Pelvic congestion syndrome due to central venous outflow obstruction: A single-center experience with may-Thurner and nutcracker syndromes.

Abstract

Objective: Pelvic congestion syndrome (PCS) due to central venous outflow obstruction (CVOO) such as May-Thurner syndrome (MTS) and nutcracker syndrome (NCS) is a significant cause of chronic pelvic pain (CPP) in women. This study aimed to investigate the clinical presentation, imaging characteristics, and outcomes of interventional treatments in patients with PCS with MTS and/or NCS.

Methods: This retrospective study included the data of consecutive female patients diagnosed with PCS from 2019 to 2024 in our institution. The collected patient data included age, CPP duration, imaging-diagnosed causes (MTS, NCS, or both), procedure type performed (bilateral iliac vein balloon angioplasty, stent placement, left renal vein balloon angioplasty, left ovarian vein embolization), and use of intraoperative ultrasound. Outcomes assessed included changes in pain scores (Numeric Rating Scale [NRS]), analgesic use, and quality of life (QOL). Included patients' preoperative and postoperative outcomes were compared statistically using nonparametric tests.

Results: Data of 45 women were included (mean age, 40.9 years; median duration of CPP, 3 years), with 37.8% diagnosed with MTS alone and 53.3% with both MTS and NCS. Among these, 22 had undergone bilateral iliac vein balloon angioplasty, nine (40.9%) had received stent placement, and nine (40.9%) had received embolization of left ovarian vein additionally. NRS pain scores and postoperative analgesic use were significantly reduced and QOL improvement increased (all P < 0.001).

Conclusion: Interventions for PCS due to CVOO yield significant symptom relief and QOL improvements. Embolization may offer additional benefits in enhancing QoL in this patient population.