Elsevier

JACC: Cardiovascular Interventions

Volume 14, Issue 17, 13 September 2021, Pages 1940-1946
JACC: Cardiovascular Interventions

New Research Paper
Peripheral
May-Thurner Anatomy in Patients With Chronic Thromboembolic Pulmonary Hypertension: An Important Clinical Association

https://doi.org/10.1016/j.jcin.2021.06.042Get rights and content
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Abstract

Objectives

The aim of this study was to investigate the incidence of May-Thurner anatomy (MTA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and identify its predictors.

Background

MTA is an anatomical variant characterized by compression of left common iliac vein by the overlying right iliac artery. Over time, this leads to venous intimal scarring, blood flow stasis, and the development of deep vein thrombosis (DVT). DVT is a known risk factor for the development of CTEPH. The prevalence of this anatomical variation in patients with CTEPH is unknown.

Methods

A retrospective chart review was conducted in patients referred to Temple University Hospital’s cardiac catheterization laboratory for the evaluation of CTEPH between January 2016 and June 2020. Among these patients, those who underwent invasive venography were evaluated for the presence of angiographic MTA. Multivariate regression was used to identify factors associated with presence of MTA.

Results

A total of 193 patients with CTEPH were referred for pulmonary angiography, of whom 148 patients underwent invasive venography. MTA was identified in 44 patients (29.7%). Factors associated with the presence of MTA were lower extremity DVT (odds ratio: 3.5; 95% confidence interval: 1.58-7.8; P = 0.002), and left lower extremity post-thrombotic syndrome (odds ratio: 2.0; 95% confidence interval: 0.98-4.1; P = 0.05). Patients with MTA were more likely to undergo pulmonary thromboendarterectomy than patients without MTA (79.5% vs 58.7%; P = 0.015).

Conclusions

MTA is very common in patients with CTEPH. History of lower extremity DVT and or left lower extremity post-thrombotic syndrome was associated with the presence of MTA.

Key Words

chronic thromboembolic pulmonary hypertension
May-Thurner anatomy
pulmonary embolism
pulmonary thromboendarterectomy

Abbreviations and Acronyms

CIV
common iliac vein
CTEPH
chronic thromboembolic pulmonary hypertension
DVT
deep vein thrombosis
IVUS
intravascular ultrasound
MTA
May-Thurner anatomy
MTS
May-Thurner syndrome
OR
odds ratio
PA
pulmonary artery
PE
pulmonary embolism
PTE
pulmonary thromboendarterectomy
PTS
post-thrombotic syndrome

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