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Endovascular venous stenting in May-Thurner syndrome
R H Heijmen1, T L Bollen, D A Duyndam
1Departments of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Insights
Endovascular venous stenting effectively treats May-Thurner syndrome, a condition causing iliofemoral thrombosis due to vein compression. This minimally invasive procedure offers a high success rate for symptom relief and vein patency.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- May-Thurner syndrome involves chronic compression of the left common iliac vein, leading to impaired venous return and thrombosis.
- Surgical treatment for May-Thurner syndrome necessitates extensive dissection.
- Endovascular venous stenting presents a less invasive alternative.
Purpose of the Study:
- To evaluate the efficacy and safety of endovascular venous stenting for May-Thurner syndrome.
- To assess medium-term patency rates and symptom resolution following the procedure.
Main Methods:
- Six patients with symptomatic May-Thurner syndrome underwent percutaneous transluminal angioplasty and self-expanding stent implantation.
- Postprocedure phlebography and color-coded duplex scanning were used for assessment.
- Follow-up included clinical evaluation and imaging at a median of 12 months.
Main Results:
- All patients demonstrated patent iliofemoral veins with improved venous outflow post-stenting.
- Five out of six patients were symptom-free at follow-up.
- One patient experienced stent occlusion but resolved symptoms with restored collateral circulation after angioplasty.
Conclusions:
- Endovascular venous stenting is technically feasible for May-Thurner syndrome.
- The procedure achieves high medium-term patency rates and symptom reduction in most patients.
- Venous stenting offers a viable percutaneous alternative to surgical intervention.
Background:
Chronic pulsatile compression of the left common iliac vein between the crossing right common iliac artery and the lowest lumbar vertebral body may induce focal intimal proliferation of the vein (May-Thurner syndrome), resulting in impaired venous return and left iliofemoral thrombosis. Corrective surgical treatment requires extensive dissection. In this report, we describe our experience with endovascular venous stenting in May-Thurner syndrome.
Methods:
Six patients with symptomatic May-Thurner syndrome were treated with percutaneous transluminal angioplasty and implantation of self-expanding stents. RESULTS Postprocedure phlebography revealed patent iliofemoral veins with unimpeded venous outflow and disappearance of collaterals in all patients. No procedure-related complications occurred. At follow-up (median, 12 months), 5 of 6 patients were free of symptoms. In one patient lower extremity edema was aggravated despite a patent stented segment of the left iliac vein. The patient continues to wear support stockings to compensate for continuing venous insufficiency. Color coded duplex scanning revealed patency at regular intervals in 5 patients. In one patient, occlusion of the stented venous segment with return of symptoms was detected at one month. Patency could not be restored despite catheter-directed thrombolytic therapy. After angioplasty, however, adequate collateral circulation was restored and symptoms resolved completely.
Conclusions:
Endovascular venous stenting in May-Thurner syndrome is technically feasible, and leads to reduction of symptoms in the majority of patients with high patency rates in the medium-term. This approach may prove to be a percutaneous alternative to surgical treatment.