May‐Thurner syndrome and thrombosis: A systematic review of antithrombotic use after endovascular stent placement

BACKGROUND: May‐Thurner Syndrome (MTS) is caused by compression of the left common iliac vein between the right common iliac artery and the pelvis. It likely predisposes an individual to lower extremity deep vein thrombosis (DVT) as well as symptoms of unilateral lower extremity swelling and discomfort in the absence of a known history of thrombosis. In the case of MTS‐associated acute thrombosis, there is low‐quality evidence to suggest that endovascular intervention including thrombolysis and endovascular stent placement reduces the risk of recurrent thrombosis. However, the optimal type and duration of antithrombotic therapy after stent placement for left iliofemoral vein stenosis is not known. METHODS: A systematic literature search including studies that evaluated the outcome of endovascular stent occlusion and systemic anticoagulant use in patients with MTS associated DVT was performed. The primary outcome of interest was 12‐month risk of endovascular stent occlusion or recurrent DVT. RESULTS: A total of five studies encompassing 61 patients were included in our study. All studies were retrospective without a comparator group. A variety of anticoagulants and durations were prescribed. Of the 55 patients evaluable, the 12‐month rate of endovascular stent occlusion or recurrent DVT ranged from 0% to 40%. The 12‐month stent patency rate ranged from 60% to 100%. CONCLUSIONS: The published evidence regarding antithrombotic treatment for patients with MTS who have undergone stent placement for a DVT is limited. Further high‐quality, prospective studies are needed in this setting to inform clinical decision making.