Pediatric May-Thurner Syndrome-Systematic review and individual patient data meta-analysis

• Type of Material: Article
• Authors: Laura Avila, The Hospital for Sick Children, Toronto; Noelle Cullinan, The Hospital for Sick Children, Toronto; Michael White, Emory University; Marian Gaballah, Childrens Hospital of Philadelphia; Anne Marie Cahill, Childrens Hospital of Philadelphia; Deepti Warad, Mayo Clinic, Rochester; Vilmarie Rodriguez, Mayo Clinic, Rochester; Cristina Tarango, University of Cincinnati; Anna Hoppmann, University of Alabama Birmingham; Stephen Nelson, Childrens Hosp & Clin Minnesota; Tomas Kuhn, University of Ostrava; Tina Biss, Newcastle Upon Tyne Hosp NHS Fdn Trust; Aaron Weiss, Maine Medical Center; Michael Temple, The Hospital for Sick Children; João G Amaral, The Hospital for Sick Children, Toronto; Nour Amiri, The Hospital for Sick Children, Toronto; Ana C Xavier, University of Alabama Birmingham; Samuele Renzi, The Hospital for Sick Children, Toronto; Leonardo R Brandao, The Hospital for Sick Children, Toronto
• Language: English
• Date: 2021-04-01
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1111/jth.15284
• Title of Journal or Parent Work: JOURNAL OF THROMBOSIS AND HAEMOSTASIS
• Volume: 19
• Issue: 5
• Start Page: 1283
• End Page: 1293
• Keywords: iliac vein compression; Science & Technology; Peripheral Vascular Disease; post‐ Life Sciences & Biomedicine; Hematology; phlebitic syndrome; thrombotic syndrome; anticoagulants; iliac vein lesion; Cardiovascular System & Cardiology

Abstract

Background: The outcomes of deep vein thrombosis (DVT) in children with May-Thurner Syndrome (MTS) remain unclear. Objectives: This systematic review and patient-level meta-analysis aims to describe the outcomes of children with MTS presenting with DVT. Methods: A systematic review of the published literature was performed. Data related to patients <18 years diagnosed with MTS and DVT was extracted. Risk of bias was assessed using the Murad criteria. Outcomes included vessel patency post-treatment, DVT recurrence, and post-thrombotic syndrome (PTS). Predictive and explanatory models were developed for these outcomes. Results: In total, 109 cases were identified (age range 4–17 years; 77 females) in 28 studies; 75% of patients had ≥1 additional risk factor for DVT. PTS was seen in 61% of patients, DVT recurrence in 38%, and complete vessel patency post-treatment in 65%. The models developed to predict and explain PTS performed poorly overall. Recurrent thrombosis (adjusted for age and patency) predicted PTS (odds ratio [OR] 3.36, 95% confidence interval [CI] 1.28–8.82). DVT management strategies (adjusted for age and DVT characteristics) predicted vessel patency (OR 2.10, 95% CI 1.43–3.08). Lack of complete vessel patency (adjusted for age and thrombophilia) predicted recurrent DVT (OR 2.70, 95% CI 1.09–6.67). Sensitivity analyses showed the same direction of effects for all outcomes. Conclusions: PTS and DVT recurrence occur frequently in pediatric MTS. PTS prediction is complex and it was not possible to identify early predictors to guide clinical practice. Use of imaging-guided therapy and thrombus burden predicted venous patency, and lack of patency predicted DVT recurrence.