Why Many People Don’t Need a Stent for May–Thurner Syndrome

Jeffrey H. Miller, M.D.
Jan 22
3 min read

If you’ve ever had a CT scan or ultrasound of your abdomen or pelvis, you may have been told you have something called May–Thurner Syndrome or “iliac vein compression.”

But the truth is, most people with this “compression” are completely healthy and don’t need a stent at all.

Let’s break it down.

What Is May–Thurner Syndrome?

May-Thurner Syndrome is a vascular condition that causes the right iliac artery to compress the left iliac artery in the pelvis. This causes a lack of blood flow throughout the left leg up into the artery.

May–Thurner Syndrome symptoms can be:

Sudden, severe leg swelling
Deep vein thrombosis (DVT)
Painful, hard-to-ignore symptoms

Most patients being told they have May–Thurner today do not have this kind of problem. In many people, the left iliac vein can get gently pressed on by a nearby artery. This is normal anatomy. True May-Thurner Syndrome is rare and causes major blockages.

So Why Are Stents Being Recommended?

Sometimes imaging tests (CT, MRI, IVUS) show a narrow vein. But this alone doesn't tell us if the vein is causing a problem. Unfortunately, in recent years many people have been told that this normal narrowing is:

"Dangerous”
“Blocking blood flow”
“Causing leg heaviness or swelling”
A reason to place a stent

But for most people this is not true. Stents should not be placed based on imaging alone. A normal vein can look “narrow” on a scan yet still work perfectly.

Stents Are Not Harmless

A stent stays in your body forever. Once it’s in, it can’t easily be removed. Risks include:

Chronic pain
Scarring or re-narrowing inside the stent
Stent movement or fracture
Lifelong need for additional procedures

This is why stents should only be used when absolutely necessary—in patients with clear, severe symptoms or a true blockage.

What Symptoms Actually Suggest True May-Thurner Syndrome?

A stent may be helpful only when someone has:

Sudden, major leg swelling
A deep vein thrombosis (DVT) caused by a blocked pelvic vein
Debilitating symptoms that match true venous obstruction

Mild swelling, leg fatigue, varicose veins, or pelvic discomfort are almost always caused by other, more common issues, not iliac vein compression.

What Should Patients Do Instead?

If you’ve been told you have May–Thurner Syndrome, here’s what you should know:

1. A second opinion is totally appropriate.

Especially if someone recommends a stent right away.

2. Ask whether your symptoms truly match a blocked vein.

Most do not.

3. Make sure a full vein ultrasound is done.

Many symptoms come from vein problems lower in the leg — not from the pelvis.

4. Conservative treatment often helps.

These conservative treatments frequently improve symptoms:

Compression socks
Elevation
Exercise
Treating superficial vein problems

5. Stents should be a last resort.

Not the first step.

The Bottom Line

A compressed iliac vein is very common and often normal. Most people with this finding do not have May–Thurner Syndrome and do not need a stent.

If you’ve been told otherwise, it’s okay to pause, ask questions, and get another opinion.

Stop Letting Your Legs Hold You Back

If you have restlessness, heaviness, aching, swelling, throbbing, or itchiness in your legs—or you notice varicose veins or spider veins—it's time to see a vein specialist.

Schedule an appointment today!