Endovascular venous stenting in May-Thurner syndrome

Background Chronic pulsatile compression of the left common iliac vein betw een the crossing right common iliac artery and the lowest lumbar vertebral body may induce focal intimal proliferation of the vein (May-Thurner syndro me), resulting in impaired venous return and left iliofemoral thrombosis. C orrective surgical treatment requires extensive dissection. In this report, we describe our experience with endovascular venous stenting in May-Thurne r syndrome. Methods. Six patients with symptomatic May-Thurner syndrome were treated wi th percutaneous transluminal angioplasty and implantation of self-expanding stents, Results, Postprocedure phlebography revealed patent iliofemoral ve ins with unimpeded venous outflow and disappearance of collaterals in all p atients. No procedure-related complications occurred. At follow-up (median, 12 months), 5 of 6 patients were free of symptoms, In one patient lower ex tremity edema was aggravated despite a patent stented segment of the left i liac vein. The patient continues to wear support stockings to compensate fo r continuing venous insufficiency. Color coded duplex scanning revealed pat ency at regular intervals in 5 patients. In one patient, occlusion of the s tented venous segment with return of symptoms was detected at one month Pat ency could not be restored despite catheter-directed thrombolytic therapy. After angioplasty, however, adequate collateral circulation was restored an d symptoms resolved completely. Conclusions. Endovascular venous stenting in May-Thurner syndrome is techni cally feasible, and leads to reduction of symptoms in the majority of patie nts with high patency rates in the medium-term This approach may prove to b e a percutaneous alternative to surgical treatment.