Venoplasty & iliac vein stenting · the procedure for May-Thurner syndrome
May-Thurner treatment is a pinhole procedure: through a vein in the groin, an interventional radiologist confirms the narrowing, opens it with a small balloon, and leaves a mesh stent in place so the artery can’t squeeze the vein flat again. Done in our office, under sedation, home the same day. It is also a permanent implant — and this page tells you what that means before it tells you the results. Covered by most insurance plans, including Medicare and Medicaid — and we’re in-network with most plans. No referral needed for your initial consultation.
Covered by most insurance, including Medicare & Medicaid No referral needed for your initial consultation
Maybe a scan came back with the words “iliac vein compression” and someone said stent. Maybe you had a left-leg clot, it’s been treated, and now the question is why it happened. Or maybe you’ve had a heavy, swollen left leg for years and finally found the name for it.
If you’re still at the “do I actually have May-Thurner?” stage, start with our May-Thurner syndrome page — it explains why the left leg, why a narrowed vein on a scan is not a diagnosis, and how we decide who should be treated at all.
This page is for the next question: what the procedure actually does, what it asks of you afterward, and what the day is actually like.
The procedure
In May-Thurner, the artery to your right leg crosses over the main vein from your left leg and pins it against the spine, so the vein drains slowly and the leg swells and aches.¹ The fix is mechanical: get inside the vein, open the narrowed spot, and put something there that holds it open. A balloon (venoplasty) does the opening — but the narrowing is scar-like and springs back once the balloon comes out, so a balloon alone doesn’t last.³ A stent — a small, self-expanding mesh tube — is what makes it last: it sits inside the vein, pushes back against the artery, and over the following weeks your own vein lining grows over it and it becomes part of the wall.
That’s why the honest name for this procedure has two halves — venoplasty and stenting — and why we say up front what the second half means: the stent doesn’t come back out.
What to know first
A venous stent is hardware, and it does not come back out. That’s the price of a fix that lasts — balloon alone recoils.³ It also means the decision to place one deserves more care than the decision to try a pill, and we make it that way: on real symptoms, on proper imaging, and only after other causes of the leg are ruled out. If your leg has no symptoms, you don’t need one, and we’ll say so.
In the pooled studies, up to two in three patients had new low-back pain after a venous stent.⁴ It’s usually mild, it usually settles on its own over days to weeks — and it’s alarming if nobody warned you. Consider yourself warned — it is expected, and it passes.
What medications you’ll take afterward, for how long, and how any of this fits with a pregnancy you’re planning — those answers depend on your history and your clot risk, and they don’t belong in a web page. We go through them with you, in person, before you decide anything.
Limits first, results second — that’s the order you deserve. Now the day itself, then the studies.
Procedure day
Before anything is scheduled: you’ve had a consultation, your imaging — the leg ultrasound and the CT or MR venogram — has been reviewed against your symptoms and your exam, other causes of the swelling have been looked for, and your benefits have been checked. If you’ve had a clot, it has been treated and is stable; we don’t treat May-Thurner while a clot is active. You know where you stand — medically and financially — before you commit to anything.
The morning of: you come to our office — not a hospital. The procedure happens in our own interventional radiology suite. You’ll have fasted beforehand, and you’ll bring a driver — no exceptions: the sedation means you can’t drive yourself home. You’ll get the exact instructions, in writing, well before the day.
During the procedure: you’re given twilight sedation through an IV, with a dedicated sedation nurse with you the whole time. The interventional radiologist numbs a spot in your groin and enters the vein through a pinhole — no incision, no stitches. First comes the look: X-ray dye pictures of the vein (a venogram) that confirm the narrowing your scan showed. If it doesn’t match — if the vein isn’t narrow enough to matter — we stop there, and that’s a good outcome, not a wasted one. If it does, a small balloon opens the narrowed segment, and a self-expanding mesh stent is placed across it and released. It expands on its own to hold the vein open against the artery. You won’t feel any of this happening. Plan on about an hour to two, all told.
