Contralateral deep vein thrombosis after iliac vein stenting in patients with May-Thurner syndrome

초록

PURPOSE: To investigate the prevalence and possible causes of contralateral deep vein thrombosis (DVT) after iliac vein stenting in patients with May-Thurner syndrome (MTS). MATERIALS AND METHODS: We retrospectively analyzed data of 111 patients (mean age, 63.1 ± 15.2 years) who received common iliac vein (CIV) stenting for symptomatic MTS at our institution from October 2004 to January 2017. The median followup was 36 months (range, 1-142 months). Patients’ demographic, comorbidities, stent location, treatment and complications were recorded. RESULTS: Ten patients (9%, M:F = 4:6) exhibited contralateral DVT at a median timing of 40 months (range, 6-98 months). The median follow up was 73.5 months (range, 20-134 months). The median age was 69 years (range, 42-85 years). Possible causes were venous intimal hyperplasia (VIH) (n = 7), “jailing” (n = 2) and undefined (n = 1). All patients with VIH had previous CIV stents overextended to the inferior vena cava (IVC). Contralateral DVT group had higher rate of overextended stents than non-contralateral DVT group (80% vs. 16.8%, p < 0.01). Additional stents were deployed in 7 patients. Up to the last visit, 7/10 patients had bilateral CIV patency. CONCLUSION: Contralateral DVT after CIV stenting is noteworthy. It often occurs at a late timing during follow up. Overextension of the previous CIV stent to the IVC is associated the development of contralateral DVT and VIH should be considered a possible cause. For stenting of MTS, the CIV stent should be confined within the confluence, not contact the IVC wall.