Pediatric May‐Thurner Syndrome—Systematic review and individual patient data meta‐analysis

Abstract

Background: The outcomes of deep vein thrombosis (DVT) in children with May-Thurner Syndrome (MTS) remain unclear.Objectives: This systematic review and patient-level meta-analysis aims to describe the outcomes of children with MTS presenting with DVT. Methods:A systematic review of the published literature was performed. Data related to patients <18 years diagnosed with MTS and DVT was extracted. Risk of bias was assessed using the Murad criteria. Outcomes included vessel patency post-treatment, DVT recurrence, and post-thrombotic syndrome (PTS). Predictive and explanatory models were developed for these outcomes.Results: In total, 109 cases were identified (age range 4-17 years; 77 females) in 28 studies; 75% of patients had ≥1 additional risk factor for DVT. PTS was seen in 61% of patients, DVT recurrence in 38%, and complete vessel patency post-treatment in 65%. The models developed to predict and explain PTS performed poorly overall. Recurrent thrombosis (adjusted for age and patency) predicted PTS (odds ratio [OR] 3.36, 95% confidence interval [CI] 1.28-8.82). DVT management strategies (adjusted for age and DVT characteristics) predicted vessel patency (OR 2.10, 95% CI 1.43-3.08). Lack of complete vessel patency (adjusted for age and thrombophilia) predicted recurrent DVT (OR 2.70, 95% CI 1.09-6.67). Sensitivity analyses showed the same direction of effects for all outcomes.Conclusions: PTS and DVT recurrence occur frequently in pediatric MTS. PTS prediction is complex and it was not possible to identify early predictors to guide clinical practice. Use of imaging-guided therapy and thrombus burden predicted venous patency, and lack of patency predicted DVT recurrence.

Combined high-resolution 3D CUBE T1-weighted imaging and non-contrast-enhanced magnetic resonance venography for evaluation of vein stenosis in May–Thurner syndrome

“…36 A meta-analysis indicated that in pediatric MTS, the morbidity rate from PTS is 61% and the rate of recurrent DVT is 38%. 37 MRI can reduce the need for x-ray irradiation and contrast agent intake and can be used as a substitute tool for pediatric and pregnant patients. A case report also covered the use of NCE MRV for diagnosing DVT or MTS in patients with renal insufficiency.…”

Case Report: Rare Iliac Vein Compression (May–Thurner) Syndrome in a Pediatric Patient

“…Many people have varying degrees of compression of the left common iliac vein but have no clinical manifestations. So the presence of venous symptoms is critical to IVCS diagnosis (5,6). IVCS mainly occurs in young and middle-aged women, and 18% to 49% of patients manifested deep venous thrombosis in the left lower extremity (7).…”

Recurrent thrombosis with a mispositioned stent after treatment of an adolescent with May–Thurner syndrome

“…10,11 Other May-Thurner case series have reported the recurrence of DVT rates to be 28%-40% after initial treatment. 2,5,7,12 Our patient's recurrent clot is unique, as his left iliac vein stent placed by the outside hospital that extended past the iliac bifurcation was the etiology of his extensive contralateral clot burden. After his initial diagnosis of May-Thurner, the patient was anticoagulated for 9 months before transitioning to anti-platelet therapy alone.…”

“…There is paucity of literature surrounding pediatric May-Thurner syndrome compared to adults, which may be due to the infrequency of serious deep venous thrombosis (DVT) in the pediatric population that present to medical care. 2 Treatment modalities for pediatric patients with symptomatic May-Thurner syndrome include treating the acute clot (systemic anticoagulation, catheter-directed thrombolysis, and/or thrombectomy) and relieving the anatomic abnormality with stent placement. 3 In this case report, we describe an adolescent boy treated at a large, tertiary children's hospital with May-Thurner syndrome and a unique presentation of recurrent thrombosis after prior stent placement.…”