title: Outcomes of endovascular intervention for May-Thurner syndrome.
abstract: BACKGROUND
  Endovascular interventions for May-Thurner syndrome (MTS) have become first-line therapy, often performed in a young patient population despite the lack of robust supportive data. This article reports on long-term outcomes from a large series of patients treated in the setting of de novo or postthrombotic presentation.
  
  
  METHODS
  A retrospective review of MTS patients treated between 2006 and 2010 was conducted at two institutions. Patients who presented with acute iliofemoral deep vein thrombosis (DVT) were treated with either catheter-directed thrombolysis (CDT) and/or pharmacomechanical thrombolysis and identified as having a venous stenosis by venogram or intravascular ultrasound (IVUS). Patients who presented with chronic venous insufficiency symptoms or recalcitrant ulceration but no DVT and evidence of MTS on duplex ultrasound, magnetic resonance venography, or computerized tomography venography were evaluated by venography. IVUS was selectively utilized. Stenting of the iliocaval junction was performed in all patients with a >50% diameter stenosis by IVUS or venogram.
  
  
  RESULTS
  Seventy patients with MTS underwent 77 lower extremity interventions. They were divided into two groups: postthrombotic (group 1) and de novo presentation of chronic swelling/pain or ulceration but no DVT (group 2). There were 56 extremities in group 1 and 21 extremities in group 2. Both groups were comparable in terms of gender distribution and comorbidities, but hypercoagulable state was more common in group 1 (P = .014), and average CEAP and Villalta scores on presentation were higher in group 2 (P < .001). There were left-sided symptoms in 40 (78%) patients in group 1 and 15 (79%) in group 2 (P = 1.00). Female patients were more likely to have left-sided symptoms compared with male patients (odds ratio, 4.88; 95% confidence interval, 1.49-15.89; P = .014). The average stent size was significantly different among the groups (P < .027), with different types used in each group. There was one patient in group 1 who had significant periprocedural bleeding (1 unit transfused) during the CDT portion of the procedure. Mean follow up was 29.7 months in group 1 (range, 18.4-58.3 months) and 22.4 months in group 2 (range, 17.1-42 months). Complete or partial symptom relief was reported for 52 (92.9%) extremities in group 1 and 20 (95.2%) extremities in group 2 (P = 1.00). The overall primary patency of group 1 at 36 months by life-table analysis was 91% with a secondary patency of 95%. The primary and secondary patency for group 2 was 91% at 36 months.
  
  
  CONCLUSIONS
  Stenting of MTS has proven to be safe, efficacious, and durable for up to 36 months in both the postthrombotic patient as well as those treated for edema alone.
authors.affiliation: Department of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: erichager777@gmail.com.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Hager
authors.affiliation: Department of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Theodore
authors.initials: T
authors.lastname: Yuo
authors.affiliation: Bradford Medical Center, Bradford, Pa.
authors.forename: Robert
authors.initials: R
authors.lastname: Tahara
authors.affiliation: Department of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Ellen
authors.initials: E
authors.lastname: Dillavou
authors.affiliation: Department of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Georges
authors.initials: G
authors.lastname: Al-Khoury
authors.affiliation: Department of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Luke
authors.initials: L
authors.lastname: Marone
authors.affiliation: Department of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Michel
authors.initials: M
authors.lastname: Makaroun
authors.affiliation: Department of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Rabih A
authors.initials: RA
authors.lastname: Chaer