Iliocaval stenting for May-Thurner syndrome: Initial experience

Abstract

The aim of this report is to describe our experience in endovascular treatment of May-Thurner syndrome. We report three cases of iliocaval stenosis treated endovascularly at our institution. We included three patients age range from 41 to 85 years with two presenting with acute deep vein thrombosis and associated limb swelling and one with chronic lower limb symptoms. We reviewed the technical success, complications, and stent patency on follow-up, latter was monitored be serial imaging. The three cases of iliocaval stenosis were treated with endovascular stenting with follow-up imaging follow-up period ranged from 6 to 13 months (mean 5.6 months) with two out of the three cases maintaining stent patency. One case was complicated by intraprocedural reopening of previously venous bleed. Clinical symptoms resolved with no recurrence in two out of three cases. One case experienced symptomatic in-stent thrombosis following endovascular treatment. Endovascular treatment of iliocaval stenosis appears effective in immediate technical success. Periprocedural attention to anticoagulation and stent position are important in preventing in-stent restenosis.

Keywords: Chronic venous insufficiency; Deep vein thrombosis; May–Thurner syndrome; Venous stent.

Figure 1:

A 61-year-old lady presented with prior left lower limb deep vein thrombosis with CT confirmed May–Thurner’s syndrome. Contrast-enhanced venous phase CT with compression of the left common iliac vein by the right common iliac artery against the lumbar vertebra (arrow).

Figure 2:

DSA from the venous access at the great saphenous vein showing diseased left common iliac and left external iliac veins (arrow) with venous collaterals seen.

Figure 3:

Post-procedure DSA shows technically successful stent deployment with substantial reduction in collaterals.

Figure 4:

41-year-old man with contrast enhanced CT findings compatible with May-Thurner Syndrome and thrombus from the left common iliac vein the upper portion of the left femoral vein. The venogram at the upper portion of the superficial femoral vein showing occlusive thrombus at the common femoral vein (arrow).

Figure 5:

Placement of three stents performed, ensuring overlap, followed by post-deployment balloon angioplasty to achieve desired diameter (arrow).

Figure 6:

Post-procedure venogram shows good flow through the stents with no substantial collateral flow.

Figure 7:

An 85-year-old lady with CT findings compatible with May-Thurner syndrome and a left pelvic haematoma. Slow contrast extravasation to the known left pelvic haematoma is shown.

Figure 8:

Post-procedure digital subtraction angiogram demonstrating no extravasation nor gross collateral flow.