A retrospective comparison of thrombectomy followed by stenting and thrombectomy alone for the management of deep vein thrombosis with May-Thurner syndrome

Chen Huang; Wenwen Zhang; Huoqi Liang

doi:10.1016/j.jvsv.2020.08.031

A retrospective comparison of thrombectomy followed by stenting and thrombectomy alone for the management of deep vein thrombosis with May-Thurner syndrome

J Vasc Surg Venous Lymphat Disord. 2021 May;9(3):635-642. doi: 10.1016/j.jvsv.2020.08.031. Epub 2020 Oct 9.

Authors

Chen Huang¹, Wenwen Zhang², Huoqi Liang³

Affiliations

¹ Department of Vascular Surgery, Affiliated Hospital of Nantong University, Nantong, China. Electronic address: huangchen132@sina.com.
² Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University Medical School, Nanchang, China.
³ Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Soochow, Jiangsu, China.

PMID: 33045391
DOI: 10.1016/j.jvsv.2020.08.031

Abstract

Objective: To summarize the clinical results of thrombectomy with stenting (TBS) in patients with deep venous thrombosis (DVT) secondary to May-Thurner syndrome (MTS) compared with the outcomes in patients treated with thrombectomy alone (TB).

Methods: A retrospective observation of patients with proximal DVT secondary to MTS was conducted in our institution. Patients accepted treatment including either catheter-directed TBS or TB. The complications and stent patency rates were recorded after treatments. The clinical results were assessed in both groups. The independent predictors for in-stent restenosis were further calculated in this study.

Results: We included 372 patients with DVT secondary to MTS. Two hundred twenty-one patients received treatment with thrombectomy with TBS and 151 with TB. A longer mean procedure time (65.1 ± 13.9 minutes vs 49.5 ± 15.7 minutes; P < .001) and higher venous perforation rate (23 patients vs 5 patients; P = .011) were observed in the TBS group than in the TB group. The median follow-up time was 34 months. The patency rates in the TBS group at 36 months were as follows: primary patency rate of 74.0% and secondary patency rate of 92.1%. Independent predictors for restenosis included visible remaining collateral vessels (hazard ratio [HR], 1.12-3.29; P = .02), residual thrombus (HR, 1.40-4.38; P = .002), and tapered iliac vein (HR, 1.26-4.06; P = .006). Clinical results, including Venous Clinical Severity Scores (TBS, 8.0 ± 3.0; TB, 11.4 ± 3.2), Chronic Venous Insufficiency Questionnaire score (TBS, 76.4 ± 4.0; TB, 83.1 ± 4.6), Villalta scores (TBS, 3.8 ± 1.7; TB, 6.6 ± 3.2), and edema scores (TBS, 0.7 ± 0.7; TB, 1.6 ± 0.6), improved significantly in the TBS group.

Conclusions: TBS is effective and feasible for patients with proximal DVT secondary to MTS. Furthermore, compared with TB, additional stenting might be effective in improving the venous clinical results at follow-up observations.

Keywords: Clinical results; DVT; Endovascular surgery; May-Thurner syndrome; Risk factors.

Publication types

Comparative Study
Observational Study

MeSH terms

Adult
Aged
Aged, 80 and over
Collateral Circulation
Endovascular Procedures / adverse effects
Endovascular Procedures / instrumentation*
Female
Humans
Male
May-Thurner Syndrome / diagnostic imaging
May-Thurner Syndrome / physiopathology
May-Thurner Syndrome / therapy*
Middle Aged
Recurrence
Retrospective Studies
Risk Assessment
Risk Factors
Stents*
Thrombectomy* / adverse effects
Time Factors
Treatment Outcome
Vascular Patency
Venous Thrombosis / diagnostic imaging
Venous Thrombosis / physiopathology
Venous Thrombosis / therapy*