Author + information
- 1Cedars-Sinai Medical Center, Los Angeles, California, United States
- 2Cedar Sinai Medical Center, Los Angeles, California, United States
- 3Cedars-Sinai Medical Center/Westside Medical Associates of Los Angeles, Beverly Hills, California, United States
- 4Arrowhead Regional Medical Center, Colton, California, United States
May-Thurner Syndrome is the pathologic compression of the L common iliac vein by the R common iliac artery and has an incidence of 22%, in a cadaver study. Venous compression syndrome (VCS) can also occur in the external iliac, common femoral vein and R sided veins as well. VCS prevalence ranges from 2-65% in pts with L-sided iliofemoral DVT and is unknown in non-thrombotic pts with venous insufficiency. We previously reported using ABLAVAR (albumin-bound gadolinium, longer intravascular t1/2), allowing significantly improved simultaneous MR arterial and venous imaging (SMRAVI) compared to standard gadolinium, resulting in sig improved accuracy for the diagnosis of VCS.
82 pts (67±16yo, 35% men), 76 with advanced venous reflux disease and 6 with recurrent or extensive DVT, were evaluated from January to June 2016. Vein stenosis >=50% on SMRAVI with ABLAVAR is considered positive. Those pts proceeded to IVUS, venography, and if appropriate, stenting.
67 (82%) pts had compression >=50%. 32 (47%) pts had severe compression >=70%. 30 (45%) of those with VCS proceeded to IVUS (97% correlation). 29 of those pts proceeded to stenting (42 stents, avg diameter 18mm). 26 (90%) pts had a significant improvement of VCS symptoms at 4 weeks. 4/14 (29%) pts had resolution of reflux by US imaging.
Among pts with CVI and DVT, we diagnosed a significantly higher incidence of VCS than previously reported, and were able to effectively treat them with stenting, demonstrating excellent short-term clinical and physiologic improvement, i.e. resolution of DVR and improvement of leg edema and pain.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention