Amy Bonner’s blood clot seemed to come out of nowhere. An innovative procedure saved her from a life of pain—or worse.
Amy is a vibrant, active advertising executive who loves to perform in community theater. She had no idea she was born with May-Thurner Syndrome (MTS), a rare condition of the lower vascular system until, at age 36, it caused a life-threatening blood clot in her left leg.
“I was just feeling lousy one night, right after dinner,” she recalls. “I decided to head upstairs and lie down. As I climbed the stairs, I noticed that my leg felt heavy, like it was asleep. I looked down at my leg, and it was purple.”
Pittsburgh’s streets were glazed by an ice storm that evening and driving to the local emergency department was risky. So, Amy called her health insurer’s Nurse On Call service and described her symptoms.
“She said to me, ‘Honey, you should get to a hospital right now,’” Amy says. “I was already listening to my own inner voice that told me this was more than a tired leg. It was that ‘honey’ that convinced me this was serious. That’s when we got in the car.”
MTS is a kink in the plumbing caused when the left iliac vein, a large vein that moves blood from the left leg up toward the heart, is compressed by the overlying right iliac artery. Most people with this condition live a long life, never knowing they have it. It can cause discomfort, swelling, and pain that is never diagnosed.
Or, as in Amy’s cause, the bottlenecked vein can generate a serious blood clot called deep vein thrombosis (DVT). DVT can mean more than a life of leg pain. If the clot breaks up and moves to the heart, lung or brain, DVT can quickly become a life-threatening event.
6-Inch Blood Clot
In the emergency department, an ultrasound revealed a six-inch clot in Amy’s left iliac vein, and she was transferred to UPMC Presbyterian, home of the nationally recognized UPMC Heart and Vascular Institute.
This is where UPMC brings cardiologists, cardiac surgeons, and vascular surgeons together for collaborative research and clinical care that benefits heart and transplant patients, as well as vascular patients like Amy. Having access to the UPMC Heart and Vascular Institute’s multidisciplinary team of pulmonary specialists, interventional cardiologists, and cardiac and vascular surgeons helped ensure that the risk of DVT complications — such as pulmonary embolism — could be managed.
Amy’s case was referred to the vascular surgery team at UPMC Presbyterian. They explained to her that MTS is not very common, with only about 50 cases seen in western Pennsylvania over the past 10 years. That number of cases includes Amy’s, which doctors describe as “end stage.”
The Goal: Quality of Life
Doctors say standard treatment in an older patient would be a blood thinner, which would enable the patient to live with the clot and avoid an intervention, but because Amy is young, they recommended a more innovative, minimally invasive procedure.
They would dissolve and remove the clot with drugs delivered through a catheter, followed by the placement of a stent to strengthen the vein and prevent further clotting.
The stent, typically used for arterial applications, hadn’t been used widely for veins at the time of Amy’s procedure, and it has proven to be effective.
Now symptom-free and still active in local theater, Amy comes back to the UPMC Heart and Vascular Institute every year for a checkup and to stay current on developments in MTS.
Editor's Note: This video was originally published on , and was last reviewed on .