Endovascular management of iliac vein compression (May-Thurner) syndrome

PURPOSE: To evaluate the feasibility of endovascular techniques in treating venous outflow obstruction resulting from compression of the iliac vein by the iliac artery of the left lower extremity (May-Thurner syndrome). MATERIALS AND METHODS: A retrospective analysis of 39 patients (29 women, 1 0 men; median age, 46 years) with iliac vein compression syndrome (IVCS) wa s performed. Nineteen patients presented with acute deep vein thrombosis (D VT) and 20 patients presented with chronic symptoms, All patients presented with leg edema or pain. In the acute group, patients were treated with cat heter-directed thrombolysis (120,000-180,000 IU urokinase/h) and angioplast y followed by stent placement. In the chronic group, patients were treated with use of angioplasty and stent placement alone (n = 8), or in combinatio n with thrombolysis (n = 12), Patients were then followed-up with duplex ul trasound and a quality-of-life assessment. RESULTS: Initial technical success was achieved in 34 of 39 patients (87%). The overall patency rate at 1 year was 79%. Symptomatically, 85% of patien ts were completely or partially improved compared with findings before trea tment. Thirty-five of 39 patients received stents, The 1-year patency rate for patients with acute symptoms who received stents was 91.6%; for patient s with chronic symptoms who received stents, the 1-year patency rate was 93 .9%. Five technical failures occurred, Major complications included acute i liac vein rethrombosis (< 24 hours) requiring reintervention (n = 2), Minor complications included perisheath hematomas (n 4) and minor bleeding (n = I). There were no deaths, pulmonary embolus, cerebral hemorrhage, or major bleeding complications, CONCLUSION: Endovascular reconstruction of occluded iliac veins secondary t o IVCS (May-Thurner) appears to be safe and effective.