Thrombolysis in May-Thurner Syndrome and Iliofemoral DVT An Illustrative Case and Narrative Review of the Literature

Main Article Content

Matthew Patel
Kevin Singh
Adam Mazzetti
Eric Kaplovitch

May-Thurner Syndrome, Thrombolysis, Iliofemoral DVT

Abstract

Post-thrombotic syndrome (PTS) describes residual leg swelling, pain, and venous insufficiency that persists after acute deep vein thrombosis (DVT). PTS occurs in 40 to 60% of patients and contributes significantly to patient morbidity and healthcare costs. Despite standard therapy including anticoagulation, early ambulation, and compression stockings. PTS is more common in iliofemoral DVT. Despite conflicting evidence, there has been increasing use of endovascular therapies such as thrombolysis, thrombectomy, and venous stenting to reduce the incidence of PTS. May-Thurner Syndrome (MTS) is a significant risk factor for the development of iliofemoral DVT and PTS because of the compression of the left common iliac vein by the overlying right common iliac artery. The main objective is to review the evidence for endovascular management of iliofemoral DVT using MTS as an illustration of a patient population that may benefit from this therapy. Currently, endovascular therapies are not the recommended routine management of nongangrenous iliofemoral DVT. But can be considered in exceptional cases, such as MTS or other compressive syndromes, for obtaining venous patency and potentially prevent severe PTS.
Resume
Le syndrome postphlébitique (SPP) correspond à un œdème résiduel des jambes, à de la douleur et à une insuffisance veineuse qui persiste après une thrombose veineuse profonde (TVP) aiguë. Il survient chez de 40 à 60 % des patients et contribue grandement à la morbidité du patient et aux coûts en soins de santé, malgré les traitements classiques comprenant l’anticoagulothérapie, l’ambulation précoce et les bas de contention. Le SPP est plus fréquent dans les cas de TVP iliofémorales. Malgré des données probantes contradictoires, on utilise de plus en plus les traitements endovasculaires comme la thrombolyse, la thrombectomie et la mise en place d’endoprothèses veineuses pour réduire la fréquence du SPP. Le syndrome de May-Thurner (SMT) est un facteur de risque important de l’apparition d’une TVP iliofémorale et du SPP en raison de la compression de la veine iliaque commune gauche par l’artère iliaque commune droite contre le plan vertébral. Le principal objectif consiste à examiner les données probantes relatives à la prise en charge endovasculaire de la TVP iliofémorale en utilisant le SMT pour illustrer une population de patients qui pourrait bénéficier de ce traitement. À l’heure actuelle, on ne recommande pas les traitements endovasculaires dans la prise en charge courante de la TVP iliofémorale non gangréneuse, mais dans des cas exceptionnels, comme le SMT ou autres syndromes de compression, ils peuvent être envisagés pour obtenir une perméabilité veineuse et prévenir les cas graves de SPP.

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