Iliac Vein Stenting Restores Comfort After Years of Leg and Pelvic Symptoms

Patient: Female, 49 years old
Procedure: IVUS‑guided iliac vein stent placement
Date of Follow‑Up: Three months post‑procedure

Background
Victoria, a 49‑year‑old woman with a history of multiple pregnancies, had previously undergone vein treatments that included ablation and microphlebectomy for superficial venous insufficiency. Despite these interventions, she continued to experience persistent left leg swelling and aching, heaviness and fatigue in both legs, and pelvic symptoms such as pressure, urinary discomfort (dysuria) and pain with intercourse (dyspareunia).

Diagnosis and Testing
An iliac vein ultrasound showed a significant narrowing of the left common iliac vein, suggesting an internal vein compression – often called May‑Thurner syndrome. Intravascular ultrasound (IVUS), a highly detailed imaging method performed inside the vein, confirmed severe compression with an 82.8% reduction in cross‑sectional area. This explained her continued venous and pelvic symptoms despite prior surface vein treatment.

Treatment
Victoria underwent a minimally invasive procedure that included balloon angioplasty to open the compressed segment, followed by placement of a stent to keep the left iliac vein open. Follow‑up IVUS showed a large and healthy post‑stent lumen with a six‑fold increase in vein area and a fifty‑fold improvement in blood flow through the previously narrowed section.

Outcome
At her three‑month follow‑up, Victoria reported marked improvement in swelling and heaviness of both legs and complete resolution of urinary pain and pelvic pressure. Her quality of life improved significantly, and imaging confirmed that the stent remained widely open with strong blood flow.

Clinical Insight
This case shows how blocked or compressed central veins can cause ongoing swelling and pelvic discomfort even after superficial vein treatments. When symptoms persist on one side or include pelvic discomfort, deeper venous evaluation with iliac duplex and IVUS imaging is essential to identify and correct hidden outflow obstructions.