Prioritizing relieving iliac venous compression contributes to treating varicose veins of lower extremities patients with May-Thurner syndrome

Abstract

Objective

We suspect that the May-Thurner syndrome (MTS) is the main etiology of secondary varicose veins of the lower extremities (VVLE). However, there is no definitive agreement on the priority and necessity of relieving iliac vein compression when treating patients with VVLE and MTS.

Method

In this study, according to the results of anterograde venography of lower extremity, 99 patients were divided into two groups, namely, simple VVLE (n = 66) and VVLE-MTS groups (n = 33). The patients in the former group only received sclerotherapy, while the patients in later group received the combination treatments of intravascular balloon dilatation, stent placement of iliac vein, and sclerotherapy. After surgery, we applied VVCS score, postoperative recanalization rate, and improvement in clinical symptom to assess therapeutic effects.

Results

VCSS score: At 1 week, 1 month, 3 months, and 6 months after operation, there were significant differences between group A and group B (p < 0.01), the difference of VCSS: compared with preoperation, there was statistical difference between group A and group B at 1 week after operation (p < 0.01), there was no statistical difference 6 months after operation (p = 0.052); Postoperative recanalization: cumulative trunk recanalization events 6 months after surgery There was no statistical difference between (p = 0.192) and branch recanalization events (p = 0.207). When the two events were combined to increase the positive rate, no statistical difference was found. However, after stratifying patients, mild (CEAP2-3) and moderate (CEAP4) patients were obtained. There was no statistical difference in the incidence of recanalization events between the two groups, but there was a statistical difference between severe (CEAP5-6) groups (p = 0.025).

Conclusion

It was great of importance and necessity of solving iliac vein compression prior to treating VVLE when handling patients with VVLE and MTS, especially for the cases with high CEAP score.

Keywords

Varicose veins of the lower extremities May-Thurner syndrome,stent implantation endovenous laser treatment sclerosing foam

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