4:12 PM Abstract No. 359 Single-session flow restoration in May-Thurner syndrome with secondary acute iliofemoral deep venous thrombosis

Abstract

Catheter-directed thrombolysis (CDT) for iliofemoral deep venous thrombosis (DVT) associated with May-Thurner syndrome (MTS) traditionally requires lytic infusion in an intensive care unit (ICU) and multi-day procedures. The advent of venous-specific thrombolytic devices has improved procedural efficiency. We aim to evaluate the efficacy of single-session therapy utilizing rheolytic pharmacomechanical thrombectomy (PMT) followed by stent placement for MTS with secondary acute DVT. MTS patients treated in a single-session were retrospectively analyzed. All procedures were performed utilizing 8Fr rheolytic PMT with power-pulse administration of 10 mg of alteplase into thrombosed segments, 30-minute dwell time, followed by thrombectomy mode. Additional balloon angioplasty/suction thrombectomy was employed as necessary; 14 mm iliac vein self-expanding stents were placed in all patients. Pre- and postprocedure venous clinical severity scores (VCSS) were calculated and paired t-test was performed; significance was determined at p<0.05. From 7/2016 to present, 6 patients (4M:2F, mean age 51) with acute left iliofemoral DVT secondary to MTS were identified; initial diagnosis was via venous duplex exam. All patients presented with lower extremity edema/pain; mean symptom duration was 3 (range, 1-7) days. Rheolytic PMT with total run time confined to less than 240 seconds, followed by suction thrombectomy (4/6 patients), balloon angioplasty (2/6 patients), and stent placement was performed. Single-session flow restoration with symptomatic relief was achieved in all patients; VCSS decreased from a mean of 6 ± 0.8 (SEM) to 1.8 ± 0.8 (p = 0.002) postprocedure. Patients were followed up by computed tomographic venography (CTV) at approximately 1 month, all patients demonstrated stent patency. Single-session treatment appears effective for MTS with secondary acute DVT when 8Fr rheolytic PMT is used with local lytic administration, potentially improving DVT thrombolysis safety profile by limiting prolonged lytic exposure and avoiding ICU observation. Further study is necessary to confirm the long-term efficacy of this protocol.