Minimally invasive treatments for venous compression syndromes

Abstract

The management of venous compression syndromes has historically been reliant on surgical treatment when conservative measures fail. There are, however, several settings in which endovascular therapy can play a significant role as an adjunct or even a replacement to more invasive surgical methods.We explore the role of minimally invasive treatment options for three of the most well-studied venous compression syndromes. The clinical aspects and pathophysiology of Paget-Schroetter syndrome (PSS), nutcracker syndrome, and May-Thurner syndrome are discussed in detail, with particular emphasis on the role that interventionalists can play in minimally invasive treatment.

Diagnóstico e tratamento da síndrome de quebra-nozes (nutcracker ): revisão dos últimos 10 anos

“…3,4,7,8 Elastic compression stockings can also be useful for patients with pelvic and flank pain. 13,14…”

“…Since then, a wide variety of techniques have been described. 13,14 Treatment is indicated in patients with severe symptoms, such as intense hematuria, combined or not with anemia, intense pelvic pain and pain in the abdominal flank, or symptoms persisting for more than 6 months in adults and 24 months in those less than 18 years old. 3,5,15,16 Surgical treatment is necessary to avoid development of chronic glomerulopathy and compromised renal function, permanent dilatation of the gonadal vein, and thrombosis of the renal vein.…”

“…3,17 Despite the low postoperative risk, possible complications include deep venous thrombosis, retroperitoneal hematoma, paralytic ileus, and intestinal obstruction by adherences. 7,13 A considerable number of patients undergo restenosis and occlusion of the transposed vein and require reintervention. 19 The advantages of this operation are the short period of renal ischemia and few anastomoses, with high rates of symptomatic resolution, especially of the complaints of hematuria and flank pain, and it is considered the gold standard treatment for nutcracker syndrome.…”

“…Endovascular surgery is a form of intervention that is becoming ever more popular among specialists for treatment of vascular lesions, including nutcracker syndrome. 13,14,26,27 Although many surgeons still choose traditional open surgery methods, this type of intervention involves a greater risk of morbidity and of complications, when compared with less invasive approaches. 13 Thus, since reported cases in which endovascular treatment has been used have achieved satisfactory results for treatment of venous obstruction diseases, these approaches are increasingly recommended by researchers.…”

Revascularização venosa via transposição de veia gonadal esquerda em síndrome de nutcracker posterior: relato de caso

“…Less commonly, compression may occur between the aorta and the spinal column, when the LRV follows a retroaortic path, and such cases are called posterior nutcracker syndrome. 2 The compression can cause venous hypertension with distal dilatation of the LRV and varicosities of the ureter and renal pelvis, manifesting with macroscopic and microscopic hematuria, flank pain and orthostatic proteinuria. 3 Diagnosis is difficult, made on the basis of exclusion of other more prevalent causes, using imaging methods.…”