Successful Iliac Vein Stenting Resolves Pelvic and Back Pain

Patient: Female, 60 years old

Background:
Maria came in with symptoms of pelvic venous congestion, including a heavy feeling in her lower pelvis, vague lower abdominal discomfort, low back pain, and swelling in her legs. These symptoms were puzzling and had not been clearly diagnosed until detailed vein imaging was performed.

Diagnosis and Testing:
An iliac duplex ultrasound showed narrowing (compression) of the left common iliac vein, suggesting May-Thurner syndrome, a condition where the vein is compressed and blocks blood flow. Intravascular ultrasound (IVUS) confirmed the diagnosis. Additional imaging revealed abnormal blood flow in pelvic veins consistent with pelvic congestion syndrome.

Treatment:
Maria underwent a procedure to open the compressed left iliac vein using balloon angioplasty and had a stent placed to keep it open and improve blood flow.

Results (One Month After Procedure):
Maria reports excellent progress with complete relief from pelvic heaviness, abdominal discomfort and low back pain. Her leg swelling has improved significantly, and skin changes are minimal or absent. She tolerates her blood-thinning medications Xarelto and Plavix well, with only mild bruising as a side effect.

Plan Going Forward:
Maria will continue on the blood thinners for two more months and return for a follow-up ultrasound to check the stent’s status. If the stent remains open and functioning well, she will transition to aspirin alone. Monitoring will continue to ensure symptoms stay resolved and the stent remains patent.

Summary:
This case highlights an atypical presentation of pelvic venous disease caused by May-Thurner syndrome. Accurate diagnosis with advanced imaging and treatment with vein stenting led to complete symptom resolution and significant improvement in Maria’s quality of life.