The veins in the pelvis - called iliac veins - can be blocked by something outside the vein compressing it or by something within the vein impeding flow.

One way for the vein to become obstructed is for it to be compressed against the spinal column by the overlying arteries - this is referred to as May-Thurner Syndrome. It is a relatively frequent anatomical configuration and most of the time causes no issues and does not need treatment. It can occasionally cause leg symptoms or cause DVT, if this is the case surgical treatment should be considered.

Another way for the vein to become blocked is after a DVT. DVTs are normally resolved by the body but can occasionally cause scarring and blockage of the vein causing significant symptoms.

Dr Werner-Gibbings has a special interest in the full spectrum of venous disease. He undertook a fellowship at St Thomas’ Hospital in London, working with world leading venous surgeons Mr Stephen Black and Mr Prakash Saha. While there he gained extensive experience in the treatment of May-Thurner disease and Thrombotic occlusions of the deep venous system.

Venous disease is only an issue if it is causing you an issue. The majority of people will have an obstructive lesion of their veins and not even notice.

If, for whatever reason, the problem is causing you issues, then things can be done.

A an ultrasound and CT will be undertaken to determine what is the possible cause of your symptoms. An MRI may also be employed to further delineate the nature of your disease

The first line of treatment is leg elevation and compression stockings. The compression should improve the swelling and control discomfort and is often all patients need.

In case of ulceration, more aggressive wound care and stronger compression is needed to attempt to heal the ulcer.

For those who are not managing with compression alone surgery may be useful in improving symptoms. This involves doing a catheter based venogram through a small cut in the groin and using ultrasound and venography to assess the vessels. Once this has been done Dr Werner-Gibbings will discuss with you the possible treatment options.

Venous stenting is a relatively new treatment that has shown durable and effective results in patients with venous disease. However it is a significant undertaking, requiring intense follow up, strong anticoagulation and possibly multiple further procedures. After all this, it still may not be successful, as such Dr Werner-Gibbings reserves this treatment for motivated patients with significant symptoms and favourable anatomy.

If you would like guidance on your venous disease, please make an appointment and Dr Werner-Gibbings will be more than happy to discuss treatment options with you.