In Reply to: Re: Case 0400_09 -- Pelvic Congestion Syndrome:The Diagnostic Value of Venography posted by Moni Stein on April 10, 2000 at 11:48:31:
I treated a pelvic congestion syndrome associated with May-Thurner syndrome. I initially studied the ovarian veins with a tilt table and realized what was going on after sending the
target catheter into the pelvis and seeing large cross pelvic varices draining the left leg.
She had a hysterectomy in the past. I angioplastied the Left Iliac vein and coiled the largest
left incompetant hypogastric vein. I wanted to see if I was on the right track before I placed more metal in her. Amazingly, she had 3 weeks of pain relief. Her pelvic and left leg pain are
related to prolonged standing-she works as an oral surgeon assistant. When the pain recurred
I got an MRV that showed persistant flow through additional pelvic varicies and recurrance
of the iliac vein stenosis. I stented the iliac vein and coiled the other varices from the left and
right external iliac veins. She had a month of relief. Pain recurred and venogram/duplex studies showed no incompetant valves, no reflux into pelvis, and widely patent iliac vein stent. She has had multiple nerve blocks without relief and a neg CT for disc herniation.
Does anyone know about the nuerologic component of May Thurner syndrome or have any
ideas regarding this case?