Common iliac vein stenting for May-Thurner syndrome and subsequent pregnancy

• Published in: Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) Vol. 10; no. 2; pp. 348 - 352
• Main Authors: Speranza, Giancarlo, Sadek, Mikel, Jacobowitz, Glenn
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2022
• Subjects: Adult; Anticoagulants - therapeutic use; Electronic Health Records; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovenous stenting; Female; Humans; Iliac Vein - diagnostic imaging; Iliac Vein - physiopathology; Live Birth; May-Thurner syndrome; May-Thurner Syndrome - diagnostic imaging; May-Thurner Syndrome - physiopathology; May-Thurner Syndrome - therapy; Platelet Aggregation Inhibitors - therapeutic use; Pregnancy; Pregnancy Complications - etiology; Retrospective Studies; Risk Assessment; Risk Factors; Stents; Time Factors; Treatment Outcome; Vascular Patency; Young Adult; Pregnancy; May-Thurner syndrome; Endovenous stenting
• ISSN: 2213-333X; 2213-3348
• DOI: 10.1016/j.jvsv.2021.07.018

For women with left common iliac vein compression (ie, May-Thurner syndrome) who undergo venous stenting and subsequently become pregnant, concerns have been raised regarding a possible compromise of stent patency due to compression from the gravid uterus and the hypercoagulability induced by pregnancy. Only a small body of literature exists on this subject, and limited management guidelines are available. The present study was designed to evaluate the safety of iliac vein stenting for May-Thurner syndrome (MTS) with subsequent pregnancy. Female patients who had undergone common iliac vein stenting at our center who were aged 18 to 45 years and had subsequently become pregnant were identified. A retrospective medical record review of eight eligible patients was conducted, recording the demographics, procedural characteristics, and anticoagulation strategies. The primary outcome evaluated was stent patency. All eight patients had undergone left common iliac vein stenting for MTS. A total of eight stents were placed, and all demonstrated duplex ultrasound patency throughout pregnancy and postpartum. Seven patients delivered healthy pregnancies, and one experienced a stillbirth. The clinical CEAP (clinical, etiologic, anatomic, pathophysiologic) class remained unchanged or improved from pregnancy to postpartum for all patients. The average age at stent placement was 31 ± 5 years, and the average interval from stent placement to pregnancy was 28 ± 19 months. One patient developed nonobstructive deep vein thrombosis (DVT) of the left femoral vein during pregnancy and was treated with therapeutic enoxaparin. The nonobstructive DVT did not compromise the iliac vein stent. Two patients received low-dose aspirin and prophylactic doses of enoxaparin, one for a history of DVT and factor V Leiden and one for a recent history of fertility treatment. The five remaining patients received no anticoagulation, three received low-dose aspirin, and two received no antiplatelet therapy. Common iliac vein stent patency was not compromised by subsequent pregnancy in our eight patients with MTS. Furthermore, the stents remained patent throughout pregnancy in patients receiving a wide range of anticoagulation and antiplatelet treatments, suggesting that no uniform therapeutic threshold exists and treatment should be individualized. For most patients, low-dose aspirin alone or no treatment was adequate. This could have implications for counseling women who require intervention for MTS and are of child-bearing age.