Afterward: you rest with us, then someone drives you home — the same day. Most people are walking normally that day and back to ordinary activity within a few days. You go home with your after-care instructions, the back-pain warning you’ve already read, compression stockings, and the on-call doctor’s cell phone number. Not an answering service — the doctor. And the next day, we call you to check on you. Every patient, every time.
The weeks after: swelling and heaviness often start improving within days to weeks as the leg finally drains the way it should;⁴ skin changes take longer. Some low-back ache in the first days is expected. We see you back with an ultrasound to confirm the stent is open — and we keep checking, on a schedule you’ll leave with. You’ll have written instructions, a scheduled follow-up, and a phone number that reaches a doctor — so at no point are you at home wondering whether what you’re feeling is normal.
The published evidence
98 in 100
Stents placed for iliac vein compression without a clot were still open at two years (98.4%; 99.6% at six months) in a 2025 review of 27 studies and 4,782 patients.⁴
80–100%
Range across those studies for improvement in leg swelling after stenting; pain relief was reported up to 100%.⁴
+14.5
Points better on vein-specific quality of life — and 2.0 points better on symptom severity — at six months with stenting plus usual care vs usual care alone, in a 2026 NEJM randomized trial (C-TRACT, 225 patients). Those patients all had a prior clot — the trial did not study compression without a clot.⁵
2 in 3
Up to two in three patients report new low-back pain after a venous stent. Usually mild and temporary — and worth knowing before, not after.⁴
What the numbers don’t say: the 98% figure is about the hardware staying open — it comes mostly from studies where the doctors chose the patients, and choosing well is the whole game. The randomized trial is six months long and in a different group from most people reading this. Guideline bodies have not yet made stenting a routine recommendation; the trial’s editorial says 12–24-month data are needed first.⁵ Bleeding was roughly three times as common in the trial’s stented group (about 12% vs 4%, almost all minor).⁵ We tell you all of this because a stent is permanent and you get one vote.
Sources: 1. May-Thurner Syndrome. StatPearls, NCBI Bookshelf NBK554377. 2. StatPearls; Knuttinen MG et al., Cardiovasc Diagn Ther. 3. Murphy EH, Black SA. Avoiding misuse and overuse of iliac vein stenting for chronic venous disease. Endovascular Today, July 2018 — >1/3 of asymptomatic individuals with >70% compression; no indication to treat asymptomatic compression; angioplasty alone recoils. 4. Li M, Wang S, Zhao J, et al. Iliac vein stenting outcomes in non-thrombotic and thrombotic diseases: systematic review and meta-analysis. Biomol Biomed 2025;26(5):759–773 — 27 studies, 4,782 patients; non-thrombotic primary patency 99.6% (6 mo), 98.4% (24 mo); edema relief 80–100%; back pain up to 66%; stent thrombosis 0–10.2%; stent collapse 3.3–11.3%; pulmonary embolism 0%. 5. Vedantham S, et al. C-TRACT. N Engl J Med 2026 (published 13 April 2026) — 225 patients with post-thrombotic syndrome and iliac obstruction; VCSS adjusted difference −2.0 (95% CI −3.2 to −0.8); VEINES-QOL +14.5 (9.5–19.4); bleeding 11.6% vs 3.6%; accompanying editorial on 12–24-month data before guideline incorporation.
Candidacy
The full “how we decide” is on the May-Thurner syndrome page. The short version:
We turn away patients who aren’t candidates for what we do. With a permanent implant, that isn’t a slogan — it’s the whole point.
Your care team
May-Thurner treatment at ARV Centers is performed by Board Certified Vascular and Interventional Radiologists — and we’re glad to coordinate with your hematologist, OB/GYN, or vascular doctor before and after.
After your procedure
When you go home, you take the on-call doctor’s cell phone number with you. Not an answering service — the doctor.
And you don’t have to wonder whether to bother us: we call you the next day to check in. Every patient, every procedure. With a stent, “after” also means scheduled ultrasounds to confirm it’s open — you’ll leave with the dates.
Before you leave, you’ll get this card
Your procedure:
On-call doctor:
Cell phone: written by hand, before you walk out
Call me if anything worries you.
