STENTING FOR ILIAC VEIN COMPRESSION FOR MAY-THURNER SYNDROME (PREAUTHORIZATION REQUIRED)

III.196





III.196 STENTING FOR ILIAC VEIN COMPRESSION FOR MAY-THURNER SYNDROME (PREAUTHORIZATION REQUIRED)


Description

Reflux is the primary pathology in chronic venous insufficiency (CVI). Management and treatment of varicosities has been the mainstay for many years.  There may be a small subset of individuals who would benefit from stenting of the Iliac vein when obstruction is present, such as in cases of May-Thurner syndrome.  The indications for intervention are not well defined.   Also routine interrogation of the iliac system cannot be recommended at this time.

UptoDate defines May Thurner as “hemodynamically significant compression of the left common iliac vein between the overlying right common iliac artery and the underlying vertebral body. May-Thurner syndrome, or iliac vein compression syndrome is a common anatomic pattern in normal subjects, which has been associated with unprovoked left iliofemoral deep venous thrombosis (DVT) or chronic venous insufficiency. Data indicates that this can be a normal variant found in asymptomatic individuals.

May Thurner is generally seen in females.  They may have episodes of deep vein thrombosis, unilateral leg swelling or redness or discoloration of the skin of the lower leg.  Stenting in this situation has been shown to be beneficial in patients with severe disabling symptoms.



Dates

  • Original Effective
    12-01-2016
  • Last Review
    05-01-2024
  • Next Review
    05-05-2025

Policy

Iliac vein stenting is scientifically validated for the treatment of May Thurner syndrome (iliac vein compression syndrome) with the following symptoms:

               Unilateral leg swelling and pain; AND

               The patient has a definitive diagnostic imaging study such as venogram, CT or MRI of May Thurner’s syndrome (iliac vein compression); AND

               Skin changes associated with venous insufficiency or ulcerations AND history DVT or post thrombotic syndrome; AND

               Patient has failed 3 months of conservative management with compression stockings, leg elevation and management of any thromboses

Iliac vein stenting is considered investigational for all other diagnoses as not supported by the medical literature.  Other procedures such as bilateral iliac vein stenting, embolization or stenting of hypogastric veins, embolization or stenting of gonadal veins in association with unilateral iliac vein stenting are not medically necessary. 

 

The patient has had a definitive diagnostic venography, CT or MRI



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    Codes

          
              Full Description
                TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION AND INCLUDING ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED; INITIAL VEIN
          
              Full Description
                TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION AND INCLUDING ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED; EACH ADDITIONAL VEIN (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)




    References

    2004

    Kibbe MR. et al. Iliac vein compression in an asymptomatic population Journal of Vascular Surgery 2004; 39 (5): 937
    2010

    Raju, Seshadri. et al. Unexpected major role for venous stenting in deep reflux disease. Journal of Vascular Surgery. 2010 February; 51 (2) 401-408
    2007

    Mussa, Firas. Et al. Iliac vein stenting for chronic venous insufficiency. Texas Heart Institute Journal 2007; 34: 60-6
    2007

    Husmann, MJ. Et al. Stenting of common iliac vein obstructions combined with regional thrombolysis and thrombolectomy in acute deep vein thrombosis. Eur J Vasc Endovasc Surg 2007; 34, 87-91
    2013

    Raju, Seshadri. Et al. Best management options for chronic iliac vein stenosis and occlusion. Journal of vascular surgery. 2013 April; 57 (4) 1163-1169
    2015

    Sista, Akhilesh. Et al. Endovascular interventions for acute and chronic lower extremity deep venous disease: State of the Art. Radiology 276 (1) July 2015 31-53.
    2022

    De Maeseneer, M, Kakkos, S, Aherne, T, et al. European Society for Vascular Surgery(ESVS)- editor's choice -  2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg. 2022; 63:184-267.
    2022

    Majeed GM, Lodhia K, Carter J, et al. A systematic review and meta-analysis of 12-month patency after intervention for iliofemoral obstruction using dedicated or non-dedicated venous stents. J Endovasc Ther. 2022; 29(3):478-492.
    2023

    Liu, C., Zhou, Y., Sun, Y., Xu, M., Wang, G., & Tang, L. (2023). Effect of the timing of iliac vein stent implantation on catheter-directed thrombolysis in acute lower extremity deep venous thrombosis patients with severe iliac vein stenosis: a retrospective study. Phlebology, 2683555231157566. Advance online publication. https://doi.org/10.1177/02683555231157566tps://doi.org/10.1177/02683555231157566 opens a dialog windo

     
    2021

    Hng J, Su S, Atkinson N. May-Thurner syndrome, a diagnosis to consider in young males with no risk factors: a case report and review of the literature. J Med Case Rep. 2021 Mar 19;15(1):141. doi: 10.1186/s13256-021-02730-8. Erratum in: J Med Case Rep. 2021 Nov 26;15(1):571. PMID: 33736685; PMCID: PMC7977182.
    2021

    Ferreira AM, Oliveira-Pinto J, Duarte-Gamas L, et al. Mid-term patency of iliac venous stenting for post-thrombotic syndrome. Int Angiol. 2021;40(3):196-205. PMID: 33739078

    Revisions

    04-15-2025

    References updated.  No change to policy.