First Experience in Endovascular Stenting in Patients with Both May-Thurner and Pelvic Congestion Syndromes

Abstract

Objective-to assess endovascular stenting (ES) of the iliac veins in the treatment of the May-Thurner syndrome (MTS) in patients with pelvic congestion syndrome (PCS) and varicocele. Material and methods. Endovascular stenting of the iliac veins was performed in 7 female patients PCS and 1 male patient with varicocele. All patients underwent duplex ultrasound and computed tomography of the pelvic veins, as well as pelvic phlebography. Self-expanding stents were inserted in all cases. Pelvic pain was assessed by visual-analogue scale before and 4 to 7 days after procedure. Results. Technical success, i.e. restoration of normal patency of the left common iliac vein, was achieved in 8 patients. In 2 patients, stent was displaced towards the inferior vena cava (IVC), which required implantation of a second stent using the stentin-stent technique. Dislocation of the stent into the IVC at 6 months after the intervention was found in 1 patient, but did not result in any complications during further follow-up. All the patients reported reduction of pelvic pain within 4 to 7 days after procedure. The PCS severity score was decreased from 7.2±1.3 to 6.2±0.4 at 1 month after the procedure. However, no further decrease was observed in female patients. At 1 month after ES, the male patient noted a complete disappearance of discomfort in the left inguinal region and left testicle during and after intercourse. Conclusion. Stenting of common iliac vein in patients with MTS leads to decrease of pelvic pain in patients with PCS.