Straight answers
The procedure itself, no — you’re sedated and comfortable, the pinhole in the groin is numbed, and you won’t feel the catheter, the balloon, or the stent going in. The honest pain conversation is about afterward: many people get a low-back ache in the first days as the vein and the tissue around the stent adjust. It’s usually mild and settles on its own.⁴ We’d rather you hear that from us now than discover it at home.
We wish. The narrowing in May-Thurner is scar-like and springs back after a balloon alone, so a lasting fix means a stent.³ If you’d rather not have permanent hardware, that’s a completely legitimate choice — compression stockings and treating any clot remain real options. We’ll help you weigh it, not push it.
You won’t feel it once the first days pass — it sits inside a large vein deep in the pelvis, and your own vein lining grows over it. Venous stents are built to push outward against exactly this kind of compression. In the pooled studies, stent collapse or clotting happened in a small minority, and both can often be treated; that’s the reason for the follow-up ultrasounds, and one of the reasons we choose candidates carefully.⁴
Venous stenting has been done for decades, and the durability record is strong: in the largest review, stents placed for compression without a clot were still open in more than 98% of people at two years.⁴ In 2026, the New England Journal of Medicine published the first large randomized trial — 225 patients, run by the NIH — and stenting improved symptoms and quality of life at six months compared with standard care alone.⁵ Read the fine print with us, though: those patients all had a prior clot with lasting damage. The trial didn’t study compression without a clot, and guideline groups haven’t yet made stenting a routine recommendation. That’s the honest state of the evidence, and it’s why we’re so careful about who we treat.
The common one: new low-back pain (up to two in three, usually mild and temporary).⁴ The less common ones: bleeding (about 12% vs 4% in the trial’s stented arm, almost all minor),⁵ the stent clotting or collapsing (each in a small minority, often treatable), a clot in the same or the other leg, and the ordinary rare risks of any catheter procedure.⁴ Across the pooled studies, no lung clots (pulmonary embolism) were reported after stenting.⁴ We go through your specific numbers in plain language before you decide anything.
We stop. The venogram at the start of the procedure is there to confirm what your scan showed — and if it doesn’t, no balloon and no stent. That’s a good outcome, not a wasted trip: it means you don’t carry a permanent implant you didn’t need. The imaging review beforehand is what earns you a procedure date in the first place — but we’d rather you know the stop is possible before the day than be surprised by it.
Those are real questions, and they’re yours specifically — the answers depend on whether you’ve had a clot, your bleeding risk, your other conditions, and your plans. We don’t publish a one-size answer because there isn’t one. We go through it with you, in person, before you decide anything — and we’re glad to coordinate with your hematologist or OB.
Then you belong in a hospital, not on this page — sudden swelling, pain, or shortness of breath is an emergency-room visit. An active clot is treated there, and we don’t treat May-Thurner while a clot is active. Once the DVT has been treated and things are stable, we evaluate for the compression and decide on treatment.
Yes — most plans, including Medicare and Medicaid, and we’re in-network with most plans. We do a complimentary benefits check before any procedure is scheduled — usually on the day of your consultation. No surprises.
Not for your initial consultation — call us directly. If your plan requires a referral or prior authorization for treatment itself, we’ll identify that during the complimentary benefits check and help you get it.
Free checklist
Ten questions to ask before anyone stents your vein — including us. A one-page, plain-English checklist from our physicians: what a proper May-Thurner workup includes, the difference between compression and syndrome, what to ask about before and after, and the numbers a good answer should contain. No appointment required, and no follow-up phone call unless you ask for one.
We’ll email your checklist plus occasional patient education. Unsubscribe anytime. Privacy policy.
Bring your imaging if you have it — the CT or MR venogram, the ultrasound, the report that says “compression.” Call us directly, or send this form and we’ll call you to schedule. We do a complimentary benefits check before any procedure. No surprises. Want a head start? Download the May-Thurner consultation packet and fill it in at home.
210-405-1335Closed on major holidays.
3212 Napier Park, San Antonio, TX 78231
Stand-in image (Map © OpenStreetMap) — the live site embeds the interactive Google map here
No referral needed for your initial consultation.
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