[Cockett's syndrome, a rare differential diagnosis of unilateral inferior member oedema]

We present here a typical picture of May-Thurner syndrome, rare but treatable etiology with specific treatment, of unilateral leg oedema and thromboembolic disease of the young woman.

Early and Mid-Term Outcomes of Femoro-Ilio-Caval Vein Stent Implantation

OBJECTIVE

We sought to investigate mid-term clinical outcomes and identify risk factors in one of the largest comprehensive series reported of femoro-ilio-caval (FIC) vein stent placement.

BACKGROUND

Endovascular intervention with balloon angioplasty and stenting of the iliac and common femoral veins has become first-line treatment for symptomatic deep venous outflow obstruction.

METHODS

We conducted a single-center, retrospective analysis of 180 patients who underwent FIC stent implantation between May 2017 and May 2019; 327 procedures were performed. Our primary objective was to evaluate a composite of stent thrombosis and stent restenosis. Secondary outcomes included individual predictors of in-stent restenosis (ISR) and in-stent thrombosis (IST), primary and secondary patency, access-site complications, major bleeding, pulmonary embolism, cardiovascular death, any death, intracranial bleeding, all-cause mortality, and components of major adverse cardiac and cerebrovascular events (MACCE) in a 24-month period.

RESULTS

A total of 327 procedures were performed for 180 patients. At 2-year follow up, 78.3% of cases remained free of any complication. Primary outcome occurred in 53 procedures (16.2%) and was highest at early (<30 days) follow-up. Primary patency at 2-year follow-up was 78.43%. There were no deaths, 1 patient (0.3%) had a subdural hematoma, and 3 patients (0.9%) had MACCE. Age and post-thrombotic syndrome (PTS) were significant predictors of primary outcome. PTS and Venous Clinical Severity score (VCSS) ≥10 were found to have higher rates of thrombosis. Active smokers, the elderly, history of deep vein thrombosis (DVT), and VCSS ≥10 had a statistically significant elevated risk of ISR.

CONCLUSION

Endovascular treatment with stent implantation for non-thrombotic iliac vein lesion and PTS is safe, with low morbidity, zero mortality, low complications, and persistent improvement of symptoms. Age and PTS were significant predictors of primary outcome.

Pediatric May-Thurner Syndrome-Systematic review and individual patient data meta-analysis

BACKGROUND

The outcomes of deep vein thrombosis (DVT) in children with May-Thurner Syndrome (MTS) remain unclear.

OBJECTIVES

This systematic review and patient-level meta-analysis aims to describe the outcomes of children with MTS presenting with DVT.

METHODS

A systematic review of the published literature was performed. Data related to patients <18 years diagnosed with MTS and DVT was extracted. Risk of bias was assessed using the Murad criteria. Outcomes included vessel patency post-treatment, DVT recurrence, and post-thrombotic syndrome (PTS). Predictive and explanatory models were developed for these outcomes.

RESULTS

In total, 109 cases were identified (age range 4-17 years; 77 females) in 28 studies; 75% of patients had ≥1 additional risk factor for DVT. PTS was seen in 61% of patients, DVT recurrence in 38%, and complete vessel patency post-treatment in 65%. The models developed to predict and explain PTS performed poorly overall. Recurrent thrombosis (adjusted for age and patency) predicted PTS (odds ratio [OR] 3.36, 95% confidence interval [CI] 1.28-8.82). DVT management strategies (adjusted for age and DVT characteristics) predicted vessel patency (OR 2.10, 95% CI 1.43-3.08). Lack of complete vessel patency (adjusted for age and thrombophilia) predicted recurrent DVT (OR 2.70, 95% CI 1.09-6.67). Sensitivity analyses showed the same direction of effects for all outcomes.

CONCLUSIONS

PTS and DVT recurrence occur frequently in pediatric MTS. PTS prediction is complex and it was not possible to identify early predictors to guide clinical practice. Use of imaging-guided therapy and thrombus burden predicted venous patency, and lack of patency predicted DVT recurrence.

May-Thurner Syndrome Is Aggravated by Pregnancy

This study aims to emphasize that asymptomatic patients with undiagnosed and asymptomatic May-Thurner syndrome (MTS) may firstly develop severe compression during pregnancy. A 40-year-old woman, G1P0, at 22 weeks of twin gestation presented with left lower extremity edema and pain. One twin was structurally normal while the other had bilateral renal agenesis with oligohydramnios. Magnetic resonance venography (MRV) revealed severe compression of the left iliac vein by the right iliac artery without evidence of deep vein thrombosis (DVT). Conservative treatment with anticoagulant prophylaxis was instituted throughout the rest of pregnancy and postpartum period. She was also complicated with severe pre-eclampsia, a cesarean section was performed due to a prolapsed cord at 27 weeks of gestation, and she gave birth to a surviving baby weighing 1100 g. In conclusion, this case report provides evidence that pregnancy can disclose a subtle May-Thurner anatomy to be symptomatic without DVT. Successful pregnancy outcomes could be achieved with conservative treatment and anticoagulant prophylaxis.