Iliofemoral Venous Stenting (May-Thurner)

Background and indications

Iliofemoral venous stenting is the endovascular treatment for iliofemoral venous stenosis or occlusion. May-Thurner syndrome (left common iliac vein compression by right common iliac artery) is the most common indication, causing recurrent left iliofemoral DVT or disabling post-thrombotic syndrome (PTS).

Other indications include: symptomatic chronic post-thrombotic venous stenosis (edema, pain, venous ulcers), and extensive acute iliofemoral venous thrombosis (complementing thrombolysis/thrombectomy).

Pre-procedure assessment

Assessment includes iliofemoral venous CT angiography (stenosis mapping, iliac compression), venous Doppler ultrasound, intraprocedural IVUS (intravascular ultrasound) for stenosis evaluation, and coagulation/thrombophilia panel.

Procedure

Under local anesthesia and sedation, ipsilateral femoral or popliteal venous access is obtained. Under fluoroscopic guidance, the stenosis is crossed. IVUS evaluates stenosis degree (> 50% stenosis is significant). A dedicated self-expanding venous stent (14-16 mm, Wallstent or dedicated nitinol stent) is deployed. The procedure takes 1 to 2 hours.

Results and scientific evidence

Iliofemoral venous stenting offers 80-90% 2-year primary patency for non-thrombotic stenosis (May-Thurner) and 60-80% for post-thrombotic stenosis. Clinical improvement (edema reduction, venous ulcer healing) is achieved in 70-85% of cases (Raju et al., Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2014).

Risks and complications

Stent thrombosis (5-10%, mainly first month — anticoagulation required), access site hematoma (3-5%), pulmonary embolism (< 1%), venous perforation (< 0.5%).

Recovery

1-2 night hospitalization. Anticoagulation 6-12 months (or long-term if thrombophilia). Compression stockings. Control Doppler ultrasound at 1, 3, 6, and 12 months.

Practical information

The procedure is performed as a short inpatient stay. It is performed by a vascular interventional radiologist, in coordination with the angiologist.