Endovascular management of symptomatic May-Thurner syndrome: real-world procedural approaches and outcomes.

BACKGROUND

May-Thurner syndrome (MTS) is characterized by extrinsic venous compression by the arterial system in ilio-caval territory leading to venous stasis, a predisposition to deep vein thrombosis (DVT), and edema. Endovascular interventions have become the cornerstone of treatment for patients with symptomatic MTS. We evaluated the safety and outcomes of patients with MTS who underwent endovascular management at our tertiary care center.

METHODS

We included 19 patients with symptomatic MTS who underwent vascular interventional procedures. Data were extracted from electronic medical records. The study outcomes included procedural safety, the Villalta score, and venous patency during follow-up.

RESULTS

All patients had left-sided DVT and 47.4% had predisposing factors. Seven patients underwent a single-stage procedure with mechanical thrombectomy with or without thrombolysis, and six received stents. Twelve underwent a two-stage procedure, including initial thrombectomy with or without thrombolysis, continuous infusion thrombolysis for several hours in between, and repeat thrombectomy with or without thrombolysis, angioplasty, and stenting at the end. The mean Villalta score was 0.8 ± 1.6, with 94% venous patency at a median follow-up of 6 months.

CONCLUSION

Endovascular interventions achieved excellent short-term outcomes, including high procedural success, substantial symptom resolution, and near-complete venous patency. These findings underscore the importance of prompt diagnosis and appropriate management of patients with symptomatic MTS.