Korean J Thorac Cardiovasc Surg.  2009 Dec;42(6):757-762.

Pharmaco-mechanical Thrombectomy and Stent Placement in Patients with May-Thurner Syndrome and Lower Extremity Deep Venous Thrombosis

• Jeon YS
• Kim YS
• Cho JS
• Yoon YH
• Baek WK
• Kim KH
• Kim JT

Abstract

BACKGROUND
Compression of the left common iliac vein by the overriding common iliac artery is frequently combined with acute deep vein thrombosis in patients with May-Thurner Syndrome. We evaluate the results of treatment with thrombolysis and thrombectomy followed by stenting in 34 patients with May-Thurner Syndrome combined with lower extremity deep venous thrombosis. MATERIAL AND METHOD: The authors retrospectively reviewed the records of 34 patients (mean age: 65+/-14 year old) who had undergone stent insertion for acute deep vein thrombosis that was caused by May-Thurner syndrome. After thrombectomy and thrombolysis, insertion of a wall stent and balloon angioplasty were performed to relieve the compression of the left common iliac vein. Urokinase at a rate of 80,000 to 120,000 U/hour was infused into the thrombosed vein via a multi-side hole thrombolysis catheter. A retrieval inferior vena cava (IVC) filter was placed to protect against pulmonary embolism in 30 patients (88%). Oral anticoagulation with warfarin was maintained for 3 months, and follow-up Multi Detector Computerized Tomography (MDCT) angiography was done at the date of the patients' hospital discharge and at the 6 months follow-up. RESULT: The symptoms of deep venous thrombosis disappeared in two patients (4%), and there was clinical improvement within 48 hours in twenty eight patients (82%), but there was no improvement in four patients (8%). The MDCT angiography at discharge showed no thrombus in 9 patients (26%) and partial thrombus in 21 (62%), whereas the follow-up MDCT at 6.4+/-5.5 months (32 patients) revealed no thrombus in 23 patients (72%), and partial thrombus in 9 patients (26%). Two patients (6%) had recurrence of DVT, so they underwent retreatment.
CONCLUSION
Stent insertion with catheter-directed thrombolysis and thrombectomy is an effective treatment for May-Thurner syndrome combined with acute deep vein thrombosis in the lower extremity.

Keyword

Deep vein thrombosis; Stents; Venous thrombosis

MeSH Terms

Angiography
Angioplasty, Balloon
Catheters
Follow-Up Studies
Humans
Iliac Artery
Iliac Vein
Lower Extremity
May-Thurner Syndrome
Pulmonary Embolism
Recurrence
Retreatment
Retrospective Studies
Stents
Thrombectomy
Thrombosis
Urokinase-Type Plasminogen Activator
Veins
Vena Cava, Inferior
Venous Thrombosis
Warfarin
Urokinase-Type Plasminogen Activator
Warfarin