A case of reverse pelvic congestion syndrome?
Published in the J Vasc Interv Radiol, the authors present a case of a 52-year-old woman with May-Thurner syndrome who underwent left iliac vein stent placement 2.5 years ago at an outside institution presented with pelvic pain and pressure, dyspareunia, and right lower extremity swelling.

Iliac venogram showed a left common iliac vein stent bridging across the right common iliac vein inflow with a collateral network of pelvic varicosities draining via enlarged bilateral gonadal veins. Clinical presentation and imaging findings were suggestive of pelvic congestion syndrome, although in an uphill rather than downhill configuration. Right iliac vein thrombolysis and balloon angioplasty were performed, and symptoms resolved.

She presented 3 months later with symptom recurrence. Venography demonstrated recurrent stenosis in the previously treated right common iliac vein with recurrent pelvic varicosities and gonadal vein collateral flow.

A kissing iliocaval stent redirecting the originally malpositioned left common iliac vein stent away from the right common iliac vein lateral wall was placed. Following this procedure, symptoms resolved, and the stents remained patent through 18 months of follow-up.

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