Clinical Study
Predictors of Disease Recurrence after Venoplasty and Stent Placement for May–Thurner Syndrome

https://doi.org/10.1016/j.jvir.2019.07.012Get rights and content

Abstract

Purpose

To identify factors independently associated with disease recurrence after venoplasty and stent placement for May–Thurner syndrome (MTS).

Materials and Methods

Fifty-nine consecutive patients (age, 47 y ± 15; 93% female) were identified who had undergone endovascular stent placement for MTS. Patient charts were reviewed for demographic data, risk factors for venous thrombosis, comorbidities, and venous inflow or outflow at first follow-up (3 wk to 6 mo after treatment). Logistic regression was used to identify independent predictors of symptom recurrence or repeat intervention, and multivariate analysis of variance and receiver operator characteristic curve analysis were used to assess relationships between degrees of in-stent stenosis and other variables in the 73% of patients with available cross-sectional imaging. Median follow up was 20.7 months (interquartile range, 4.7–49.5 mo).

Results

All procedures were technically successful. Disease recurrence, defined as symptom recurrence following initial postprocedural resolution, was observed in 38% of patients. No preprocedural variable was found to be independently predictive of disease recurrence; however, poor venous inflow or outflow were both strongly associated with recurrent disease, with adjusted odds ratios and 95% confidence intervals of 38.02 (3.76–384.20; P = .002) and 7.00 (1.15–42.71; P = .04), respectively. Higher degrees of in-stent stenosis were also associated with symptom recurrence, with an area under the curve of 0.93 (P = .000002) and 39%–41% stenosis being 78%–83% sensitive and 88%–92% specific for symptom recurrence.

Conclusions

These results suggest that cross-sectional imaging can help differentiate patients in whom closer follow-up may be warranted after venoplasty and stent placement for MTS and also guide counseling regarding prognosis.

Section snippets

Materials and Methods

This study was approved by the institutional review board. Informed consent was waived in view of the retrospective nature of the investigation.

Results

Fifty of 59 patients (85%) returned for scheduled postprocedural follow-up visits, and cross-sectional imaging follow-up was available in 43 patients (73%). Median follow-up was 20.7 months (interquartile range, 4.7–49.5 mo). Demographic characteristics of the full cohort and subgroup with available clinical imaging follow-up are summarized and compared in Table 1.

The subgroup with available cross-sectional imaging was representative of the full cohort (P ≥ .05) in terms of all demographic

Discussion

The present study reviewed 59 patients treated with venoplasty and stent placement for MTS at a single institution. MTS symptoms recurred in 38% of patients during a median follow-up period of 20.7 months, leading to repeat intervention in 74% of these patients. When adjusting for demographic characteristics, risk factors for thrombosis, and comorbidities that could causes similar symptoms, only identification of poor venous inflow and/or poor venous outflow at the first follow-up appointment

References (16)

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None of the authors have identified a conflict of interest.

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