Optimization of Arterial Stents for May-Thurner Syndrome Management in West Java: Experience and Outcome

Abstract

Abstract Context: May-Thurner syndrome (MTS) is an anatomical defect where the right common iliac artery overrides and compresses the left iliofemoral vein. MTS causes deep vein thrombosis (DVT) but is often underdiagnosed. As anticoagulant management (warfarin) rarely achieves target INR, endovascular management is vital for MTS. Surgical and endovascular management of MTS has known to have similar good outcome. Endovascular management is generally facilitated using a venous stent. However, the unavailability of the venous stent in Indonesia made arterial stent be optimized during vein stenting procedure. Aims: We aim to report our experience. Settings and Design: Consecutive observational study within 26 months in a hospital in West Java including 6 MTS patients. Subjects and Methods: Diagnosis is established by the finding of proximal femoral DVT by ultrasonography further confirmed by computed tomography (CT) angiography. Endovascular management was done using arterial stent placement. After endovascular management, we reviewed the outcome on a follow-up including stent fracture, in-stent restenosis (ISR), and stent patency. These are also monitored by serial imaging by CT Angiography, with periods ranging from 1.5 to 10 months (mean: 4.08 months). Direct oral anticoagulants and antiplatelets are usually given along with compression stockings following the procedure. Statistical Analysis Used: None. Results: No stent fracture, no ISR, and the stent remained patent after follow-up. No patient had complications. Conclusions: Apart from the difference in radial power compared to the venous stent, the arterial stent is feasible to use during MTS endovascular management with good postprocedural results. Prompt management is needed to prevent complication and chronic total occlusion. Comprehensive management should be ensured to optimize patients’ quality of life. We do hope that venous stent will be available in the future.