Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 May;19(5):1283-1293.
doi: 10.1111/jth.15284. Epub 2021 Apr 1.

Pediatric May-Thurner Syndrome-Systematic review and individual patient data meta-analysis

Laura Avila  1 , Noelle Cullinan  1 , Michael White  2 , Marian Gaballah  3 , Anne Marie Cahill  3 , Deepti Warad  4 , Vilmarie Rodriguez  4 , Cristina Tarango  5 , Anna Hoppmann  6 , Stephen Nelson  7 , Tomas Kuhn  8 , Tina Biss  9 , Aaron Weiss  10 , Michael Temple  1 , João G Amaral  1 , Nour Amiri  1 , Ana C Xavier  6 , Samuele Renzi  1 , Leonardo R Brandão  1
Affiliations
Meta-Analysis

Pediatric May-Thurner Syndrome-Systematic review and individual patient data meta-analysis

Laura Avila et al. J Thromb Haemost. 2021 May.

Abstract

Background: The outcomes of deep vein thrombosis (DVT) in children with May-Thurner Syndrome (MTS) remain unclear.

Objectives: This systematic review and patient-level meta-analysis aims to describe the outcomes of children with MTS presenting with DVT.

Methods: A systematic review of the published literature was performed. Data related to patients <18 years diagnosed with MTS and DVT was extracted. Risk of bias was assessed using the Murad criteria. Outcomes included vessel patency post-treatment, DVT recurrence, and post-thrombotic syndrome (PTS). Predictive and explanatory models were developed for these outcomes.

Results: In total, 109 cases were identified (age range 4-17 years; 77 females) in 28 studies; 75% of patients had ≥1 additional risk factor for DVT. PTS was seen in 61% of patients, DVT recurrence in 38%, and complete vessel patency post-treatment in 65%. The models developed to predict and explain PTS performed poorly overall. Recurrent thrombosis (adjusted for age and patency) predicted PTS (odds ratio [OR] 3.36, 95% confidence interval [CI] 1.28-8.82). DVT management strategies (adjusted for age and DVT characteristics) predicted vessel patency (OR 2.10, 95% CI 1.43-3.08). Lack of complete vessel patency (adjusted for age and thrombophilia) predicted recurrent DVT (OR 2.70, 95% CI 1.09-6.67). Sensitivity analyses showed the same direction of effects for all outcomes.

Conclusions: PTS and DVT recurrence occur frequently in pediatric MTS. PTS prediction is complex and it was not possible to identify early predictors to guide clinical practice. Use of imaging-guided therapy and thrombus burden predicted venous patency, and lack of patency predicted DVT recurrence.

Keywords: anticoagulants; iliac vein compression; iliac vein lesion; post-phlebitic syndrome; post-thrombotic syndrome.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST

The authors have no conflicts to declare.

Figures

FIGURE 1
FIGURE 1
Flowchart of study selection
FIGURE 2
FIGURE 2
Outcome post-thrombotic syndrome (PTS), previously published predictors, partial effect plots, calibration curve, and nomogram
FIGURE 3
FIGURE 3
Outcome patency, partial effect plots, calibration curve, and nomogram. DVT, deep vein thrombosis
FIGURE 4
FIGURE 4
Outcome recurrence, partial effect plots, calibration curve, and nomogram
See this image and copyright information in PMC

References

    1. Eklof B, Perrin M, Delis KT, et al. Updated terminology of chronic venous disorders: the VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 2009;49:498–501. - PubMed
    1. Virchow R. Ueber die Erweiterung kleinerer Gefäfse: Hierzu Tab. IV. Arch Für Pathol Anat Physiol Für Klin Med. 1851;3(3):427–462.
    1. May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957;8(5):419–427. - PubMed
    1. May R, Thurner J. A vascular spur in the vena iliaca communis sinistra as a cause of predominantly left-sided thrombosis of the pelvic veins. Z Kreislaufforsch. 1956;45(23–24):912–922. - PubMed
    1. Plate G, Ohlin P, Eklöf B. Pulmonary embolism in acute iliofemoral venous thrombosis. Br J Surg. 1985;72(11):912–915. - PubMed