Vivak Hansrani1, Saad Moughal2, Ahmed Elmetwally2, Haytham Al-Khaffaf2. 1. Department of Vascular Surgery, Royal Blackburn Hospital, East Lancashire NHS Trust, Blackburn, UK. Electronic address: vivak.hansrani@manchester.ac.uk. 2. Department of Vascular Surgery, Royal Blackburn Hospital, East Lancashire NHS Trust, Blackburn, UK.
Abstract
OBJECTIVE: To investigate the presentation, etiology, management and outcomes of May-Thurner syndrome (MTS) in adolescents aged under 18. METHODS: We searched electronic bibliographic databases to identify published reports of MTS in patients under 18 years of age. We conducted our review according to the PRISMA statement standards. RESULTS: Ten studies encompassing 22 patients treated for MTS in adolescent cases were identified. The mean age of patients was 15 years (range, 10-18 years). Of the 22 patients, 12 (55%) were confirmed to have proximal deep vein thrombosis as the primary indication for intervention. Treatment methods included catheter-directed thrombolysis and iliac vein stenting (41%), pharmacomechanical thrombolysis and iliac vein stenting (18%), iliac vein stenting alone (27%), open surgery (14%), catheter-directed thrombolysis (5%), and anticoagulation alone (5%). Complications were infrequent. All studies reported subjective improvements in clinical symptoms with only two studies using validate outcome measures. In total, 9 of 22 patients (41%) had addition risk factors that may precipitate thrombosis. CONCLUSIONS: As in adults, the most common form of treatment seen in the literature is a combination of catheter direct thrombolysis, followed by iliac vein stenting with subsequent anticoagulation. Complications from interventions were low. It is unclear how these interventions affect symptomology and the long-term sequalae associated endovascular surgery and stenting in adolescents. Further research is needed in well-designed studies with adequate follow-up.
OBJECTIVE: To investigate the presentation, etiology, management and outcomes of May-Thurner syndrome (MTS) in adolescents aged under 18. METHODS: We searched electronic bibliographic databases to identify published reports of MTS in patients under 18 years of age. We conducted our review according to the PRISMA statement standards. RESULTS: Ten studies encompassing 22 patients treated for MTS in adolescent cases were identified. The mean age of patients was 15 years (range, 10-18 years). Of the 22 patients, 12 (55%) were confirmed to have proximal deep vein thrombosis as the primary indication for intervention. Treatment methods included catheter-directed thrombolysis and iliac vein stenting (41%), pharmacomechanical thrombolysis and iliac vein stenting (18%), iliac vein stenting alone (27%), open surgery (14%), catheter-directed thrombolysis (5%), and anticoagulation alone (5%). Complications were infrequent. All studies reported subjective improvements in clinical symptoms with only two studies using validate outcome measures. In total, 9 of 22 patients (41%) had addition risk factors that may precipitate thrombosis. CONCLUSIONS: As in adults, the most common form of treatment seen in the literature is a combination of catheter direct thrombolysis, followed by iliac vein stenting with subsequent anticoagulation. Complications from interventions were low. It is unclear how these interventions affect symptomology and the long-term sequalae associated endovascular surgery and stenting in adolescents. Further research is needed in well-designed studies with adequate follow-up.
Authors: Khawaja B Waheed; Hassan R Mohammed; Khaled S Salem; Mohamed A Shaltout; Ali S Alshehri; Emad F Said; Abdulhadi S Almubarak; Zechariah J Arulanantham Journal: Saudi Med J Date: 2022-01 Impact factor: 1.422