A review into the management of May-Thurner syndrome in adolescents

Hansrani, Vivak; Moughal, Saad; Elmetwally, Ahmed; Al‐Khaffaf, Haytham

doi:10.1016/j.jvsv.2020.05.006

Cited by 9 publications

(12 citation statements)

References 22 publications

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“…There is evidence to support this decision as it appears to improve function and pain in the short term and it could reduce the risk for the development of post-thrombotic syndrome in the long term (PTS) ( 14 , 15 , 18 ). Similar to the adult data, the combination of CDT and iliac vein stenting followed by anticoagulation is the most common treatment for VTE In the setting of May-Thurner, the evidence suggests that complications using this strategy are low ( 42 ). It seems reasonable to consider thrombolysis in pediatric patients with May-Thurner based on the short-term benefits, seemingly low complication rate, and potential long-term functional gains.…”

Section: Thrombolysis In Childrenmentioning

confidence: 84%

Thrombolysis in Children: A Case Report and Review of the Literature

et al. 2022

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Thromboembolism (TE), including venous thromboembolism (VTE), arterial TE, arterial ischemic stroke (AIS), and myocardial infarction (MI), is considered a relatively rare complication in the pediatric population. Yet, the incidence is rising, especially in hospitalized children. The vast majority of pediatric TE occurs in the setting of at least one identifiable risk factor. Most recently, acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C) have demonstrated an increased risk for TE development. The mainstay for the management pediatric TE has been anticoagulation. Thrombolytic therapy is employed more frequently in adult patients with ample data supporting its use. The data for thrombolysis in pediatric patients is more limited, but the utilization of this therapy is becoming more commonplace in tertiary care pediatric hospitals. Understanding the data on thrombolysis use in pediatric TE and the involved risks is critical before initiating one of these therapies. In this paper, we present the case of an adolescent male with acute fulminant myocarditis and cardiogenic shock likely secondary to MIS-C requiring extracorporeal life support (ECLS) who developed an extensive thrombus burden that was successfully resolved utilizing four simultaneous catheter-directed thrombolysis (CDT) infusions in addition to a review of the literature on the use of thrombolytic therapy in children.

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Section: Thrombolysis In Childrenmentioning

confidence: 84%

Thrombolysis in Children: A Case Report and Review of the Literature

et al. 2022

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“…In the individual case series review carried out by V. Hansrani and R. Goldman, which included 32 patients (20 female patients and 12 male), only two associated manifestations of the superficial venous system of variceal type, both in women of the age of 17 years. In these same reviews, some patients had anticoagulation schedules for life, others from 10 days to 9 months, and some were not anticoagulated, without clear results [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

May-Thurner syndrome with inferior mesenteric vein drainage and porta system - Case report

Avendaño

García

Carvajal

et al. 2021

Radiology Case Reports

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We present the case of a 12-year-old girl with a history of vascular anomalies in the lower pelvic limbs and back, who developed unilateral deep vein thrombosis of the left lower limb after her pubertal development, she was diagnosed with May-Thurner syndrome with an abnormal venous drainage of the pelvic structures through the superior hemorrhoidal veins to the inferior mesenteric vein towards the porta system, this being a chronic manifestation. This kind of behavior has not been documented in the reviewed medical literature. Secondarily, balloon angioplasty was performed without breaking the stenotic ring. As a second attempt, it was decided to place the venous stent, with satisfactory resolution of the symptoms. There are controversies about the indications for the use of anticoagulants and antiplatelet agents, or the indications to place a venous stent in children. We must consider an approach to for effective therapeutic treatment in these cases is to control bleeding, the main goal being trying to avoid ulcerations in the lower limb due to venous insufficiency with irreversible affectation of the valvular system.

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“…2 Treatment modalities for pediatric patients with symptomatic May-Thurner syndrome include treating the acute clot (systemic anticoagulation, catheter-directed thrombolysis, and/or thrombectomy) and relieving the anatomic abnormality with stent placement. 3 In this case report, we describe an adolescent boy treated at a large, tertiary children's hospital with May-Thurner syndrome and a unique presentation of recurrent thrombosis after prior stent placement. Informed consent was obtained.…”

Section: Recurrent Thrombosis With a Mispositioned Stent After Treatm...mentioning

confidence: 97%

“…The most common treatment for May-Thurner is a combination of catheterdirected thrombolysis, followed by iliac vein stenting and systemic anticoagulation, however there are still risks. [3][4][5][6] The prevalence of PE in pediatric May-Thurner cases is not frequently reported given its rarity, however it is possible. A 2020 case series of adolescents with symptomatic May-Thurner had an incidence of four in 15 individuals, and a 2021 case series of adolescents with DVTs treated by catheterthrombolysis had a PE incidence of one in 16 individuals.…”

Section: Recurrent Thrombosis With a Mispositioned Stent After Treatm...mentioning

confidence: 99%