Endovascular Treatment of May-Thurner Syndrome in an Office-Based Laboratory.

May-Thurner syndrome (MTS) is a rare condition that increases the risk of left-sided iliofemoral venous thrombosis due to compression of the left common iliac vein by the right common iliac artery. Treatment for symptomatic MTS typically includes combined anticoagulation and endovascular therapy. This patient presented to the emergency department with acute left lower extremity pain and swelling. After imaging confirmed MTS, the patient was discharged from the ED and expeditiously treated in an office-based lab (OBL) setting with venous thrombectomy, angioplasty, and stenting. The setting where endovascular therapy is performed may significantly impact access to care for patients. Additionally, cost-effectiveness is a factor that should be considered when deciding the treatment site of service. We demonstrate the safety and cost-viability of performing venous thrombectomy, angioplasty, and stenting in an outpatient setting for the treatment of acute iliofemoral venous thrombosis.

Treating Chronic Iliac Vein Stent Occlusion in an Office-Based Lab Setting.

Iliac vein stenting is performed when sufficient venous patency is not achieved via angioplasty or lysis. Iliac vein stenting is known to be effective; however, occlusion of the stent occurs occasionally. There is a lack of effective treatment options for those with failed prior venous stents, and traditional methods may involve the removal of the stent and surgical reconstruction. We present a patient with a right leg post-thrombotic syndrome and narcotic abuse after occlusion of a previously placed right common iliac/external iliac vein stent 25 years prior. After transfer to an office-based lab (OBL), femoral vein access was achieved. Then, a second stent was deployed adjacent to the previously chronically thrombosed stent. Imaging confirmed adequate deployment of the new stent and venous flow. Treatment resulted in a significant decrease in patient pain and cessation of narcotics. We demonstrate successful recanalization of a right iliac vein thrombosis via parallel deployment of a stent adjacent to a chronically thrombosed stent.