However, because of the morbidity associated with surgical techniques, percutaneous endoluminal left renal vein stenting is now performed [62]. No studies have demonstrated benefit of renal vein stenting on pelvic origin lower extremity varicose veins. A limited number of studies have demonstrated remission of pelvic venous symptoms with stenting of the left renal vein as an alternative to open surgery [63], although none have demonstrated improvement in lower extremity varicose veins or symptoms. Left Renal Vein Surgery Though no literature has focused on nutcracker syndrome causing pelvic-derived varicose veins, the treatment of pelvic venous disease due to nutcracker syndrome has been primarily surgical in the past, employing left renal vein bypass, transposition, and external stent placement. However, because of the morbidity associated with surgical techniques, percutaneous endoluminal left renal vein stenting is increasingly performed [62]. Rundqvist et al [64] described the first open surgical removal of the left ovarian vein in patients with pelvic congestion syndrome. Symptomatic improvement was described in two-thirds of this studied cohort. Laparoscopic left ovarian vein surgical ligation in patients with pelvic congestion syndrome was described in 2003 by Gargiulo et al [65]; 23 out of 23 patients reported complete resolution of symptoms in the 1-year follow-up. No studies have demonstrated benefit of renal vein surgery on pelvic origin lower extremity varicose veins. Surgery should be considered in patients with lifestyle-limiting chronic pelvic pain that have recurred despite embolotherapy [63,66]. Lower Extremity Chronic Venous Disease Microphlebectomy There is no relevant literature regarding the use of microphlebectomy in the treatment of isolated pelvic-derived lower extremity varicose veins. However, it is well established as an effective tool at eliminating varicose veins in general and may be helpful in the correct clinical setting.
Lower Extremity Chronic Venous Disease. However, because of the morbidity associated with surgical techniques, percutaneous endoluminal left renal vein stenting is now performed [62]. No studies have demonstrated benefit of renal vein stenting on pelvic origin lower extremity varicose veins. A limited number of studies have demonstrated remission of pelvic venous symptoms with stenting of the left renal vein as an alternative to open surgery [63], although none have demonstrated improvement in lower extremity varicose veins or symptoms. Left Renal Vein Surgery Though no literature has focused on nutcracker syndrome causing pelvic-derived varicose veins, the treatment of pelvic venous disease due to nutcracker syndrome has been primarily surgical in the past, employing left renal vein bypass, transposition, and external stent placement. However, because of the morbidity associated with surgical techniques, percutaneous endoluminal left renal vein stenting is increasingly performed [62]. Rundqvist et al [64] described the first open surgical removal of the left ovarian vein in patients with pelvic congestion syndrome. Symptomatic improvement was described in two-thirds of this studied cohort. Laparoscopic left ovarian vein surgical ligation in patients with pelvic congestion syndrome was described in 2003 by Gargiulo et al [65]; 23 out of 23 patients reported complete resolution of symptoms in the 1-year follow-up. No studies have demonstrated benefit of renal vein surgery on pelvic origin lower extremity varicose veins. Surgery should be considered in patients with lifestyle-limiting chronic pelvic pain that have recurred despite embolotherapy [63,66]. Lower Extremity Chronic Venous Disease Microphlebectomy There is no relevant literature regarding the use of microphlebectomy in the treatment of isolated pelvic-derived lower extremity varicose veins. However, it is well established as an effective tool at eliminating varicose veins in general and may be helpful in the correct clinical setting.