Improvement of quality of life in women ≤ 25-years-old with chronic pelvic pain following stenting of nonthrombotic iliac vein compression.

Abstract

Stenting of nonthrombotic iliac vein compression for chronic pelvic pain (CPP) is controversial, especially in young populations. The current study evaluated the effects of iliac vein stenting on CPP through the assessment of quality-of-life (QoL) and pain scores in female patients ≤25-year-old. A retrospective single site cohort study was conducted for 30 female patients who were treated with left common iliac vein (LCIV) stenting for CPP. QoL was assessed before and after stenting using the following assessments: International Pelvic Pain Society (IPPS), Pelvic Congestion Syndrome (PCS), Pelvic Pain and Urinary Urgency Frequency (PUF), Rome III IBS, ancillary symptoms assessment, and pain scores. Secondary evaluation of the accuracy of radiologic interpretations of iliac vein compression on CT and MRI was also performed. Finally, commonly associated comorbidities within this population were assessed. Patient reported outcomes in 30 iliac vein stent patients demonstrated improvements in QoL post-stenting as demonstrated through significant reductions in IPPS, PCS, and pain scores (p = .0103, .0156, and .0092, respectively). Many of the cross-sectional imaging studies that were read by the interpreting radiologist as normal or mild compression were later identified as moderate or severe by the interventional radiologist clinically evaluating the patient. These patients went on to show significant compression on venography and intravascular ultrasound with associated clinical improvement after stenting. Significant improvements in QoL were identified in young women with CPP after LCIV stenting. Similarities in the clinical presentation of common comorbidities and misinterpretation of cross-sectional imaging studies may make the identification of pelvic venous disease more challenging. Our findings endorse the need for further research on stenting in young women with venous origin CPP through comparative outcomes studies and blinded randomized controlled trials.