Pelvic Venous Compression, often associated with May-Thurner Syndrome, is a condition that can lead to chronic pelvic pain. It occurs when the common iliac vein in the pelvis is compressed between the artery that supplies blood to the right leg (the common iliac artery) and the spine. Typically, the left iliac vein is affected, although other nearby veins can also experience compression. This pressure can lead to scar tissue forming inside the vein, reducing blood flow from the legs back to the heart. PVC is common, affecting approximately 20-25% of people, and is more frequently seen in women. While it is a structural variation, it does not necessarily cause symptoms for everyone and is not related to genetic factors or lifestyle. This is important, as many people have an anatomical compression of their iliac vein, and experience no symptoms! Very few people with iliac vein compression should seek intervention. One must meet strict symptomatic and imaging criteria, to be considered for surgery.
In cases where the vein’s narrowing is significant, there is an elevated risk of developing a Deep Vein Thrombosis (DVT), especially when other risk factors are present. Patient who develop a large DVT are offered treatment to remove the clot. Nearly all of these patients will require a stent in their common iliac vein to prevent the clot from re-ocurring.
PVC signs vary widely and may include:
This procedure is performed to address issues resulting from compression of the common iliac vein, which can sometimes affect both the left and right sides. Compression in this area can lead to conditions such as pelvic congestion syndrome, recurrent varicose veins, and chronic venous insufficiency, which may include venous ulcers. Diagnosing these issues typically involves a duplex ultrasound scan, with further confirmation through venography, CT, or MRI.
Conducted in an angiogram suite with X-ray guidance, this procedure can be done with either general anesthesia or sedation combined with local anesthesia. As an outpatient treatment, a needle and small sheaths (tubes) are used to access veins in the right and left groin, allowing the insertion of balloons and stents. The compressed section of the vein is widened with a balloon, and a stent is placed to maintain openness. This procedure usually targets the left side but may involve the right side as well, taking around 45 minutes in total.
For any concerns following your procedure, please reach out to your healthcare provider. Additionally, emergency care is available 24/7 at local hospital emergency departments.
Overview of Nutcracker Syndrome
Nutcracker phenomenon is a vascular condition where the left renal vein becomes compressed, most commonly between the aorta and the superior mesenteric artery.
This configuration resembles a nutcracker, giving the condition its name. When this compression leads to clinical symptoms, it is referred to as nutcracker syndrome. The increased pressure within the left renal vein can cause left flank pain and visible blood in the urine (hematuria). Additionally, blood may reroute through collateral veins, causing backflow into surrounding organs and leading to symptoms listed below.
Although not life-threatening, nutcracker syndrome can significantly impact quality of life for symptomatic patients. Diagnosis often involves imaging studies, and treatment depends on symptom severity, with some patients requiring observation and others needing intervention.
Nutcracker syndrome presents with a range of symptoms and lacks standard diagnostic criteria, which can result in delays or misdiagnosis.
Typically, the condition arises due to compression of the left renal vein by the aorta and superior mesenteric artery. Factors that may increase the likelihood of nutcracker syndrome include a lack of abdominal fat, growth spurts in children and adolescents, and certain spinal conditions such as lumbar lordosis. Other causes can include pancreatic cysts or tumors, retroperitoneal tumors, swollen lymph nodes near the abdominal aorta, or an abdominal aortic aneurysm.
To confirm a diagnosis of nutcracker syndrome or to rule out other conditions, your healthcare provider may review your medical history, conduct a physical examination, and order specific tests, which could include:
For mild cases, observation may be sufficient, and growth or weight gain may alleviate symptoms in younger patients. In cases of severe symptoms, one of several interventions might be recommended, depending on factors like the patient’s anatomy, age, and likelihood of symptom relief. Options include:
Nutcracker syndrome is relatively rare. The key components include flank pain, persistent blood in the urine and likely a dilated and incompetent gonadal vein. Many patients with compression do not have any symptoms and the diagnosis needs to be made with symptoms as well as objective signs of pathology (blood in the urine) and imaging to confirm the diagnosis.
Consulting locations
WOLLONGONG
Artery and Vein Clinic
402 Crown St
Wollongong
NSW 2500
GREGORY HILLS
Artery and Vein Clinic
Soma Centre
Suite 8/7, Gregory Hills drive
Gregory hills
NSW 2557
Orange
Artery and Vein Clinic
117 Molder st
Orange
NSW 2800
Contact Info
Wollongong
Phone: (02) 4226 9333
Fax: (02) 4229 4006
Gregory Hills
Phone: (02) 4601 1055
Fax: (02) 4601 1058
Orange
Phone: (02) 4601 1055
Fax: (02) 4601 1058
Healthlink EDI: wgvascul
Office Hours
9am – 4:30pm Monday to Friday
Phone Hours
7am – 6pm Monday to Friday
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