Heijmen R H, Bollen T L, Duyndam D A, Overtoom T T, Van Den Berg J C, Moll F L
Departments of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
J Cardiovasc Surg (Torino). 2001 Feb;42(1):83-7.
Chronic pulsatile compression of the left common iliac vein between the crossing right common iliac artery and the lowest lumbar vertebral body may induce focal intimal proliferation of the vein (May-Thurner syndrome), resulting in impaired venous return and left iliofemoral thrombosis. Corrective surgical treatment requires extensive dissection. In this report, we describe our experience with endovascular venous stenting in May-Thurner syndrome.
Six patients with symptomatic May-Thurner syndrome were treated with percutaneous transluminal angioplasty and implantation of self-expanding stents. RESULTS Postprocedure phlebography revealed patent iliofemoral veins with unimpeded venous outflow and disappearance of collaterals in all patients. No procedure-related complications occurred. At follow-up (median, 12 months), 5 of 6 patients were free of symptoms. In one patient lower extremity edema was aggravated despite a patent stented segment of the left iliac vein. The patient continues to wear support stockings to compensate for continuing venous insufficiency. Color coded duplex scanning revealed patency at regular intervals in 5 patients. In one patient, occlusion of the stented venous segment with return of symptoms was detected at one month. Patency could not be restored despite catheter-directed thrombolytic therapy. After angioplasty, however, adequate collateral circulation was restored and symptoms resolved completely.
Endovascular venous stenting in May-Thurner syndrome is technically feasible, and leads to reduction of symptoms in the majority of patients with high patency rates in the medium-term. This approach may prove to be a percutaneous alternative to surgical treatment.
左髂总静脉在右髂总动脉与最低腰椎椎体交叉处受到慢性搏动性压迫，可能导致静脉内膜局部增生（May-Thurner综合征），进而引起静脉回流障碍和左髂股静脉血栓形成。矫正性手术治疗需要广泛的解剖操作。在本报告中，我们描述了我们在May-Thurner综合征中进行血管内静脉支架置入术的经验。
6例有症状的May-Thurner综合征患者接受了经皮腔内血管成形术和自膨式支架植入术。结果术后静脉造影显示所有患者的髂股静脉通畅，静脉流出无阻碍，侧支血管消失。未发生与手术相关的并发症。随访（中位时间为12个月）时，6例患者中有5例无症状。1例患者尽管左髂静脉支架段通畅，但下肢水肿加重。该患者继续穿着弹力袜以代偿持续存在的静脉功能不全。彩色编码双功扫描显示5例患者的支架定期通畅。1例患者在1个月时检测到支架置入的静脉段闭塞且症状复发。尽管进行了导管定向溶栓治疗，但仍未能恢复通畅。然而，血管成形术后，恢复了足够的侧支循环，症状完全缓解。
May-Thurner综合征的血管内静脉支架置入术在技术上是可行的，并且在大多数患者中可减轻症状，中期通畅率较高。这种方法可能被证明是一种替代手术治疗的经皮方法。
