The effect of stent placement for May-Thurner syndrome combined with symptomatic superficial venous reflux disease.

Objective: The current study aimed to determine whether it is necessary to correct May-Thurner syndrome (MTS) simultaneously with superficial venous reflux disease (S-VRD) in limbs of combined symptomatic MTS/S-VRD.

Methods: A retrospective analysis of patients with S-VRD combined with MTS was conducted in a single institution from January 2001 to December 2010. Doppler ultrasound and phlebography were performed in patients with VRD. Computed tomography angiography or transfemoral venography was selectively performed in patients with severe symptoms or findings on phlebography suggestive of MTS. MTS was found in 207 patients. Among these, 121 patients were successfully treated with stent placement combined with endovenous laser ablation (EVLA); the remaining 86 patients, who were treated with EVLA for S-VRD alone, served as a control group. Clinical results, venous reflux, and quality of life were evaluated before and after treatment. Stent patency was followed up with Doppler ultrasound.

Results: There was no significant difference in age, female to male ratio, clinical symptoms, comorbidities, or percentage with S-VRD between the two groups. A total of 125 stents were placed in 121 patients in the EVLA + stent group. The rate of technical success was 100%. Follow-up periods ranged from 1 to 91 months (mean, 70.4 ± 21.3 months). The 4-year primary patency rate was 93.3%. The incidence of pain, edema, and ulceration was decreased significantly in the stent + EVLA group. However, there was a high rate of S-VRD recurrence in the EVLA-alone group. Quality of life improved significantly in the EVLA + stent group; improvements included relief of pain, edema, and fatigue and increased physical activity. For deep venous reflux, there was no significant improvement after stent placement for MTS.

Conclusions: Stent placement is an effective and durable treatment of MTS combined with symptomatic S-VRD; it results in a high level of long-term patency and a significant relief of pain, edema, and ulceration. Furthermore, correction of MTS plays an important role in decreasing the recurrence rate of S-VRD after EVLA.