Endovascular interventions in the treatment of pelvic congestion syndrome caused by May-Thurner syndrome

Objective: The objective of this study was to assess the effect of various endovascular interventions on the clinical manifestations of the pelvic congestion syndrome (PCS) caused by May-Thurner syndrome (MTS). Methods: The study included 12 female patients with PCS caused by MTS. Patients were examined by duplex ultrasound, computed tomography of the pelvic veins, and ovarian and pelvic venography. All 12 patients underwent endovascular stenting of the left common iliac vein (CIV), and 10 of them underwent subsequent endovascular embolization of the left gonadal vein. The indication for stenting was the presence of stenosis (>50%) of the CIV with clinical symptoms and signs of PCS. Self-expanding stents (Wallstent, 14-16 mm x 60-90 mm; Boston Scientific, Marlborough, Mass) were used. Patients with persistent symptoms of PCS after stenting underwent gonadal vein embolization with MReye metal coils (diameter, 10-15 mm; length, 10-20 cm; Cook Medical, Bloomington, Ind). Results: Technical success of stenting, namely, the restoration of normal patency of the left CIV, was achieved in 12 patients. In two patients, a stent was displaced toward the inferior vena cava, which required implantation of a second stent. In another patient, the stent was displaced into the inferior vena cava at 6 months after the intervention, which was not associated with any complication during the follow-up period. The mean venous pelvic pain severity score decreased from 7.7 +/- 0.8 at baseline to 4.8 +/- 0.3 after 1 month and stayed at this level during the 6-month follow-up period. Complete elimination of PCS symptoms at 6 months after stenting was achieved in 2 patients, and 10 patients underwent embolization of the left gonadal vein 6 months after stenting because of persistent pelvic pain. Conclusions: Endovascular stenting of the left CIV is an effective technique for relieving symptoms of PCS due to MTS in only 16.6% of patients. Stenting of the left CIV in combination with embolization of gonadal veins results in elimination of the signs of PCS in 83.4% of patients. Probably only gonadal vein embolization can be used in the treatment of MTS-related PCS. To confirm this hypothesis, further comparative studies are warranted.