Contralateral Deep Vein Thrombosis after Iliac Vein Stent Placement in Patients with May-Thurner Syndrome

Le, Trong Binh; Lee, Taeg Ki; Park, Keun-Myoung; Jeon, Yong Sun; Hong, Kwang Pyo; Cho, Soon Gu

doi:10.1016/j.jvir.2018.01.771

Cited by 30 publications

(26 citation statements)

References 21 publications

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“…Data presented here and fluoroscopy postendovascular reconstruction show consistent crossing of the culpable lesion, with adequate right common iliac venous drainage using the described technique (Fig 8). These findings are concordant with Le at al (7) in defining the proper stent landing zone "for MTS is being confined within the confluence, without touching the IVC wall." It could also be argued that some coverage is required because of the oblique course of the proximal RCIA.…”

Section: Discussionsupporting

confidence: 86%

“…Reasons for this include difficulty identifying the confluence, ensuring lesion crossing, and overcoming shortcomings in available stent technology (4). A potential link with IVC extension or "jailing" of the right common iliac vein and contralateral DVT has been identified (7,22).…”

Section: Discussionmentioning

confidence: 99%

“…The most important reason for this was that if the stent was placed too short, there was a risk of treatment failure by allowing the overriding artery to continue crushing the vein. Conversely, iliocaval extension of stents may increase the risk of contralateral right common iliac vein pseudointima formation and subsequent DVT (7,8).…”

Section: Introductionmentioning

confidence: 99%

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Aiming for the Bottom Corner: How to Score a Field Goal When Landing Venous Stents in May–Thurner Syndrome

Bajwa

Bergin

O’Sullivan

2019

Journal of Vascular and Interventional Radiology

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Purpose: To report an iliac venous stent landing technique using only fluoroscopy in patients with May-Thurner syndrome (MTS). Material and Methods: Sixty-five patients (69% female) who had self-expanding nitinol stents deployed for symptomatic MTS were retrospectively analyzed. Mean age was 50 years (range 18-80). The cephalic stent right lower corner was deployed to the right of the lumbar vertebra spinous process (SP), but not as far to the right as the right pedicle lateral border. Mode stent diameter and length were 14 mm (range 12-18) and 120 cm (range 60-180), determined by venography, respectively. The anatomical positions of the right common iliac artery, inferior vena cava (IVC), and stent were assessed relative to these bony landmarks on computed tomography venography. Results: Position of the proximal right common iliac artery right lateral border lay a mean distance of 12 mm (±8 to the right of the SP and 13 mm (±7) left of the right pedicle lateral border. Mean position of the IVC right lateral wall lay 1 mm (±6) to the right of the right pedicle lateral border. Mean position of the cephalic stent right lower corner was 6 mm (±6) to the left of the right pedicle lateral border and 19 mm (±7) to the right of the SP. The mean space left between the cephalic stent right lower corner and the IVC right lateral wall was 5 mm (±5). Primary patency rate at 1 year was 88%. Conclusions: Important vascular structures lie in predictable locations relative to bony landmarks, facilitating accurate venous stent placement using fluoroscopy only. ABBREVIATIONS AP ¼ anteroposterior, DVT ¼ deep venous thrombosis, IVC ¼ inferior vena cava, MTS ¼ May-Thurner syndrome, RCIA ¼ right common iliac artery, SD ¼ standard deviation, SP ¼ spinous process From the Faculty of Radiology (R.B.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Aiming for the Bottom Corner: How to Score a Field Goal When Landing Venous Stents in May–Thurner Syndrome

Bajwa

Bergin

O’Sullivan

2019

Journal of Vascular and Interventional Radiology

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“…There is also a study regarding the risk for intimal hyperplasia and DVT in the contralateral extremity after migration or extension of the stent to the inferior vena cava. [12] The stent patency rates of the patients with stent implantation by direct and progressive methods were found to be 93.5% and 97.8%, respectively (p=0.323) and the mean Villalta scores were found to be 4.2±2.5 and 2.1±1.9, respectively. [13] In addition, one-year patency rates were reported as higher than 90% with specialized vein stents.…”

Section: Discussionmentioning

confidence: 88%

Mid-term results of deep vein thrombosis treatment: Comparison of interventional and medical therapies

