More women die from blood clots than from all motor vehicles, breast cancer and AIDS combined.
More women die from blood clots than from all motor vehicles, breast cancer and AIDS combined.
To the twenty-year-old reading this, I am so glad that you survived your pulmonary embolism or deep vein thrombosis. You have been scared to death, and your carefree life has now taken a scary turn.  You may have received vague answers to your questions. Nothing makes sense; why did this happen to me? The medical professionals give short answers without explanation, usually something like this “It’s due to you taking birth control.”  The focus changes to blood thinners, CT’s, and pulmonologist.  Hopefully, they checked you for clotting disorders Factor IV Leiden, protein C, protein S, and others and of positive sent you to a hematologist. 

teach the advanced vein class for Philips Healthcare and go around the country, educating physicians and Sonographers on deep venous pathology.  Iliac Vein Compression ( May-Thurner) is not well understood by a majority of physicians; hopefully, that will change.  So let me lay this out for you in the simplest terms. 
Three things cause blood clots (Virchow’s Triad)
  • Stagnation (blood slowing down or not moving) 
  • Change in blood chemistry (hormones, birth control, etc.) 
  • Trauma

When doctors or people say, “Birth control causes blood clots.” They are saying that the change in hormones causes the blood clots.  That being said, millions of women take birth control - and of course, not everyone gets blood clots.  
Back to Iliac Vein Compression - when a vein is compressed in the abdomen (usually by the artery as it crossed over the vein and the spine is under the vein), it is similar to someone putting their finger on the end of a garden hose or kinking a garden hose. 
The flow at the narrowing is fast, but behind the compression, the flow slows down, increasing the pressure.  The higher the pressure, the slower the flow.  In this scenario, the patient has the slow flow and a change in blood chemistry from the birth control pills. 
You have all of this information (you may need to read it twice), now what do you do?  The best way to detect if you have iliac vein compression is intravascular ultrasound or IVUS, however, it is invasive and expensive. CT and MRI are only about 50% accurate.  Our facility has a 90% accuracy rate performing an abdominal venous duplex exam. The exam is non-invasive, not painful and much less expensive. It is an exam that Brian Sapp, RVT, RPhS teaches and has perfected over the past decade.         Other facilities perform this exam, however few of any have the accuracy of Truffles Vein Specialists. For this reason we have patient fly to Atlanta just to Get an accurate diagnosis. 
Signs and symptoms  of iliac vein compression 
  1. Sudden back pain after starting birth control
  2. Sudden spider veins popping out laterally on the thighs
  3. One leg larger than the other 
  4. Tapered calf poor transition from the calf to the  ankle or (cankle) if you are thin a skankle. Yeah, we made that up, but it is a thing. 
  5. Pain during menstruation (the way to get around an iliac vein compression is through the pelvis).
  6. Pain during or after sex
  7. Low back or hip pain
  8. Irritable bowel 
  9. Hemorrhoids 
  10. Veins in the pelvic area /labia (especially during pregnancy)
  11. Cold feet 
  12. Legs that feel heavy
  13. Restless legs at night
  14. Nocturnal urination 
  15. Swelling or edema

I don’t know where you live, but I would like to offer guidance on what should be your next steps. Steps your doctor may not know or understand.  Give us a call 678-833-1444 or share your story with us.  We hope you get to feeling better.  

Left proximal common iliac vein compression. The flow increases in speed through the compressed area. Normal flow is dark blue, the fastest flow is orange-red and turbulent.
Left proximal common iliac vein compression. The flow increases in speed through the compressed area. Normal flow is dark blue, the fastest flow is orange-red and turbulent.