AVF Session: Pelvic Venous Disorders and Compression Syndromes

Iliac Vein Stent Durability and Pelvic Congestion Recognition

A review of nearly 3,000 iliac vein stent patients found 12% needed reintervention, most often for new contralateral lesions rather than failure at the original site. A national database study found pelvic congestion syndrome diagnoses have risen sharply since improved coding was introduced, but procedural rates stayed flat, suggesting the condition remains under-recognized and under-treated.

Surgical Approaches to Nutcracker and May-Thurner Syndromes

A robotic left renal vein transposition technique for Nutcracker syndrome achieved good technical success and patency without conversion to open surgery. A separate series used open decompression, rather than stenting, for May-Thurner syndrome in hypermobile Ehlers-Danlos patients, since stents in this population were prone to migration and vein wall complications.

Novel Embolization and a Zone-Based Framework

A case demonstrated accessing an unusually large right gonadal vein through a left-sided approach and internal jugular sheath to treat bilateral pelvic disease with coil embolization. A zone-based classification of pelvic venous disorders was proposed to guide treatment based on which combination of reflux and decompression pathways produces a patient’s symptoms.