Endovascular management of compression syndromes associated with pelvic venous disease

Compression syndromes play an important role in pelvic venous disease (PeVD). Although compressive lesions of the common iliac and renal veins are common on non-invasive imaging studies, they are usually asymptomatic and the factors associated with the development of symptoms remain poorly understood. The prevalence of pelvic or lower-extremity symptoms and varicose veins caused by compression of an iliac or left renal vein is unknown. However, a high index of suspicion is needed in the work-up of PeVD, particularly in patients who are refractory to the initial treatment. Once a symptomatic compression syndrome is discovered in a PeVD patient, this should be treated first. After treating compression syndromes, there should be a waiting period to notice if the complaints and symptoms diminish.