Kük¹

2019

Turk J Vasc Surg

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Objectives: This study aims to compare different modalities used in the treatment of deep vein thrombosis (DVT) and to identify risk factors for post-thrombotic syndrome (PTS). Patients and methods: A total of 217 patients (119 males, 98 females; mean age 51.2±18.1 years; range, 15 to 96 years) who were treated for DVT with medical and interventional methods between August 2012 and September 2018 were retrospectively analyzed. The interventional group (Group I) consisted of 35 patients and the medical group (Group M) consisted of 182 patients. The patients were compared for risk factors, anatomic extension, and final clinical pictures. Results: The mean follow-up was 2.6±2.5 years. Group I had more proximal involvement according to the Lower Extremity Thrombosis (LET) classification (p=0.0001). Recurrent DVT rates were 22.9% (n=8) and 13.9% (n=23) in Group I and Group M, respectively (p=0.198). The mean recurrence-free survival duration in Group I and Group M was 1.6±1.7 and 2.6±3.7 years, respectively (p=0.052). Two-year recurrence-free survival rates in Group I and Group M were 73.3±9.8% and 85.9±3.7%, respectively (p=0.479). None of the Group I patients had pulmonary embolism (PE) during follow-up. In Group M, five patients had PE (p=0.614). In the final controls, the mean Villalta scores in Group I and Group M were 3.0±2.6 and 5.4±5.2, respectively (p=0.013). The rates of patients with Villalta scores >5 were 3.4% (n=1) in Group I and 41.0% (n=32) in Group M (p=0.0001). The mean Venous Clinical Severity Scores (VCSS) were statistically significantly different in Group I and Group M (2.6±3.5 and 4.4±3.6; p=0.027). Anticoagulant-related bleeding complication rates in Group I and Group M were 27.6% (n=8) and 41.0% (n=32) (p=0.195). Conclusion: Interventional DVT treatment results in decreased symptom severity and PTS occurrence at two years. Interventional therapy options in iliofemoral DVT offers persistent advantage in the mid-term.

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“…The proportion of patients PTO and NIVL varied between studies. 8,10,[15][16][17][18][19][20][21][22][23][24] In seven studies, there was a predominance of patients with PTO, while in four studies NIVL patients were the majority. The male/female ratio varied between 1:1.3 and 1:9.…”

Section: Resultsmentioning

confidence: 94%

Contralateral deep vein thrombosis after stenting across the iliocaval confluence in chronic venous disease – A systematic review

et al. 2019

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Objective Stenting of the iliac veins is increasingly considered in the presence of symptomatic obstructive chronic lesions in the iliac vein segment. However, it is often necessary to extend the stented zone into the inferior vena cava, increasing the risk of contralateral iliac vein thrombosis. This study aims to review the current literature concerning the incidence of contralateral deep vein thrombosis after stenting across the iliocaval confluence. Methods A systematic review from potentially relevant published articles reporting contralateral deep vein thrombosis after iliac venous stenting between January 2007 and February 2019 was performed. Results A total of 764 references were retrieved initially. Twelve studies reporting events of contralateral deep vein thrombosis were selected for review, with a total of 1864 patients. Contralateral deep vein thrombosis incidence varied between 0% and 15.6%. The post-interventional and follow-up anticoagulation regimens were heterogeneous between studies. The decision to maintain patients on anticoagulation and the duration of treatment was based on the presence of comorbidities, hypercoagulable states, post-thrombotic syndrome and history of recurrent deep vein thrombosis. Patients with non-thrombotic iliac vein lesions were either anticoagulated for three or six months after stenting or received no anticoagulation. Patients with post-thrombotic syndrome were anticoagulated for longer periods. Most studies (eight studies) used an oral vitamin K antagonist agent. The data on compliance with anticoagulation treatment is scarce and few references present data on whether contralateral deep vein thrombosis occurred during anticoagulation treatment. The use of antiplatelet agents in addition to the anticoagulant treatment in the follow-up period was also variable. Conclusion The incidence of contralateral deep vein thrombosis due to iliac vein jailing is not negligible and reported being as high as 15.6%. Large-scale studies on the ideal antithrombotic treatment and its impact are necessary. It is possible that patients with stent crossing the iliocaval confluence might benefit from long-term antithrombotic treatment.

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Contralateral Deep Vein Thrombosis after Iliac Vein Stent Placement in Patients with May-Thurner Syndrome

Cited by 30 publications

References 21 publications

Aiming for the Bottom Corner: How to Score a Field Goal When Landing Venous Stents in May–Thurner Syndrome

Aiming for the Bottom Corner: How to Score a Field Goal When Landing Venous Stents in May–Thurner Syndrome

Mid-term results of deep vein thrombosis treatment: Comparison of interventional and medical therapies

Contralateral deep vein thrombosis after stenting across the iliocaval confluence in chronic venous disease – A systematic review

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