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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Frequency: Bi-Monthly

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 2001 February;42(1):83-7

VASCULAR AND ENDOVASCULAR PAPERS 

    ORIGINAL ARTICLES

Endovascular venous stenting in May-Thurner syndrome

Heijmen R. H., Bollen T. L., Duyndam D. A. C. *, Overtoom T. T. C. *, Van Den Berg J. C. *, Moll F. L.

From the Depart­ments of Vas­cular Sur­gery and *­Radiology St. ­Antonius Hos­pital Nieu­we­gein, The Neth­er­lands

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.

language: English


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