Menstrual Cramps, Swollen Feet, Back Pain?

The problem could be iliac vein compression, also known as May-Thurner syndrome.

Betsy Pavon

Betsy Pavon

Ever since Betsy Pavon was a young girl, she wanted to work in the medical field. Once she was old enough, she attended college and earned an associate degree, became a medical assistant and found a position in a pediatric nephrology practice.

“I prepare the patients,” Betsy explains. “I take their vital signs, determine what they’re coming in for and prep their charts, so the providers know if labs or imaging tests have been done. I handle records requests and scheduling, such as follow-up or nurse visits.

“Since I work for a nephrologist, I also assist with kidney transplants. I deal with many hospitals, schedule transplant surgeries and make sure patient records are intact for everyone involved.”

Betsy, 22, loves her job; she enjoys helping sick children. But being a medical assistant isn’t her definitive career goal. Her ultimate ambition is to be a physician assistant (PA).

“While in school, I did a rotation at an orthopedic office and met some great PAs that inspired me,” she recalls. “Ever since, I’ve wanted to be a PA, and I’m leaning toward the specialty of orthopedics. During my rotation, I fell in love with broken bones. I thought it was interesting how bone deformities can occur and how they can be repaired.

“I have about three years of school remaining to earn my bachelor’s degree. Then, it’s another 2½ or three years to earn a PA degree.”

For nearly half her life, Betsy’s been on the receiving end of medical care. She’s struggled with menstrual cramps and low back pain since her preteen years. She also struggles with discomfort in her legs.

“On my 20th birthday, my mom and little brother noticed that when I stood or sat for a long time, my feet would turn purple and swell,” Betsy laments. “I also started getting these bad, aching pains up and down both of my legs.

“For years, I experienced intense lower back pain that was worse when I got my menstrual period. It was unbearable, a 10 on a scale of one to 10. But every time I went to the doctor, they’d say, It’s just hormones. It’s normal. I thought, This is not normal!

“Even my gynecologist kept saying, Get a different type of birth control. Use a heating pad. But those things never worked. Neither did pain medication such as ibuprofen or Midol®. When my feet started turning purple, I was urged to see a vein specialist. I did some research and discovered Dr. Magnant.”

Joseph Magnant, MD, FACS, RPVI, is a board-certified vascular surgeon at Vein Specialists, which has offices in Fort Myers and Bonita Springs. He is dedicated to the modern and comprehensive evaluation of leg vein disorders.

Dr. Magnant uses the most advanced, minimally invasive techniques to diagnose and treat patients.

May-Thurner Syndrome

“Ms. Pavon is a young woman whose primary complaint was pelvic pain, low back pain and terrible pain with her menstrual cycles,” Dr. Magnant recalls. “These are common symptoms of pelvic congestion syndrome. There’s a laundry list of disorders with symptoms that mimic this syndrome, including endometriosis, ovarian cysts and bladder problems such as interstitial cystitis.

“What Ms. Pavon had was iliac vein compression, also known as May-Thurner syndrome. This condition exists when the vein that drains the left leg and left side of the pelvis is compressed between the lumbar spine and the artery that crosses in front of it, the right common iliac artery. It causes an hourglass-shaped narrowing and the formation of intrapelvic varicose veins.”

About five years ago, iliac vein compression and pelvic congestion syndrome became readily diagnosable and treatable through a catheter-based imaging technology called intravascular ultrasound (IVUS) and IVUS-directed angioplasty with stent placement to widen the narrowed veins.

Dr. Magnant used both techniques with Betsy.

“We performed IVUS on Ms. Pavon and discovered she had a 95 percent narrowing of her left common iliac vein at the point where her right iliac artery was compressing the vein against her spine,” the doctor discloses. “Through a needlestick in the left femoral vein in her thigh, we were able to reach the iliac vein and stretch out that narrowed spot.

“Once we completed the angioplasty, we chose an appropriate-sized stent to place within the vein to hold it open. Through this IVUS-directed stent placement, we were able to reestablish the normal size of the vein so that blood from the left side of her pelvis and her left leg could drain normally. It also allowed the pelvic varicose veins to decompress.”

Pelvic congestion syndrome often coexists with venous insufficiency, a condition that occurs when leg veins are damaged and don’t allow blood to flow back toward the heart. Varicose veins are a common sign of this condition, as are symptoms such as aching, heaviness, swelling and restless legs.

Betsy also had venous insufficiency in her great saphenous veins, which run from the top of the foot to the upper thigh. That was the source of pain down Betsy’s legs.

“Ms. Pavon had vein problems in her legs as well, which we treated using endovenous ablation,” Dr. Magnant explains. “That procedure is performed in our office using local anesthesia and ultrasound guidance.”

During an endovenous ablation, Dr. Magnant accesses the leaky veins through tiny punctures in the skin. Using heat (laser or radiofrequency energy), the leaking veins are sealed and blood flow is rerouted through healthy veins.

“Great Improvement”

Betsy Pavon

“Now, the cramps are resolved, and I don’t get the lower back pain as bad as before.” – Betsy

After the IVUS-directed angioplasty with stent placement and the endovenous ablation, Betsy experienced a dramatic improvement in her level of pain.

“Dr. Magnant performed a procedure to close the leaking saphenous vein in my left leg, so I don’t have the aching pain anymore,” Betsy enthuses. “The pain in that leg is zero. I have to schedule a procedure for my right leg soon to close that vein. But the pain in my right leg isn’t nearly as bad. It’s about a five; about half the pain that I had in my left leg.

“The stent really helped with the cramps and lower back pain. Since that procedure, I’ve seen great improvement. Now, the cramps are resolved, and I don’t get the lower back pain as bad as before.

“My feet aren’t purple anymore, either. I can stand for more than 45 minutes and my feet are normal. They don’t hurt. They don’t swell. Before, they were uncomfortable. Now, they’re a lot better.”

Betsy is grateful to Dr. Magnant and his staff at Vein Specialists for their dedication to helping patients with vein-related pain feel at ease during their procedures.

“Dr. Magnant is very kind and helpful,” she raves. “He thoroughly explained everything to me and my mom. Because of the COVID pandemic, my mom couldn’t be with me, but his staff called her regularly to tell her, Your daughter is going into surgery. She’s perfectly fine. They had great bedside manners.

“Anytime someone talks about problems with their veins, I say, Please go to Dr. Magnant because he helped me. I recommend him to everyone.”

© FHCN article by Patti DiPanfilo. Photos courtesy of Betsy Pavon. mkb
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    • Vein Specialists

      Vein Specialists is 100 percent dedicated to identifying and treating vein disorders. Led by Dr. Joseph G. Magnant, they understand that the venous system varies between patients and consists of both deep and superficial venous systems and a net... Read More

    • Joseph G. Magnant, MD, FACS, RPVI

      Joseph Magnant, MD, FACS, RPVI, is a fellow of the American College of Surgeons and is certified in vascular surgery by the American Board of Surgery. He earned his medical degree from the Medical College of Virginia. He completed a genera... Read More