How Nutcracker and May-Thurner Interact Clinically

What if your chronic pain, bloating, or fatigue wasn’t in your head, but in your blood vessels? In this episode, Dr. Linda Bluestein sits down with vascular surgeon Dr. Robert Hacker, who’s on the front lines of diagnosing and treating complex conditions like MALS (Median Arcuate Ligament Syndrome), Nutcracker Syndrome, May-Thurner Syndrome, and pelvic venous congestion syndrome, conditions that disproportionately affect women and often go undiagnosed for years.

Together, they dive into the frustrating diagnostic delays, the overlap between vascular compression and syndromes like POTS (Postural Orthostatic Tachycardia Syndrome) and EDS  (Ehlers-Danlos Syndrome), and how new surgical approaches are offering hope. Whether you're navigating chronic pelvic pain, unexplained GI symptoms, or fainting episodes, this conversation breaks down the misunderstood links between your veins, nerves, and connective tissue—and what to do about them.

Takeaways:

MALS isn’t rare, it’s rarely diagnosed. Dr. Hacker explains the symptoms and scans to look for when your gut symptoms don’t match the tests.

Why so many women are misdiagnosed with IBS or anxiety. Pelvic venous congestion, Nutcracker Syndrome, and May-Thurner often mimic more common conditions—but require totally different treatments.

The surprising connection between vascular compression and POTS. It’s not just nerves, your veins might be compressing in ways that worsen dysautonomia.

Surgery isn’t a silver bullet, but it can be life-changing. Dr. Hacker shares what makes a good surgical candidate and how his team helps patients navigate workup and recovery.

When your connective tissue works against your vascular system. Hypermobility and EDS can make vascular compression more likely and more complicated to treat.

Find the episode transcript here.

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