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A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis
Published on: June 2, 2015
Contralateral Deep Vein Thrombosis after Iliac Vein Stent Placement in Patients with May-Thurner Syndrome
Trong Binh Le1, Taeg Ki Lee2, Keun-Myoung Park3
1Endovascular Training Center, Inha University Hospital, 7-206 Sinheung-dong 3-ga, Jung-gu, Incheon, Republic of Korea.
Insights
Contralateral deep vein thrombosis (DVT) occurs in 9% of May-Thurner syndrome patients after common iliac vein stenting. Overextending the stent to the inferior vena cava increases DVT risk, often due to venous intimal hyperplasia.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Thrombosis Research
Background:
- May-Thurner syndrome (MTS) involves iliac vein compression, often treated with stenting.
- Deep vein thrombosis (DVT) is a potential complication following iliac vein stenting.
Purpose of the Study:
- To determine the incidence of contralateral DVT after common iliac vein (CIV) stent placement in MTS patients.
- To identify potential causes of contralateral DVT in this patient population.
Main Methods:
- Retrospective analysis of 111 patients with symptomatic MTS undergoing CIV stent implantation.
- Classification of stent location (IVC, confluence, or iliac vein) and assessment of venographic findings.
- Statistical analysis to correlate stent location with contralateral DVT development.
Main Results:
- Contralateral DVT occurred in 9% of patients, with a median onset of 40 months post-procedure.
- Venous intimal hyperplasia (VIH) and stent "jailing" were identified as potential causes.
- Overextension of the CIV stent into the inferior vena cava (IVC) was significantly associated with contralateral DVT (P < .001).
Conclusions:
- Contralateral DVT after CIV stenting for MTS has a notable incidence, often presenting late.
- Overextension of the CIV stent into the IVC is a risk factor for contralateral DVT.
- Venous intimal hyperplasia is a key potential cause of late contralateral DVT.
Purpose:
To investigate the incidence and potential causes of contralateral deep vein thrombosis (DVT) after common iliac vein (CIV) stent placement in patients with May-Thurner syndrome (MTS).
Materials And Methods:
Data of 111 patients (women: 73%) who had CIV stent implantation for symptomatic MTS at a single center were retrospectively analyzed. Mean patient age was 63.1 ± 15.2 years. Median follow-up was 36 months (range, 1-142 months). Stent location was determined by venogram and classified as extended to the inferior vena cava (IVC), covered the confluence, or confined to the iliac vein. Potential causes of contralateral DVT were presumed based on venographic findings. The relationship between stent location and contralateral DVT was analyzed.
Results:
Ten patients (9%, men/women: 4/6) exhibited contralateral DVT at a median timing of 40 months (range, 6-98 months). Median age was 69 years (range, 42-85 years). Median follow-up was 73.5 months (range, 20-134 months). Potential causes were venous intimal hyperplasia (VIH) (n = 7), "jailing" (n = 2), and indeterminate (n = 1). All patients with VIH had previous CIV stents overextended to the IVC. Overextension of CIV stent was associated with contralateral DVT (P < .001). The primary patency rate of the contralateral CIV stent was 70% at 20 months.
Conclusions:
Contralateral DVT after CIV stent implantation has a relatively high incidence and often occurs late during follow-up. Overextension of the CIV stent to the IVC is associated with development of contralateral DVT, and VIH should be considered a potential cause.
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