Case Series
The seven patients treated at our institution appear in Table 1 as
“present cases.” All seven complained of long-term severe left flank
and abdominal pain. Other symptomatology included hematuria of unknown
etiology and pelvic congestion symptoms. These patients had been treated
for non-specific pain. Many were on long term opioid therapy.
There were six females and one male. Age ranged from 19 to 58. Our
initial workup consisted of CT venography, which showed LRV enlargement
in all seven patients. IVUS was subsequently used in all seven patients
and showed LRV diameter and degree of compression supportive of NCS.
One patient underwent endovascular intervention with stenting. One had
gonadal vein transposition. Three underwent robot-assisted laparoscopic
LRV PTFE cuff placement. One had LRV bypass with PTFE. One had LRV
transposition (Figure 2). All patients reported reduced postoperative
pain. Some had lingering mild discomfort but opioid pain medications
were discontinued in all seven patients. They reported significant
improvements in quality of life and symptoms at follow up visits.