Percutaneous treatment of deep vein thrombosis in May-Thurner syndrome.
OBJECTIVE
May-Thurner syndrome is an uncommon disease entity in which the left common iliac vein is compressed by the right common iliac artery with subsequent development of deep vein thrombosis and chronic venous insufficiency. We report our experience on the treatment of extensive iliofemoral deep venous thrombosis due to May-Thurner syndrome using endovascular techniques.


METHODS
The study group comprised 21 patients (8 men, 13 women; mean age 51 years) diagnosed with May-Thurner syndrome by venogram. Eighteen patients were treated with catheter-guided thrombolysis; 3 patients with short segment involvement did not require thrombolysis. After completion of the thrombolytic therapy, the residual venous narrowing was treated by balloon angioplasty and/or placement of a self-expandable stent.


RESULTS
The mean total dose of urokinase was 4.28 +/- 1.89 million units, and the mean duration of infusion was 72 +/- 35 hr. Eighteen of the 21 patients received stent deployment. The mean diameter of the stents was 12.9 +/- 2.0 mm. Initial technical successes with immediate symptom resolution were achieved in 20 of the 21 patients (95%). We performed a follow-up venogram 6 months after procedure and checked clinical symptoms at outpatient clinics (mean follow-up duration 10.8 months). Among the patients who received stent implantation, 2 had recurrent thrombotic occlusion during the follow-up period. Three patients, who did not receive stent implantation, all had recurrent thrombosis. There were no major bleeding complications except in 1 patient who developed retroperitoneal hematoma.


CONCLUSIONS
Catheter-guided thrombolysis and angioplasty with stent implantation is a safe and effective method for the treatment of May-Thurner syndrome.
Kim
Jong-Youn
JY
Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.
Choi
Donghoon
D
Guk Ko
Young
Y
Park
Sungha
S
Jang
Yangsoo
Y
Lee
Do Yun
DY
D000328:Adult; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007083:Iliac Artery; D007084:Iliac Vein; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011655:Pulmonary Embolism / Q000150:complications; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*