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

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

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


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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.

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