Common Iliac Vein Stenting for May-Thurner Syndrome and Subsequent Pregnancy.

Abstract

BACKGROUND\nIn women with left common iliac vein compression (i.e. 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 by the gravid uterus and hypercoagulability induced by pregnancy. Only a small body of literature exists on this subject, and there are limited management guidelines. This study was designed to evaluate the safety of iliac vein stenting for May-Thurner syndrome (MTS) with subsequent pregnancy.\n\n\nMETHODS\nFemale patients who underwent common iliac vein stenting at our center between the ages of 18-45 and subsequently became pregnant were identified. A retrospective chart review of eight eligible patients was conducted, recording demographics, procedural characteristics, and anticoagulation strategies. The primary outcome evaluated was stent patency.\n\n\nRESULTS\nAll 8 patients underwent left common iliac vein stenting for MTS. A total of 8 stents were placed, and all demonstrated duplex patency throughout pregnancy as well post-partum. Seven patients delivered healthy pregnancies, and 1 experienced a stillbirth. Clinical CEAP classes were unchanged or improved from pregnancy to post-partum for all patients. The average age at stent placement was 31±5 years, and the average time from stent placement to pregnancy was 28±19 months. One patient developed a non-obstructive deep vein thrombosis (DVT) of the left femoral vein during pregnancy and was treated with therapeutic enoxaparin. The non-obstructive DVT did not compromise the iliac vein stent. Two patients received low dose aspirin and prophylactic doses of enoxaparin, 1 for a history of DVT and Factor V Leiden and 1 for a recent history of fertility treatments. The 5 remaining patients received no anticoagulation; 3 received low dose aspirin, and 2 received no antiplatelet therapy.\n\n\nCONCLUSION\nCommon iliac vein stent patency is not compromised by subsequent pregnancy in patients with MTS. Furthermore, stents remained patent throughout pregnancy in patients receiving a wide range of anticoagulation and antiplatelet treatments, suggesting that there is no uniform therapeutic threshold, and treatment should be individualized. In most patients low dose aspirin alone or no treatment was adequate. This may have implications for counseling women who require intervention for MTS and are of child-bearing age.