Stenting for Symptomatic Left Renal Vein Compression in Patients with Complex Pelvic Venous Disease Is Safe on Long-Term Follow Up

AbstractIntroduction The ideal treatment for symptomatic left renal vein (LRV) compression continues to be debated, with several available open and endovascular options. Concerns about percutaneous stenting have been raised due to risk of stent migration, fracture, and erosion. This study aims to assess the long-term safety, patency, and effectiveness of LRV stenting. Methods A retrospective institutional chart review of all patients undergoing LRV stenting for symptomatic LRV compression between 2010 and 2024 was conducted. Baseline characteristics, operative details, complications, re-interventions, and symptom resolution were collected. Complete resolution was defined as full relief of presenting symptoms; partial resolution as patient-reported improvement without full relief; and no relief as no change from preoperative symptoms. Results A total of 44 patients were identified. Forty-three patients with complete follow-up were included in the analysis. A total of 13 patients underwent LRV transposition for symptomatic compression at our institution in the same time frame; out of which 6 required stenting due to symptom recurrence and were included in the analysis. Mean age was 42.6 years (range: 17.6-79.1). Body mass index ranged from 15.2 to 42.5 kg/m2. Most of the patients were female (42/43) and white (41/43). Thirty (69.8%) patients had a concomitant diagnosis of pelvic congestion syndrome. Seven patients underwent stenting for recurrence after LRV transposition. Pelvic or lower abdominal pain was the most common presenting symptom (35/43), followed by flank pain (25/43) and hematuria (18/43). Thirty-nine patients received a single stent, while four had two stents at index procedure. The stent size ranged from 8 to 16 mm in diameter (median 14 mm) and 30 to 60 mm in length (median 40 mm). Dedicated venous stents were used in 42% of patients after 2019. Intravascular ultrasound was used in the majority of patients (32/43, 74.4%). Sixteen patients (36.4%) underwent concomitant gonadal vein embolization. The median clinical follow-up was 46.5 months (Interquartile range: 23.7-82.2 months). No major peri-operative complications were reported. No stent migration, embolization, or vein pseudoaneurysm occurred. One case of complete stent occlusion was reported. The primary patency was 89.9% at 1 year and 82.8% at 4 years, while the primary-assisted patency remained at 100%. Symptom resolution was achieved in 90.7% (39/43) of patients (24 complete, 15 partial). Two patients eventually underwent auto-transplantation, three underwent nephrectomy (one for cancer) and one had a stent explant due to persistent pain despite patent stents. Conclusion LRV stenting for symptomatic compression offers a minimally invasive approach and results in high symptom resolution and patency with no major stent complications at long-term follow-up. It can continue to be a treatment option where appropriate expertise is available.