Placement of an iliac venous stent for the treatment of May-Thurner syndrome

Specialists in iliac vein stent placement for the treatment of May-Thurner syndrome

The Compression Syndromes and Venous Thrombosis Unit at the Publio Cordón Memorial Hospital performs iliac vein stenting in patients with May-Thurner syndrome when compression of the iliac vein is causing clinically significant venous obstruction.

In these situations, the compression is not merely an anatomical finding. It can impede the return of blood from the leg and contribute to problems such as deep vein thrombosis, persistent swelling of the limb, pain, a feeling of heaviness or functional impairment.

The treatment involves implanting a stent within the compressed vein to restore its calibre and re-establish venous flow. The aim is not to place a device simply because compression is detected in tests, but rather to first confirm that a significant venous lesion exists and that correcting it can significantly alter the patient’s clinical course.

When the indication is appropriate, this procedure improves venous drainage from the limb, reduces the risk of further blockages and alleviates symptoms that often affect daily life. The key lies in a careful assessment based on imaging tests and specific expertise in iliofemoral venous pathology.

When is iliac vein stenting indicated?

The placement of an iliac venous stent is usually considered when there is significant compression of the iliac vein and this compression is clearly linked to clinical problems.

The most common profile includes patients who have experienced iliofemoral deep vein thrombosis, people with persistent swelling in one leg, pain or a sensation of heaviness that cannot be explained by other causes, or cases of advanced venous insufficiency in which iliac obstruction contributes to the persistence of symptoms.

In some cases, it may also form part of the management of pelvic venous congestion, when assessment confirms that the haemodynamic origin of the problem lies in the iliac region.

It is important to remember that not all anatomical compression requires a stent. In many patients, compression may be detected on imaging tests without causing significant symptoms.

Where the compression is mild, does not explain the clinical presentation, or the main problem lies at another level of the venous system, other therapeutic strategies or clinical follow-up may be more appropriate. For this reason, assessment at a specialist unit is essential to determine when to intervene and when not to.

What clinical benefits can an iliac vein stent offer?

When treatment is appropriately indicated, the aim is not merely to correct a radiological finding, but to improve venous drainage and alter the patient’s clinical course. The stent acts as an internal support that keeps the compressed vein open and allows blood to flow more easily from the leg to the central venous system.

This can result in specific clinical benefits such as:

• Reduced swelling of the limb

• Relief from pain and a feeling of heaviness

• Improved functional ability in daily life

• Lower risk of further venous blockages

In patients with thrombotic disease or chronic venous obstruction, treatment may also help to reduce relapses and limit the progression of venous sequelae.

Published clinical series show high rates of technical success and good patency outcomes, particularly in carefully selected non-thrombotic lesions.

Which tests can be used to confirm the indication for a venous stent?

The indication for a venous stent must be based on tests that confirm three key aspects:

• That there is significant compression of the vein

• That this compression has a haemodynamic impact

• That it is consistent with the patient’s symptoms or history of thrombosis

The assessment usually includes a venous Doppler ultrasound and a more detailed anatomical test, such as a venous CT angiogram or venous MRI, depending on the case.

During the procedure or in the later stages of planning, intravascular ultrasound (IVUS) can play an important role. This technique allows the vein to be examined from the inside, the lesion to be measured accurately, and the therapeutic decision and stent placement to be optimised.

The success of the treatment depends largely on rigorous patient selection and careful planning of the procedure.

How the treatment is carried out

This is a minimally invasive endovascular procedure, carried out in a suite equipped for image-guided intervention. It is usually performed under local anaesthesia and mild sedation, via a venous puncture and without the need for open surgery.

Once access to the venous system has been established, the area of narrowing is examined using contrast medium and, where indicated, using IVUS, which allows the degree of compression to be accurately assessed from inside the vein.

Once the lesion has been identified, the narrowed segment is traversed and the area is prepared for stent implantation. The device is deployed within the compressed vein to restore its calibre and keep it open. In many cases, angioplasty is subsequently performed to optimise the stent’s expansion and ensure adequate venous flow.

From the patient’s perspective, this usually results in a rapid recovery, early mobilisation and a lesser physical impact than that of open surgery.

Recovery and follow-up after venous stent placement

Following venous stent placement, the patient remains under observation for the first few hours to monitor their initial progress and ensure that venous flow has been successfully restored.

In many cases, recovery is rapid, with early mobilisation and a short hospital stay. Most patients can gradually resume their normal activities within a few days, following medical advice.

Subsequently, clinical check-ups and imaging tests are carried out, usually using venous Doppler ultrasound, to check that the stent maintains good patency and that venous drainage is adequate.

Medical follow-up also includes an assessment of antithrombotic treatment, tailored to each patient according to their medical history and the type of lesion treated.

What options are available when a venous stent is not indicated?

Not all patients require a stent. In some cases, treatment may focus on anticoagulation, compression therapy or symptom management. In others, the approach may be directed towards treating acute thrombosis or its sequelae using other endovascular strategies.

It may also be the case that the primary cause of the symptoms lies not in the iliac vein, but in another component of venous disease, which must be correctly identified before any intervention is considered.

Specialist assessment of May-Thurner syndrome at the Unit

The indication for an iliac venous stent requires a rigorous and personalised clinical assessment. At the Compression Syndromes and Venous Thrombosis Unit at the Publio Cordón Memorial Hospital, each case is assessed on an individual basis with the aim of determining whether venous compression is indeed the cause of the symptoms and whether treatment is likely to provide significant clinical benefit.

This specialist assessment allows us to integrate the results of diagnostic tests, the patient’s history of thrombosis, their clinical condition and the various treatment options available.