The influence of May-Thurner syndrome on post-thrombotic syndrome in young women
Abstract
Summary.Background: The mechanism for post-thrombotic syndrome (PTS), the most important long-term sequelae of deep venous thrombosis, is not entirely known. It is probably caused by venous hypertension due to venous insufficiency and venous obstruction. Venous hypertension could also be a consequence of the May-Thurner syndrome (MTS), i.e. the obstruction of the common iliac vein. The aim of the present study was to explore if women with untreated MTS and a history of proximal DVT develop PTS more frequently. Patients and methods: A cohort of 68 female patients with a history of proximal left-sided DVT in the past were evaluated. According to Villalta score, they were segregated in two groups – with and without PTS (Villalta score ≥ 5 or < 5 points, respectively). For the diagnosis of MTS, magnetic resonance venography was performed. Results: Out of 68 patients, 25 developed PTS (36.8 %). Recurrent DVT, older age, pre-existent chronic venous insufficiency, and shorter compression stockings wearing time were statistically related to PTS. Deep and superficial valve incompetence was also significantly related to PTS, while incomplete thrombus removal showed only a trend towards PTS development. On the other hand, MTS per se turned out not to be linked to PTS. Conclusions: Our study suggests that women with MTS might not develop PTS more often, which puts aggressive treatment of MTS under question. More clinical trials are warranted to further examine this yet not fully explained field.
References
1 . The postthrombotic syndrome: current evidence and future challenges. J Thromb Haemost. 2017;15(2):230–41.
2 . Incidence and cost burden of post-thrombotic syndrome. J Thromb Thrombolys. 2009;28(4):465–76.
3 . Epidemiology and risk factors for venous thrombosis. Semin Hematol. 2007;44(2):62–9.
4 . Thromboembolic disease in females and males aged 10 to 39 years in Germany. Vasa 2018;47(6):483–9.
5 . Venous thromboembolism in women: a specific reproductive health risk. Hum Reprod Update. 2013;19(5):471–82.
6 . Imaging of venous compression syndromes. Cardiovasc Diagn Ther. 2016;6(6):519–32.
7 . The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology 1957;8(5):419–27.
8 . May-Thurner syndrome: diagnosis and management. Vasa 2013;42(2):96–105.
9 May-Thurner: diagnosis and endovascular management. Cardiovasc Diagn Ther. 2017;7(Suppl 3):S159–S64.
10 . A randomised controlled trial comparing venous stenting with conservative treatment in patients with deep venous obstruction: research protocol. Br Med J open. 2017;7(9):e017233.
11 . Role of venous outflow obstruction and venous valvular incompetence as mechanisms for venous stasis syndrome following deep vein thrombosis: a population-based cohort study. [Abstract]. Blood. 2006;108:1495.
12 . Chronic venous insufficiency. Circulation. 2014;130(4):333–46.
13 Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization. J Thromb Haemost. 2009;7(5):879–83.
14 . Measurement properties of the Villalta scale to define and classify the severity of the post-thrombotic syndrome. J Thromb Haemost. 2009;7(5):884–8.
15 . Quantitative segmental evaluation of venous valvular reflux with duplex ultrasound scanning. J Vasc Surg. 1989;10(4):425–31.
16 Multicenter assessment of venous reflux by duplex ultrasound. J Vasc Surg. 2012;55(2):437–45.
17 The impact of residual thrombosis on the long-term outcome of patients with deep venous thrombosis treated with conventional anticoagulation. Seminars in thrombosis and hemostasis. 2015;41(2):133–40.
18 . Magnetic resonance venography in the diagnosis and management of May-Thurner syndrome. Vasc Endovasc Surg. 2002;36(1):51–7.
19 . Value of magnetic resonance venography and computed tomographic venography in lower extremity chronic venous disease. Phlebology. 2013;28 Suppl 1:169–75.
20 . A Modified Poisson Regression Approach to Prospective Studies with Binary Data. Am J Epidemiol. 2004;159(7):702–6.
21 . The venous stasis syndrome after deep venous thrombosis or pulmonary embolism: a population-based study. Mayo Clin Proc. 2000;75(12):1249–56.
22 . B.T. Femoral vein pressures in postphlebitic iliac vein obstruction. Br J Surg. 1967;54(6):522–5.
23 . Left iliac venous thrombosis caused by venous spur: treatment with thrombectomy and stent implantation. J Vasc Surg. 1998;28(3):492–7.
24 . The Role of May-Thurner Syndrome in Recurrent Thrombosis after Catheter-Directed Thrombolysis of Deep Vein Thrombosis. Ann Vasc Surg. 2018;6.
25 . Development and Validation of a Practical Two-Step Prediction Model and Clinical Risk Score for Post-Thrombotic Syndrome. Thromb Haemost. 2018;118(7):1242–9.
26 Comparison of the Villalta postthrombotic syndrome score in the ipsilateral vs. contralateral leg after a first unprovoked deep vein thrombosis. J Thromb Haemost. 2012;10(6):1036–42.
27 . Management of Chronic Venous Disease. Tex Heart Inst J. 2017;44(5):347–9.
28 . May-Thurner syndrome: can it be diagnosed by a single MR venography study? Diagn Interv Radiol. 2013;19(1):44–8.
29 . The Treatment of Post-Thrombotic Syndrome. Dtsch Arztebl Int. 2016;113(50):863–70.
30 . May-Thurner syndrome: update and review. Ann Vasc Surg. 2013;27(7):984–95.
31 . Iliac vein compression in an asymptomatic patient population. J Vasc Surg. 2004;39(5):937–43.
