Endovascular Management of May-Thurner Syndrome in Adolescents: A Single-Center Experience.
OBJECTIVE
To report a single-center experience in regard to the technique, safety, and clinical outcomes of endovascular therapy for treatment of May-Thurner syndrome (MTS) in adolescent patients.


METHODS
A retrospective review identified 10 patients (6 female; mean age, 16 y; range, 12-18 y; mean weight, 73 kg; range, 50-116 kg) treated by endovascular therapy for MTS from 1998 to 2015. Clinical presentations consisted of acute thrombotic MTS (n = 6) and nonthrombotic MTS (n = 4). Catheter-directed thrombolysis was performed in all cases of thrombosis. Venoplasty and stent placement were performed in all cases. Self-expanding stents 12-16 mm in diameter and 4-9 cm in length were deployed.


RESULTS
No major periprocedural complications were observed. Median follow-up was 32 months (range, 6-109 mo). Primary and secondary patency rates were 79% and 100% at 12 months and 79% and 89% at 36 months, respectively. In a single patient with permanent loss of flow in the treated segment, multiple risk factors for thrombosis were identified. Rates of posttreatment symptoms were 0% by Villalta score and 60% (n = 6; mild symptoms) by modified Villalta score at the last clinical follow-up.


CONCLUSIONS
Endovascular therapy for the treatment of MTS in our adolescent cohort was safe and effective in relieving venous obstruction. Stent placement in patients with underlying thrombophilic disorders is associated with loss of secondary patency, suggesting the need for further consideration in this population.
Department of Radiology, Stanford University Medical Center, Stanford, California. Electronic address: goldmanr@stanford.edu.
Roger E
RE
Goldman
Stanford School of Medicine, Stanford University, 300 Pasteur Dr., Room H-1307, MC 5621, Stanford, CA 94305-5621.
Victoria A
VA
Arendt
Department of Radiology, Stanford University Medical Center, Stanford, California; Stanford School of Medicine, Stanford University, 300 Pasteur Dr., Room H-1307, MC 5621, Stanford, CA 94305-5621.
Nishita
N
Kothary
Department of Radiology, Stanford University Medical Center, Stanford, California; Stanford School of Medicine, Stanford University, 300 Pasteur Dr., Room H-1307, MC 5621, Stanford, CA 94305-5621.
William T
WT
Kuo
Department of Radiology, Stanford University Medical Center, Stanford, California; Stanford School of Medicine, Stanford University, 300 Pasteur Dr., Room H-1307, MC 5621, Stanford, CA 94305-5621.
Daniel Y
DY
Sze
Department of Radiology, Stanford University Medical Center, Stanford, California; Stanford School of Medicine, Stanford University, 300 Pasteur Dr., Room H-1307, MC 5621, Stanford, CA 94305-5621.
Lawrence V
LV
Hofmann
Stanford School of Medicine, Stanford University, 300 Pasteur Dr., Room H-1307, MC 5621, Stanford, CA 94305-5621.
Matthew P
MP
Lungren
D000293:Adolescent; D000367:Age Factors; D002140:California; D002648:Child; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D062108:May-Thurner Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
D005343:Fibrinolytic Agents