A multi-center retrospective cohort study published in the Egyptian Journal of Radiology and Nuclear Medicine reports that a combined endovascular strategy—mechanical thrombectomy followed by balloon venoplasty and stenting—achieved complete technical success in 36 patients treated for May–Thurner syndrome complicated by acute recurrent deep vein thrombosis. The procedures were performed collaboratively at two tertiary care centers, King Salman Specialized Hospital and Aswan University Hospital, between January 2023 and December 2025. At a mean follow-up of 11.8 months, ranging from 6 to 24 months, duplex ultrasound confirmed maintained primary patency in all patients, and the researchers documented significant symptomatic improvement across the cohort.
The authors emphasize that anticoagulation prevents clot propagation but does not actively remove existing thrombus or correct the underlying venous obstruction.
The study enrolled 36 consecutive adult patients over the age of 18 with confirmed acute or acute-on-chronic symptomatic iliofemoral deep vein thrombosis secondary to May–Thurner anatomy. Exclusion criteria included absolute contraindications to anticoagulation, uncorrectable coagulopathies, and an expected life expectancy of less than one year. All patients received therapeutic anticoagulation with low molecular weight heparin or unfractionated heparin immediately upon admission, before intervention, to prevent further clot growth. Interventions were performed on an urgent basis, with a mean time from symptom exacerbation to intervention of within 24 to 48 hours.
The procedural protocol followed a defined sequence. Venous access was obtained through the popliteal or common femoral vein under ultrasound guidance, and initial venography delineated the extent of the thrombus burden. Mechanical thrombectomy was then performed using specialized catheters designed to extract clot directly from the vein. Device selection was individualized according to thrombus age, burden, operator preference, and anatomical characteristics: the ClotTriever system was primarily chosen for large, organized, subacute or chronic-appearing thrombus, while the AngioJet rheolytic thrombectomy system was preferred for acute, soft, highly thrombotic loads requiring rapid debulking. In practice, ClotTriever was used in 10 of 36 cases, AngioJet in 13 cases, and generic or manual mechanical thrombectomy techniques in the remaining 13 cases.
After thrombus removal, high-pressure balloon venoplasty was carried out with non-compliant balloons ranging from 12 to 16 millimeters in diameter and 40 to 60 millimeters in length, scaled to the reference vessel diameter. Self-expanding venous stents, specifically Boston Scientific WALLSTENT-Uni Endoprostheses with diameters of 14 to 16 millimeters and lengths of 80 to 120 millimeters, were then deployed across the compressed venous segments. The most common deployed diameters were 14 millimeters in 41.7 percent of patients and 16 millimeters in 58.3 percent. Following the procedure, patients received oral anticoagulation with direct oral anticoagulants or vitamin K antagonists for 6 to 12 months, tailored to their underlying thrombotic risk factors and to stent healing confirmed on follow-up duplex ultrasound.
Technical success, defined in the study as extraction of more than 90 percent of the thrombus burden and restoration of brisk antegrade flow, was achieved in 100 percent of cases. The mean age of the cohort was 46.8 years. Immediate clinical improvement was documented in all patients, including reduction in limb circumference and relief of pain. Safety outcomes were favorable: two patients, or 5.6 percent, experienced transient contrast-induced nephropathy that resolved with conservative hydration management, and the researchers reported no instances of symptomatic pulmonary embolism or major hemorrhage. Clinical follow-up files retrieved from electronic medical records confirmed complete symptom resolution and maintained primary patency.
The authors illustrate the technique with a representative case: a 72-year-old man with hypertension and a deep vein thrombosis six months earlier presented with acute left lower limb edema. CT venography confirmed extensive thrombosis and severe compression of the left common iliac vein. Initial catheter venography demonstrated extensive clot, venous occlusion, and collateral networks bypassing the blockage. After conservative management of a transient acute kidney injury, mechanical thrombectomy achieved recanalization, and intra-procedural venoplasty displayed a persistent waist on the balloon—a visible sign of the rigid anatomical compression. A WALLSTENT was then placed and post-dilated to full expansion, and completion venography showed restored antegrade flow with resolution of the collateral vessels.
In the discussion, the authors position their findings against the existing literature. They note that their 100 percent technical success rate aligns with the ATTRACT trial regarding the benefits of thrombus removal, while the choice of mechanical thrombectomy over pharmacomechanical thrombolysis was intended to reduce the bleeding risks reported in the CaVenT study. They also cite work showing that residual thrombus often leads to re-occlusion, arguing that high-pressure balloon venoplasty created a clean landing zone for the stent. Referring to prior observations that recurrence is almost inevitable if iliac compression is left unstented, the authors argue that the persistent balloon waist illustrates a mechanical obstruction that chemical anticoagulants alone cannot resolve, supporting what they call an anatomy-first approach.
The study’s conclusions, however, must be weighed against its design limitations, which the authors themselves acknowledge. This was a retrospective, non-randomized, single-arm study of 36 patients, introducing inherent selection bias because patients selected for endovascular intervention generally had favorable functional status and anatomy amenable to advanced mechanical recanalization. The absence of a concurrent conservative control group means the study cannot establish definitive clinical superiority over anticoagulation alone; the authors restrict their conclusions to demonstrating favorable real-world feasibility, safety, and short-to-mid-term patency rates comparable to recent multi-center registries.
Within those boundaries, the study adds comparative data on device performance in a high-risk recurrent setting, an area the authors identify as a gap in the literature. The finding that a collaborative protocol combining immediate thrombus removal, correction of the compressed venous segment, and structured post-procedural anticoagulation can restore and maintain venous patency at mid-term follow-up offers a practical template for centers managing recurrent iliofemoral thrombosis. The authors’ stated conclusion is that addressing both the acute thrombus and the underlying anatomical lesion is vital for preventing recurrence and post-thrombotic morbidity, while their patient-facing summary stresses that blood thinners prevent clot growth but do not fix the mechanical compression of the vein. The datasets generated during the study are not publicly available due to patient privacy considerations but can be requested from the corresponding author.
Subject of Research: Endovascular treatment of May–Thurner syndrome complicated by acute recurrent deep vein thrombosis
Article Title: Endovascular management of May–Thurner syndrome complicated by acute recurrent deep vein thrombosis: a multi-center cohort study
Article References: Faris Altebainawi, Y., Abdulaziz Alabdali, A., & Mokhtar Eid, M. (2026). Endovascular management of May–Thurner syndrome complicated by acute recurrent deep vein thrombosis: a multi-center cohort study. Egyptian Journal of Radiology and Nuclear Medicine, 57(1), Article 218. https://doi.org/10.1186/s43055-026-01884-z
Image Credits: AI Generated
DOI: 10.1186/s43055-026-01884-z
Keywords: May-Thurner syndrome, deep vein thrombosis, mechanical thrombectomy, venous stenting, iliac vein compression, post-thrombotic syndrome, ClotTriever, AngioJet, endovascular intervention, venous patency, retrospective cohort study, anticoagulation
News Source: Ophelia Keating. (October 29, 2026). Stenting Plus Mechanical Thrombectomy Restores Vein Patency in Recurrent DVT Cohort. Scienmag.
