Iliac vein stent placement in the treatment of pelvic venous disorders in women: A systematic review

BackgroundCompression stenosis of the left common iliac vein (LCIV) in combination with pelvic venous insufficiency (PVI) represents a form of pelvic venous disorders (PeVDs). Iliac vein stent placement (IVSP), aimed at restoring adequate blood flow through the iliac veins, is considered an optimal treatment for this disorder.AimTo evaluate the efficacy and safety of IVSP in the treatment of PVI based on a systematic analysis of literature data.MethodsAn analysis of publications on use of IVSP in the treatment of a combination of LCIV compression and PVI from the PubMed, Scopus, and Web of Science databases for the period from January 2000 to December 2023 was carried out. Eligible were reports from randomized pro- and retrospective cohort studies and case series for more than 10 patients with the clinical and radiological data used to confirm indication for LCIV stenting and to assess the status of iliac and pelvic veins after the procedure. Isolated clinical cases, comments, letters, duplicate articles, publications on IVSP in patients without PVI symptoms and signs or describing the treatment of chronic venous and post-thrombotic diseases were excluded. The risk of bias was assessed using the ROB-ME tool for systematic reviews.ResultsA total of eight studies representing data of 1605 patients with a combination of LCIV compression and PVI were selected. The efficacy of isolated IVSP in relieving CPP and other symptoms and signs of PVI ranged from 16% to 80%. Gonadal vein embolization (GVE) after IVSP was required in 20 to 84% of cases. Complications related to IVSP had low SIR class and occurred in less than 1% of cases.ConclusionThe primary LCIV stenting is an effective and safe treatment for patients with LCIV compression and PVI, while GVE should be reserved as second line treatment in case of its clinical failure.