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


METHODS
A retrospective analysis of 39 patients (29 women, 10 men; median age, 46 years) with iliac vein compression syndrome (IVCS) was performed. Nineteen patients presented with acute deep vein thrombosis (DVT) and 20 patients presented with chronic symptoms. All patients presented with leg edema or pain. In the acute group, patients were treated with catheter-directed thrombolysis (120,000-180,000 IU urokinase/h) and angioplasty followed by stent placement. In the chronic group, patients were treated with use of angioplasty and stent placement alone (n = 8), or in combination with thrombolysis (n = 12). Patients were then followed-up with duplex ultrasound 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 patients were completely or partially improved compared with findings before treatment. Thirty-five of 39 patients received stents. The 1-year patency rate for patients with acute symptoms who received stents was 91.6%; for patients with chronic symptoms who received stents, the 1-year patency rate was 93.9%. Five technical failures occurred. Major complications included acute iliac vein rethrombosis (< 24 hours) requiring reintervention (n = 2). Minor complications included perisheath hematomas (n = 4) and minor bleeding (n = 1). There were no deaths, pulmonary embolus, cerebral hemorrhage, or major bleeding complications.


CONCLUSIONS
Endovascular reconstruction of occluded iliac veins secondary to IVCS (May-Thurner) appears to be safe and effective.
O'Sullivan
G J
GJ
Division of Cardiovascular-Interventional Radiology, Stanford University Medical Center, CA 94305, USA.
Semba
C P
CP
Bittner
C A
CA
Kee
S T
ST
Razavi
M K
MK
Sze
D Y
DY
Dake
M D
MD
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D002406:Catheterization, Peripheral / Q000295:instrumentation; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007084:Iliac Vein; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D010960:Plasminogen Activators / Q000627:therapeutic use; D011788:Quality of Life; D012189:Retrospective Studies; D015607:Stents; D013577:Syndrome; D015912:Thrombolytic Therapy; D018616:Ultrasonography, Doppler, Duplex; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000628:therapy
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator