Treatment of Pelvic Venous Spur (May–Thurner Syndrome) with Self-Expanding Metallic Endoprostheses

Binkert, Christoph A.; Schoch, Eric; Stuckmann, G.; Largiadèr, J; Wigger, Pius; Schoepke, W; Zollikofer, Christoph L.

doi:10.1007/s002709900205

Cited by 90 publications

(54 citation statements)

References 11 publications

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“…Contrast venography has widely been considered the gold standard diagnostic modality for MTS and has been utilized to confirm a diagnosis of MTS in several studies [5,6,12,24] . The procedure demonstrates the degree of iliac vein stenosis and can visualize any pelvic venous collaterals.…”

Section: Contrast Venography/hemodynamic Studiesmentioning

confidence: 99%

“…Currently, the use of endovascular techniques in the treatment of MTS patients is considerably successful and carries less risk than invasive surgical treatments [8] . Common endovascular treatment options include catheter-directed thrombolysis, angioplasty, and ultimately stent placement [3,5,6,10,24] . Angioplasty has been found to be associated with low long-term patency rates, which indicates that the iliac vein compression may not be alleviated with solely the use of balloon angioplasty [30] .…”

Section: Treatment Optionsmentioning

confidence: 99%

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Iliac vein compression syndrome: Clinical, imaging and pathologic findings

Brinegar

Sheth

Khademhosseini

et al. 2015

WJR

112

149

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May-Thurner syndrome (MTS) is the pathologic compression of the left common iliac vein by the right common iliac artery, resulting in left lower extremity pain, swelling, and deep venous thrombosis. Though this syndrome was first described in 1851, there are currently no standardized criteria to establish the diagnosis of MTS. Since MTS is treated by a wide array of specialties, including interventional radiology, vascular surgery, cardiology, and vascular medicine, the need for an established diagnostic criterion is imperative in order to reduce misdiagnosis and inappropriate treatment. Although MTS has historically been diagnosed by the presence of pathologic features, the use of dynamic imaging techniques has led to a more radiologic based diagnosis. Thus, imaging plays an integral part in screening patients for MTS, and the utility of a wide array of imaging modalities has been evaluated. Here, we summarize the historical aspects of the clinical features of this syndrome. We then provide a comprehensive assessment of the literature on the efficacy of imaging tools available to diagnose MTS. Lastly, we provide clinical pearls and recommendations to aid physicians in diagnosing the syndrome through the use of provocative measures.

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Section: Contrast Venography/hemodynamic Studiesmentioning

confidence: 99%

Section: Treatment Optionsmentioning

confidence: 99%

Iliac vein compression syndrome: Clinical, imaging and pathologic findings

Brinegar

Sheth

Khademhosseini

et al. 2015

WJR

112

149

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“…28) Study series featuring iliac vein stenting in MTS patients have increased in number over the past decade and have generally advocated the use of endovascular techniques. 5,6,29) Recently, a retrospective review by Titus, et al identifi ed MTS patients treated via endovenous stenting and showed that the primary patency rates were 88%, 78%, and 78%, respectively, at 6, 12, and 24 months postoperatively. 30) O'Sullivan, et al reported that the overall patency rate at 1 year was 79%.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Iliac Vein Compression (May-Thurner) Syndrome: Angioplasty and Stenting with or without Manual Aspiration Thrombectomy and Catheter-Directed Thrombolysis

Bozkaya

Çınar

Ertugay

et al. 2015

Annals of Vascular Diseases

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Purpose: May-Thurner syndrome (MTS) is a rare clinical entity featuring venous obstruction of the left lower extremity. The aim of the present study was to report our experience with MTS and to evaluate the utility of treatment using endovascular techniques. Materials and Methods:We retrospectively analyzed data on 23 MTS patients (21 females, two males; mean age 44 ± 15 years). Eighteen patients presented with deep vein thrombosis (DVT) and fi ve with symptoms associated with chronic venous hypertension (CVH). DVT patients were treated via thromboaspiration, catheter-directed thrombolysis, and angioplasty; followed by stent placement. CVH patients were treated with angioplasty and stent placement alone. All patients were followed-up using Doppler ultrasonography and computed tomography venography. Results: Complete left common iliac vein patency was achieved in 21 of the 23 patients (technical success rate: 91,3%). Complete thrombolysis was attained by 14 of the 18 DVT patients (77.7%). The mean clinical and radiological follow-up time was 15.2 ± 16.1 months. Upon follow-up, complete symptomatic regression was observed in 19 of the 23 patients (82.6%). Stent patency was complete in 19 of the 21 patients (90.4%) who received stents. Restenosis occurred in two patients. No treatment-related mortality or morbidity was observed. Conclusion: Endovascular treatment of MTS is safe and effective and reduces symptoms in most patients, associated with high medium-term patency rates.

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“…Taheri et al [6]argue that progressive symptoms will continue to develop in these patients, so the anatomic anomaly should be corrected as soon as it is identified. For this reason, surgical decompression [3, 6, 10]and more recently transluminal stenting have been recommended [12, 13, 14]. We started anticoagulant therapy and inserted a vena cava filter because our patient presented with pulmonary emboli, and anticoagulants alone were thought to be inadequate for treating his condition [12].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Emboli Caused by Iliac Compression Syndrome without Leg Symptoms

Kishi

Homma²,

Kawabata³

et al. 2002

Respiration

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Iliac compression syndrome is a clinical condition that occurs as a result of compression of the left common iliac vein by the overlying right common iliac artery. This syndrome most often affects young to middle-aged women, and patients usually have left leg symptoms. We report the unusual case of an 18-year-old male who had pulmonary emboli caused by iliac compression syndrome without leg symptoms. Combined venography and aortography confirmed the diagnosis. The patient was successfully treated with anticoagulants and vena cava filter insertion. Iliac compression syndrome should be considered when pulmonary embolism appears without obvious cause.

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Treatment of Pelvic Venous Spur (May–Thurner Syndrome) with Self-Expanding Metallic Endoprostheses

Abstract: The percutaneous transfemoral placement of self-expanding metallic stents is an effective minimally invasive alternative to surgery in the treatment of symptomatic pelvic venous spur.

Cited by 90 publications

References 11 publications

Iliac vein compression syndrome: Clinical, imaging and pathologic findings

Iliac vein compression syndrome: Clinical, imaging and pathologic findings

Endovascular Treatment of Iliac Vein Compression (May-Thurner) Syndrome: Angioplasty and Stenting with or without Manual Aspiration Thrombectomy and Catheter-Directed Thrombolysis

Pulmonary Emboli Caused by Iliac Compression Syndrome without Leg Symptoms

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