Amy Bonner: May Thurner Syndrome

Amy Bonner

The Problem: A Sudden Blood Clot

Amy Bonner enjoys being active. The 45-year-old marketing consultant loves spending time with friends and family, including her husband and two sons, traveling, and participating in community theatre. The Mount Lebanon resident never knew her active life could be threatened by a serious and rare vascular condition until almost a decade ago. "I didn't know I had May-Thurner syndrome," Amy explains.

Almost ten years ago, a then-36-year-old Amy was "just feeling lousy" one icy, winter night. "Right after dinner, I decided to head upstairs and lie down," Amy explains. "As I climbed the stairs, my left leg felt heavy, almost like it was asleep. By the time I reached the top of the stairs and looked at it, my entire leg was purple."

Amy knew this was not normal and had a feeling she should seek medical help. However, since the roads were so bad, she decided to first speak with a nurse. "I described my symptoms to the nurse on the phone and she, very calmly, replied, 'honey, you need to hang up the phone and get to the hospital right now.'" With her instinct confirmed by a medical professional, Amy immediately took off for the closest emergency department.

The Path to UPMC Heart and Vascular Institute

Amy arrived at her nearest emergency department, where the medical team remained puzzled at her condition. After being admitted for observation, the attending physician offered to conduct a venogram — an x-ray of the vein that shows blood flow — to confirm a potential diagnosis. However, when the team attempted the venogram, they discovered that Amy had a six-inch blood clot in her left iliac vein. Physicians transferred Amy to UPMC Presbyterian, where she could be evaluated and treated in the Heart and Vascular Institute Division of Vascular Surgery. The HVI offers patients access to a multidisciplinary team of pulmonary specialists, interventional cardiologists, and cardiac and vascular surgeons. Together, these teams offer collaborative care and advanced treatment for an array of cardiovascular and vascular conditions.

Amy was referred to Rabih Chaer, MD, chief of vascular surgery at UPMC Presbyterian and was diagnosed with May-Thurner syndrome. May-Thurner syndrome (MTS) is a serious vascular condition in which the right iliac artery compresses the left iliac vein. This compression causes a "kink in the plumbing," which can lead to discomfort, swelling, and pain. Sometimes, the bottlenecked vein can generate a serious blood clot called a deep vein thrombosis (DVT). DVTs can quickly turn into life-threatening situations if the clot breaks off and moves to the heart, lung, or brain. Amy was experiencing this extremely dangerous complication to a relatively unknown disease. "May-Thurner Syndrome is not very common, though awareness is increasing," Dr. Chaer explains. "We've seen maybe 50 cases over the last 10 years in western Pennsylvania, including Amy's."

The Solution: A Life-Saving Stent

Amy's six-inch blood clot was considered a DVT. Clots of this size are more common in older adults, who would typically undergo treatment via blood thinners, which would allow the patient to live with the clot and avoid intervention. However, since Amy was only 36 years old, Dr. Chaer knew this was not the right course of treatment for her to continue her active lifestyle. "Amy is young. The goal of her care was to improve her quality of life," Dr. Chaer explains. This meant engaging in a more innovative, minimally invasive procedure that was not as common at the time. "We chose to dissolve and remove Amy's clot via drugs delivered through a catheter," Dr. Chaer explains. "We then placed a stent [within the left iliac vein] to strengthen it and prevent future clotting."

The Result: Active and Symptom-Free Ten Years Later

At the time, this stent was typically only used for arterial applications, and hadn't been widely used for veins. However, 10 years later, it has proven to be more than effective. "The stent placement procedure was certainly far less invasive than surgery," Dr. Chaer explains. "It has lasted 10 years, with no complications."

Amy has been able to continue her actively involved life, while remaining symptom-free. She still participates in her local theater, and visits Dr. Chaer every year for a check-up. When asked about her care at UPMC, Amy says "I am so grateful that I was at UPMC. My nurses continually told me, 'you're lucky to be alive.' If I hadn't been there or under the care of Dr. Chaer, I don't think I would have had the same outcome." The innovative technological advances at UPMC were part of the reason behind Amy's successful treatment. "Dr. Chaer has worked with other patients with similar diagnoses to me. It's comforting, and hopeful, to know that he is so successful."

Still, almost a decade later, looking back at her experience sometimes does not feel real. "It's almost surreal, in a way, because I had been so healthy beforehand. I sometimes feel guilty that my husband and mom had to go through the fear and panic of not knowing what was going to happen to me," Amy explains. However, with the trust in Dr. Chaer's innovative treatment plan, Amy was able to be around to raise her children.

Following her diagnosis of May-Thurner syndrome, Amy and her husband discovered a new-found appreciation of life. "We were always daydreaming of things to do with our kids, but at three and five-years-old, we figured we would get to our dreams when they were older." One of these dreams included a trip to Walt Disney World, which the family took months after Amy's life-saving surgery. "We realized we just needed to do it! We've gone back a few times since that first trip and it has really become a favorite spot for our entire family." Amy and her family also enjoy trips to the beach, camping and hiking, and family game nights. Her sons, now teenagers, have learned more about their mother's health journey as they have grown up. "My youngest son, when he was about nine, said to me, 'I had no idea my mom was part-robot!' They're learning the gravity of the situation and the appreciation we have for my treatment."

Amy is grateful for the life she has now, with no limitations. "A diagnosis like this really changes your perspective; you learn not to sweat the small stuff and enjoy life. I'm so appreciative of the care I received, both ten years ago and today, from Dr. Chaer and his team in the Division of Vascular Surgery."

Amy's treatment and results may not be representative of similar cases.