Stent occlusion after catheter-directed thrombolysis and iliac vein stenting in May-Thurner syndrome with iliofemoral deep vein thrombosis: A case report and literature review

Annals of vascular surgery. Brief reports and innovations Pub Date : 2025-08-24 DOI:10.1016/j.avsurg.2025.100401

Haijun Huang, Zuoyi Yao, Ke Guo, Yunping Liu, Qian Zhang, Wei Wei, Kan Zhao

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Abstract

Background

Stent occlusion following endovascular management of May-Thurner syndrome (MTS) with iliofemoral deep vein thrombosis (DVT) remains a significant clinical challenge. This case report and literature review examines mechanical, procedural, and patient-specific determinants of stent failure in chronic venous disease.

Case Presentation

A 78-year-old female with acute left iliofemoral DVT post-hip arthroplasty underwent catheter-directed thrombolysis (CDT) and iliac vein stenting. Despite initial technical success and rivaroxaban therapy, stent occlusion occurred at 1-month follow-up, necessitating secondary stenting. Venography revealed residual thrombus at the inflow tract and incomplete coverage of the iliocaval confluence as likely contributors.

Literature Review

Analysis of 29 studies identified critical factors influencing stent patency:

Mechanical determinants: Larger stent diameter (≥16 mm) and optimized iliocaval confluence coverage reduced restenosis risk. In-stent shear rate >100 s⁻¹ and inflow luminal area >125 mm² correlated with patency.

Thrombotic risk: Chronic post-thrombotic lesions (residual thrombus >30 %) and antiphospholipid syndrome increased occlusion risk.

Anticoagulation: Combined anticoagulant/antiplatelet regimens reduced stent malfunction by 72 % (HR=0.28), while extended anticoagulation (6–12 months) showed no superiority over shorter durations in recent cohorts.

Conclusion

This case highlights the multifactorial nature of venous stent failure. Key recommendations include:

Aggressive thrombus clearance during CDT (<30 % residual burden)

IVUS-guided stent sizing to achieve optimal shear dynamics

Tailored anticoagulation incorporating thrombophilia screening

Anatomic precision in iliocaval confluence coverage

Prospective studies are needed to validate biomechanical thresholds and pharmacogenetic approaches in venous stent management.

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May-Thurner综合征伴髂股深静脉血栓形成患者经导管溶栓和髂静脉支架置入后支架闭塞1例并文献复习

背景：May-Thurner综合征（MTS）合并髂股深静脉血栓形成（DVT）的血管内治疗后支架闭塞仍然是一个重大的临床挑战。本病例报告和文献综述探讨了慢性静脉疾病中支架失效的机械、程序和患者特异性决定因素。一例78岁女性髋关节置换术后急性左髂股深静脉血栓形成，行导管溶栓（CDT）和髂静脉支架置入术。尽管最初的技术成功和利伐沙班治疗，支架闭塞发生在1个月的随访，需要二次支架置入。静脉造影显示流入道残留血栓和髂腔汇合处不完全覆盖可能是原因。文献综述：对29项研究的分析确定了影响支架通畅的关键因素：机械因素：较大的支架直径（≥16mm）和优化的髂腔汇合处覆盖可降低再狭窄风险。支架内剪切速率100 s⁻¹和流入腔面积125 mm²与通畅相关。血栓风险：慢性血栓后病变（残余血栓30%）和抗磷脂综合征增加闭塞风险。抗凝：在最近的队列研究中，抗凝/抗血小板联合治疗方案减少了72%的支架功能不全（HR=0.28），而延长抗凝治疗（6-12个月）并没有较短时间的优势。结论本病例突出了静脉支架失效的多因素性。主要建议包括：CDT期间积极清除血栓（30%残余负荷）ivus引导的支架尺寸以达到最佳剪切动力学；结合血栓形成筛查的量身定制抗凝治疗；髂腔静脉汇合处覆盖的解剖精度；需要前瞻性研究来验证生物力学阈值和药物遗传学方法在静脉支架管理中的应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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