Iliofemoral DVT and May-Thurner Syndrome
May-Thurner Syndrome is a frequent anatomic contributor to DVT.
Patients with May-Thurner Syndrome show good results when interventional treatment of DVT is combined with correcting the underlying anatomic lesion through PTA and/or stenting.
Compression of the left iliac vein by the artery is thought to be a contributing factor to development of DVT. Fifty to sixty percent of patients presenting with left leg DVT will have intraluminal webs due to vein compression. May-Thurner or iliac vein compression syndrome (IVCS) is now more readily identified as thrombolysis reveals the underlying stenosis. A retrospective analysis of 39 patients with documented left iliac vein thrombosis was undertaken to determine the safety and clinical success of endovascular treatment of IVCS.
Nineteen of the patients had acute iliofemoral thrombosis, the remaining 20 had chronic thrombosis. Early in the study, all patients were treated with CDT; later in the study, only acute patients were treated with CDT. CDT was performed overnight, then the patient examined with venography. If complete thrombolysis had been achieved, any underlying stenosis underwent angioplasty and stenting. Partial thrombolysis resulted in repositioning of the catheter and another day of CDT. Patients with no thrombolysis were deemed technical failures.
Patients with acute DVT who were stented had a 93.1% patency rate at one year follow-up. Patients with chronic DVT who were stented had a 93.9% patency rate at one year follow-up. Patients with chronic DVT who underwent thrombolysis prior to stenting had a one year follow-up patency rate of 88.2%. Chronic DVT patients who had angioplasty and stenting without thrombolysis had a one year patency rate of 100%. There were only two major complications, both rethrombosis of the iliac segment in less than 24 hours.
Reference: O’ Sullivan, JG, Semba, CP, et al. Endovascular Management of Iliac Vein Compression (May-Thurner) Syndrome. J Vasc Interv Radiol 2000; 11: 823-836.
Key Learnings:
- Left leg presentation of DVT frequently involves May-Thurner syndrome, a compression of the left iliac vein by the artery
- Removal of thrombus has allowed the underlying stenosis to be identified
- Patients who present with acute left iliac DVT have high one year patency rates when CDT is used in combination with angioplasty and stenting of underlying lesions
- Patients who present with chronic left iliac DVT have high one year patency rates when angioplasty and stenting are used alone