Wallstent Deployment Challenges and Complications in Endovenous Management of Non-thrombotic May-Thurner Syndrome

To evaluate Wallstent deployment challenges and complications during endovenous management of non-thrombotic May-Thurner syndrome (NT-MTS) and to define their underlying mechanisms and optimal management strategies.

This prospective single-center cohort study included 38 patients with NT-MTS treated with left common iliac vein stenting. Deployment-related phenomena, including foreshortening, slipping, proximal compression, and migration, were systematically assessed. Clinical outcomes were evaluated using symptom assessment and visual analog scale (VAS). Follow-up included duplex ultrasonography up to 12 months.

A total of 41 Wallstents were deployed with 100% technical success. Foreshortening and varying degrees of stent slipping were consistently observed during deployment and were managed intra-procedurally. Proximal stent compression occurred in 2 cases (5.3%), whereas cranial and caudal migration each occurred in 1 case (2.6%). Both migration events were successfully managed using endovascular techniques without surgical intervention. Complete or partial VAS improvement was observed in 100% of symptomatic patients. All venous ulcers healed, with a mean healing time of 2.5 months. No stent thrombosis or reintervention was observed during 1-year follow-up.

Wallstent deployment in NT-MTS is characterized by consistent, device-driven mechanical behavior, including foreshortening and slipping, which should be recognized as predictable rather than adverse events. Stent migration, although rare, is multifactorial and can be effectively managed using endovascular techniques. A behavior-based approach to Wallstent deployment may improve procedural control and clinical outcomes.Clinical ImpactThis study addresses the predictable mechanical behavior of Wallstents during treatment of May-Thurner syndrome and the technical challenges that may arise during deployment, as well as complications including cranial and caudal stent migration. Understanding these characteristics provides practical guidance for controlled stent deployment, including appropriate sizing, multiplanar venography, initiating deployment approximately 3 cm cranial to the intended landing zone, controlled release with repositioning when necessary, Complete lesion coverage with proximal extension a few millimeters above the IVC confluence and distal-to-proximal post-stent dilatation. The study also introduces a novel endovascular technique for managing a migrated Wallstent entirely within the IVC, allowing successful correction without aborting the primary procedure.