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Contralateral Deep Vein Thrombosis after Iliac Vein Stent Placement in Patients with May-Thurner Syndrome
Authors:Trong Binh Le  Taeg Ki Lee  Keun-Myoung Park  Yong Sun Jeon  Kee Chun Hong  Soon Gu Cho
Institution:1. Endovascular Training Center, Inha University Hospital, 7-206 Sinheung-dong 3-ga, Jung-gu, Incheon, Republic of Korea;2. Department of Radiology, Inha University School of Medicine, 7-206 Sinheung-dong 3-ga, Jung-gu, Incheon, Republic of Korea;3. Department of Vascular Surgery, Inha University School of Medicine, 7-206 Sinheung-dong 3-ga, Jung-gu, Incheon, Republic of Korea
Abstract:

Purpose

To investigate the incidence and potential causes of contralateral deep vein thrombosis (DVT) after common iliac vein (CIV) stent placement in patients with May-Thurner syndrome (MTS).

Materials and Methods

Data of 111 patients (women: 73%) who had CIV stent implantation for symptomatic MTS at a single center were retrospectively analyzed. Mean patient age was 63.1 ± 15.2 years. Median follow-up was 36 months (range, 1–142 months). Stent location was determined by venogram and classified as extended to the inferior vena cava (IVC), covered the confluence, or confined to the iliac vein. Potential causes of contralateral DVT were presumed based on venographic findings. The relationship between stent location and contralateral DVT was analyzed.

Results

Ten patients (9%, men/women: 4/6) exhibited contralateral DVT at a median timing of 40 months (range, 6–98 months). Median age was 69 years (range, 42–85 years). Median follow-up was 73.5 months (range, 20–134 months). Potential causes were venous intimal hyperplasia (VIH) (n = 7), “jailing” (n = 2), and indeterminate (n = 1). All patients with VIH had previous CIV stents overextended to the IVC. Overextension of CIV stent was associated with contralateral DVT (P < .001). The primary patency rate of the contralateral CIV stent was 70% at 20 months.

Conclusions

Contralateral DVT after CIV stent implantation has a relatively high incidence and often occurs late during follow-up. Overextension of the CIV stent to the IVC is associated with development of contralateral DVT, and VIH should be considered a potential cause.
Keywords:CDT  catheter-directed thrombolysis  CIV  common iliac vein  DVT  deep vein thrombosis  MT  manual thromboaspiration  MTS  May-Thurner syndrome  PMT  percutaneous mechanical thrombectomy  PTA  percutaneous transluminal angioplasty  VIH  venous intimal hyperplasia
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