Relief of obstructive pelvic venous symptoms with endoluminal stenting

Purpose: To select: patients for percutaneous transluminal stenting of chro nic postthrombotic pelvic venous obstructions (CPPVO), we evaluated the cli nical symptoms in a cohort of candidates and in a series of successfully tr eated patients. Methods: The symptoms of 42 patients (39 women) with CPPVO (38 left iliac; average history, 18 years) were recorded, and the venous anatomy was studie d by means of duplex scanning, subtraction venography, and computed tomogra phy or magnetic resonance imaging. Successfully stented patients were contr olled by means of duplex scanning and assessment of symptoms. Results: The typical symptoms of CPPVO were reported spontaneously by 24% o f patients and uncovered by means of a targeted interview in an additional 47%. Of 42 patients, 15 had venous claudication, four had neurogenic claudi cation (caused by dilated veins in the spinal canal that arise from the col lateral circulation), and 11 had both symptoms. Twelve patients had no spec ific symptoms. Placement of a stent was found to be technically feasible in 25 patients (60%), was attempted in 14 patients, and was primarily success ful in 12 patients. One stent occluded within the first week. All other ste nts were fully patent after a mean of 15 months (range, 1 to 43 months). Sa tisfaction was high in the patients who had the typical symptoms, but low i n those who lacked them. Conclusion: Venous claudication and neurogenic claudication caused by venou s collaterals in the spinal canal are typical clinical features of CPPVO. W e recommend searching for these symptoms, because recanalization by means o f stenting: is often feasible and rewarding.