Getting a diagnosis for May-Thurner Syndrome (MTS), Nutcracker Syndrome (NCS), or Pelvic Congestion Syndrome (PCS) is a critical first step. However, understanding treatment options and ensuring the right approach is essential for managing symptoms effectively.

Step 1: Identify Compressions Before Treating Venous Insufficiency

One of the most important things to determine before starting treatment is whether vein compressions are present. Treating insufficient veins (such as embolization of pelvic veins) without addressing compressions can worsen symptoms by increasing pressure on already compromised veins.

• If a compression (May-Thurner, Nutcracker) is present, it must be treated first before addressing venous reflux.

• If venous insufficiency (Pelvic Congestion Syndrome) is the primary issue, treatment focuses on reducing pressure in the veins.

A vascular specialist should guide this process to ensure the correct treatment plan.

Treatment Options by Condition

May-Thurner Syndrome (MTS) Treatment

• Anticoagulation – If MTS has caused a blood clot (DVT), blood thinners may be required first.

• Stenting – The most common treatment for MTS, a stent is placed in the compressed iliac vein to keep it open and restore proper blood flow.

• Follow-up Imaging – Regular monitoring ensures the stent remains open and functioning properly.

Nutcracker Syndrome (NCS) Treatment

• Conservative Management – If symptoms are mild, monitoring, lifestyle changes, and hydration may help.

• Stenting – In cases where the renal vein is severely compressed, a stent may be placed to restore blood flow.

• Surgical Options – In rare cases, renal vein transposition or other bypass techniques may be recommended if stenting is not effective.

Pelvic Congestion Syndrome (PCS) Treatment

• Ovarian & Internal Iliac Vein Embolization – A minimally invasive procedure where coils or plugs are placed in the affected veins to reduce blood pooling and pressure.

• Hormonal Therapy – Some patients experience symptom relief with hormonal medications that reduce blood vessel dilation.

• Lifestyle Changes – Compression garments, physical therapy, and exercise can help manage symptoms.

  Treatment Options for MALS

  Since MALS is caused by vascular compression, treatment typically involves surgical intervention to relieve the pressure.

  1. Celiac Artery Decompression (First-Line Treatment)

  • The median arcuate ligament is surgically released to relieve compression on the celiac artery.

  2. Celiac Plexus Nerve Removal (If Pain Persists)

  • If nerve-related pain continues after decompression, the celiac plexus nerves may be removed or blocked to reduce symptoms.

  3. Stenting (Less Common)

  • If the celiac artery has narrowing or residual stenosis after surgery, a stent may be placed to keep the artery open.

  • Stenting is not typically the first choice because it does not relieve nerve compression and may not fully resolve symptoms.

What to Expect After Treatment

• Symptom Relief – Many patients experience improvement in POTS symptoms, fatigue, pain, and circulation after proper treatment.

• Recovery Time – Minimally invasive treatments like stenting and embolization typically have short recovery times, with most patients resuming normal activities within a few days to weeks.

• Ongoing Monitoring – Follow-up imaging (ultrasound, CT, or IVUS) may be needed to ensure long-term success.

  Take Control of Your Treatment

✅ Make sure compressions are evaluated before treating venous insufficiency.

✅ Seek a vascular specialist who understands compressions and pelvic venous disorders.

✅ Understand all treatment options and work with your doctor to create a long-term plan.

With the right approach, many patients see significant improvement in symptoms and quality of life. Advocate for yourself, ask questions, and ensure you’re getting the most effective treatment for your condition.