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KMID : 0980120190170010027
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Annals of Phlebology
2019 Volume.17 No. 1 p.27 ~ p.31
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Outcome of Iliac Vein Stenting after Thrombolysis with or without Thrombectomy for Acute Iliofemoral Deep Vein Thrombosis
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Kim Min-Gyu
Kim Kyung-Yun
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Abstract
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Backgrounds: Iliac vein compression syndrome (IVCS), also known as May-Thurner syndrome (MTS), is an anatomic risk factor for acute iliofemoral deep vein thrombosis (DVT). Stent placement for venous stasis is considered an effective treatment for iliofemoral DVT secondary to IVCS. However, the outcomes of iliac vein stenting are not well understood. Therefore, the aim of this study was to evaluate the effectiveness of iliac vein stenting for the treatment of acute iliofemoral DVT secondary to IVCS.
Materials and Methods: A retrospective analysis was conducted in 40 patients (12 men and 28 women, mean age 69 years) who had acute iliofemoral DVT and were treated with iliac vein stenting after catheter directed thrombolysis (CDT) with or without thrombectomy between January 2015 and August 2018. Clinical data and radiological images were retrospectively reviewed. The patency of iliac vein stents was evaluated with computed tomography (CT) venography.
Results: All patients had a first episode of DVT. The mean duration of DVT symptoms was 5.2 days. The right extremity was affected in 4 of 40 cases (10%), the left extremity was affected in 35 (87.5%), and both extremities were affected in one patient (2.5%). As the DVT treatment modality, CDT alone was performed in 7 (17.5%) patients, combined treatment with CDT plus manual aspiration thrombectomy (MAT) was performed in 31 (77.5%) patients, and combined treatment with CDT plus pharmacomechanical thrombectomy (PMT) using AngioJet was performed in 2 (5%) patients. A total of 58 stents were implanted in 40 patients (49 self expandable nitinol stents, 6 WALLSTENTs, and 3 VIABAHN stents). Technical success was achieved in all cases. Major complications related to the procedure occurred in 3 (7.5%) patients. During the acute phase (within 2 weeks of procedure), recurrent thrombosis occurred in 2 patients. Therefore, the stent patency rate during hospitalilzation was 95%. The primary patency rate of iliac vein stenting was 90% at 6 months. Of the 40 patients, 15 were examined by CT venography approximately 1 year after the procedure (median duration : 23 months). The primary patency rate of iliac vein stenting was 80 % at 12 months, 71% at 24 months, and 59% at 27months.
Conclusions: This study shows somewhat disappointing results for iliac vein stenting in the treatment of acute iliofemoral DVT. But, due to the limitations of this study, comprehensive judgement based on the results of various studies is required to achieve optimal clinical outcomes.
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KEYWORD
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Iliac vein compression syndrome, May-Thurner syndrome, Deep vein thrombosis, Venous stenting
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