Quality of Life Improvement Following Endovascular Treatment of May-Thurner Syndrome

OBJECTIVES:
May-Thurner syndrome is an unusual vascular event characterized by left iliac vein occlusion from compression by the overlying right iliac artery. Symptomatic patients typically present with deep vein thrombosis (DVT) and are often treated with long-term anticoagulation. The purpose of this study is to evaluate the efficacy of endovascular venous stent placement and determine its impact on patient quality of life.
METHODS:
A retrospective review of eight (one male, seven female) patients treated for May-Thurner syndrome from 2004-2008 was performed. Seven patients underwent successful iliac vein stenting. Data collected included patient demographics, symptoms, diagnostic criteria, operative factors, and anticoagulation use. Quality of life was assessed through administration of the VEINES-QOL/Sym questionnaire, a previously validated instrument designed to assess patients with DVT.
RESULTS:
Age at presentation ranged from 15 to 55 years, with a median of 43. Presenting symptoms included lower extremity edema (88%), venous claudication (75%), DVT (63%), pain (50%), and varicosities (13%). Risk factors for thrombosis included pregnancy (25%), oral contraceptive use (25%), and recent surgery (13%). Oral anticoagulation was initiated preoperatively in four patients and all received anticoagulation post-intervention. Self-expanding stents were used in all patients and placed across the occluded segment, most often from the iliac vein confluence to the distal external iliac vein, with temporary IVC filters utilized in two patients. No complications were noted perioperatively, and mean follow-up time was 13 months (range 4-52). Duplex follow-up was obtained at latest follow-up, with all stents (100%) patent. All patients had interval improvement in the VEINES/QOL survey, with the mean preoperative VEINES/QOL score of 74.2 versus postoperative score of 92.3 (p=0.02) at latest follow-up, indicating improvement in quality in life following intervention.
CONCLUSIONS:
Endovascular stenting for symptomatic May-Thurner syndrome can be performed with high success rates and minimal morbidity. The majority of patients demonstrate significant improvement in symptom resolution and overall quality of life. Aggressive recanalization of iliofemoral DVT due to May-Thurner syndrome should be considered in good-risk patients.