Treatment of May-Thurner Syndrome with Venous Stents
Self-expandable stents are the preferred type of stent for treating May-Thurner syndrome, with placement in the iliac vein to relieve venous obstruction and improve clinical outcomes. 1
Stent Selection for May-Thurner Syndrome
Preferred Stent Type
- Self-expandable stents are the most commonly used and recommended stent type for May-Thurner syndrome 1, 2
- These stents have demonstrated high patency rates (90-96% at 1-year follow-up) 2
- Wallstent (Boston Scientific) is specifically mentioned in the literature as being used successfully for this condition 3, 4
- Typical stent dimensions for iliac vein placement range from 14-16mm in diameter and 60-90mm in length 4
Evidence Supporting Self-Expandable Stents
- Self-expandable stents have shown excellent anatomic success rates of 83-98% for recanalization of occluded veins 1
- Patency rates remain high with self-expandable stents, with studies showing:
- 90% patency when stents are limited to the iliac vein
- 84% patency when stent extension below the inguinal ligament is required 1
- Stent fracture is rare (reported in only 1 patient in a large study), and when it occurs, it can be successfully treated with insertion of a second stent 1
Clinical Outcomes After Stenting
- Initial reduction in lower extremity pain and swelling occurs in approximately 95% of patients 1
- Symptom improvement is maintained at 3 years in 79% (for pain) and 66% (for swelling) of patients 1
- Complete symptomatic regression occurs in approximately 82.6% of patients following endovascular treatment 2
- Quality of life scores on validated venous disease-specific measures improve significantly after stent placement 1
- Venous ulcer healing occurs in 56% of affected patients 1
Procedural Considerations
Stent Placement Technique
- Stent placement typically follows catheter-directed thrombolysis (CDT) or pharmacomechanical catheter-directed thrombolysis (PCDT) in cases with associated thrombosis 1, 2
- For isolated May-Thurner syndrome without thrombosis, direct stenting after angioplasty may be performed 3
- Stents should be sized appropriately to the vessel diameter to prevent migration
Post-Stenting Management
- Therapeutic anticoagulation is recommended after stent placement using similar dosing, monitoring, and duration as for iliofemoral deep vein thrombosis (IFDVT) patients without stents 1
- Anticoagulation is typically continued for at least 6 months after stent placement 2
- Concurrent antiplatelet therapy along with anticoagulation may be considered in patients at high risk of rethrombosis 1
Potential Complications and Pitfalls
- Stent displacement or migration can occur (reported in some cases) 4
- May require placement of additional stents
- Careful sizing and positioning is essential to prevent this complication
- Stent deformation has been observed in pregnant women but typically resolves spontaneously postpartum 1
- Stent occlusion can occur despite appropriate placement and anticoagulation 3
- Heparin-induced thrombocytopenia is a rare but serious complication that can occur during treatment 5
Special Considerations
For patients with May-Thurner syndrome and associated pelvic congestion syndrome, stenting alone may not be sufficient
- Only 16.6% of patients with both conditions achieved complete symptom relief with stenting alone
- Additional procedures such as gonadal vein embolization may be required 4
For obstructive iliac vein lesions that extend into the common femoral vein, caudal extension of stents into the common femoral vein is reasonable if unavoidable 1
May-Thurner syndrome is effectively treated with endovascular stenting, which has largely replaced open surgical approaches due to lower morbidity and excellent technical success rates. Self-expandable stents are the preferred option, with high patency rates and significant clinical improvement in the majority of patients.