Comparison of thrombectomy with stenting vs. thrombectomy alone for the treatment of acute iliofemoral deep vein thrombosis with May-Thurner syndrome

초록

Background: May-Thurner syndrome (MTS) is a common underlying cause of left-sided iliofemoral deep vein thrombosis (DVT), and persistent iliac vein compression may lead to poor venous outflow and an increased risk of recurrence and post-thrombotic complications. Although endovascular thrombectomy is widely used for acute DVT, the role of adjunctive stenting in MTS remains controversial. In this retrospective cohort study, we compared the primary patency rates and clinical outcomes of thrombectomy with stenting vs. thrombectomy alone in patients with acute DVT associated with MTS. Methods: We reviewed the data of patients with symptomatic MTS-associated acute DVT treated with thrombectomy, with or without stenting, between January 2011 and April 2023. The patients were divided into the thrombectomy with stenting (Group I) and thrombectomy alone groups (Group II). The primary endpoint was cumulative primary patency, defined as uninterrupted venous flow through the treated segment without reocclusion on follow-up duplex ultrasonography or contrast-enhanced computed tomography (CT). Technical success, clinical success, complications, and follow-up outcomes were analyzed. Results: In total, 75 patients (45 and 30 assigned to Groups I and II, respectively) were included in this study. The 30-day cumulative primary patency rate was significantly higher in Group I than in Group II (91.1% vs. 70.0%). At 12 months (86.0% vs. 66.5%) and 24 months (86.0% vs. 62.6%), Group I maintained a superior primary patency rate (log-rank P=0.019). Technical success was achieved in all cases, and overall clinical success was observed in 90.6% of the patients. No major procedure-related complications were observed. Conclusions: Thrombectomy with stenting was associated with significantly higher primary patency compared with thrombectomy alone in patients with MTS. Stenting is a more effective strategy for ensuring durable venous patency in this population.

키워드