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Acta Phlebologica 2023 August;24(2):62-7

DOI: 10.23736/S1593-232X.23.00558-1


language: English

Endovascular treatment of chronic venous insufficiency with May-Thurner Syndrome: challenges and outcome

Sayed I. YOUNIS, Baker M. GHONEIM , Mohamed SABRY, Ahmed G. KARMOTA

Department of Vascular Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt

BACKGROUND: This research aims at assessment of the role of angioplasty and stents in management of chronic venous insufficiency (CVI) secondary to May-Thurner Syndrome (MTS) with special emphasis on the technical challenges and outcome.
METHODS: This was a retrospective study done between 2019 and 2022 and included all patient with symptomatic CVI. Patients with acute deep vein thrombosis, peripheral arterial disease and active infection were excluded from study. Our primary end points were technical success and 24-month primary patency rate. Secondary endpoints were: clinical success, secondary patency rate and complication rate.
RESULTS: This study included 33 patients. Nine were male (27.2%) with mean age was 41.5 years (29 to 54 years). The most common comorbidities were: smoking (N.=13, 39.3%), diabetes (N.=5, 15%), hyperlipidemia (N.=4, 12.1%), systemic hypertension (N.=3, 9%), thrombophilia (N.=3, 9%) and pulmonary embolism (N.=3, 9%). Post-thrombotic iliac vein occlusion was present in about 32 (96.9%) and one case (3.1%) due to external compression by tumor. Left-sided occlusion occurred in 29 (87.8%) and four cases in the right side (12%). MTS was evident in 25 cases (75%) by intravascular ultrasound (IVUS). Technical success was achieved in 31 (93.9%). High pressure balloon and dedicated venous stents (Venovo™) were used in all 31 cases. Primary stent patency was 87.1% (N.=27) at two years with 100% clinical improvement assessed by Venous Clinical Severity Score. Patients with occluded stent during follow-up was asymptomatic and was managed conservatively with no need for reintervention. There was no death nor major complications.
CONCLUSIONS: Endovascular treatment and stenting is safe and effective treatment of CVI with good technical success and improved clinical outcome. IVUS is essential part of management and MTS is common underlying cause.

KEY WORDS: Venous insufficiency; Stents; May-Thurner Syndrome

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