Ovarian vein interventions in patients with combined radiologically significant left renal vein compression and symptomatic pelvic vein reflux

BackgroundThe issues of diagnosis and treatment strategy for the left renal vein compression (LRVC) have not been fully resolved, and treatment methods vary widely from medical therapy to renal autotransplantation. The aim of this study was to determine the feasibility of isolated interventions on the left ovarian vein in patients with LRVC of varying severity.MethodsThis prospective cohort study included 63 female patients with LRVC (30 symptomatic and 33 asymptomatic), selected out of 266 consecutively examined patients with pelvic venous disorders (PeVD). All participants underwent blood and urine tests, duplex ultrasound studies (DUS) of the renal and pelvic veins, and dynamic renal scintigraphy (DRS). Patients with LRVC and symptoms of pelvic venous insufficiency (PVI) and/or reflux in the left ovarian vein (LOV) further underwent ovarian vein resection or embolization. Follow-up clinical and laboratory evaluations, DUS, and DRS were performed 1 to 12 months after the intervention.ResultsLRVC was diagnosed in 23.6% of patients with PeVD, and was symptomatic in 11.3% and hemodynamically significant, according to DUS, in 4.9% of them. None of patients with LRVC had renal symptoms (pain in the left flank of the abdomen, hematuria) or impaired filtration and secretory dysfunction of the left kidney (LK), according to DRS. Symptomatic LRVC was accompanied by clinical manifestations of PeVD. Ovarian vein interventions were performed in 24 symptomatic patients and resulted in elimination of chronic pelvic pain (CPP) and pelvic venous reflux (PVR) in all cases. Follow-up examinations did not reveal any deterioration in the blood outflow through LRV or disturbances in the LK function after intervention in any patient.ConclusionsLRVC without hematuria does not deteriorate the LK filtration and secretory functions. Patients with symptomatic LRVC without hematuria can undergo isolated interventions on LOV. These interventions are effective in eliminating CPP and do not impair the LK function.