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

Gerard J. O'Sullivan, Charles P. Semba, Craig A. Bittner, T. Kee Stephen, Mahmood K. Razavi, Daniel Y. Sze, Michael D. Dake

Research output: Contribution to journalArticle

281 Scopus citations

Abstract

Purpose: 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). Materials and 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. Conclusion: Endovascular reconstruction of occluded iliac veins secondary to IVCS (May- Thurner) appears to be safe and effective.

Original languageEnglish (US)
Pages (from-to)823-836
Number of pages14
JournalJournal of Vascular and Interventional Radiology
Volume11
Issue number7
DOIs
StatePublished - Jan 1 2000
Externally publishedYes

Keywords

  • May-Thurner syndrome
  • Thrombosis, venous
  • Veins, iliac

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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