left-sided DVT despite adequate anticoagulation
• Cases of refractory left-sided varicocele 2

Key Takeaways

1. MTS is not exclusive to women and should be considered in the differential diagnosis for men with left-sided DVT
2. Early recognition and intervention may prevent complications like post-thrombotic syndrome
3. Endovascular treatment with stenting is the preferred approach for symptomatic MTS in both men and women
4. Long-term anticoagulation may be necessary following intervention

Maintaining awareness of MTS as a potential diagnosis in men can lead to more appropriate diagnostic workup and treatment, potentially reducing long-term morbidity associated with this condition.