Left-Sided Varicocele as a Rare Presentation of May-Thurner Syndrome.

Conference Paper

BACKGROUND: May-Thurner syndrome (MTS), the clinical sequelae of left iliac vein compression between the right iliac artery and the spine, is an accepted cause of lower extremity edema and venous thromboembolism. It is more prevalent in younger women and typically presents with left lower extremity symptoms. Atypical presentations such as right-sided symptoms, chronic pelvic pain, and even fatal venous rupture have been reported. Here, we describe iliac vein compression presenting as a chronic left-sided testicular varicocele. METHODS: A 22-year-old man presented with left testicular varicocele, scrotal edema, and pain after failing multiple attempts at surgical repair. MRI revealed left iliac vein compression and marked cross-pelvic collaterals. Venography and intravascular ultrasound confirmed left common iliac vein compression and typical changes of MTS. There was no gonadal vein (GV) reflux. An iliac vein stent (WALLSTENT, Boston Scientific) was placed. RESULTS: A good technical result was achieved, with elimination of internal iliac vein reflux and marked reduction in pelvic collateral flow (see image). The patient reported resolution of his symptoms. CONCLUSIONS: Varicocele is a leading cause of testosterone insufficiency and infertility in young males. In the majority of cases, successful treatment can be achieved by addressing reflux in the internal spermatic vein (ISV) and/or GV by a variety of surgical or endovascular approaches. In unusual cases, the culprit pathology may be reflux in the vein of the vas deferens, which unlike the ISV and GV, drains into the internal iliac vein. In such cases, iliac vein compression usually associated with MTS may result in varicocele. To our knowledge, this is the first report of refractory varicocele secondary to iliac vein compression successfully treated with endovenous stenting.

Full Text

Duke Authors

Cited Authors

  • Stern, JR; Patel, VI; Cafasso, DE; Gentile, NB; Meltzer, AJ

Published Date

  • July 2017

Published In

Volume / Issue

  • 42 /

Start / End Page

  • 305.e13 - 305.e16

PubMed ID

  • 28258018

Electronic International Standard Serial Number (EISSN)

  • 1615-5947

Digital Object Identifier (DOI)

  • 10.1016/j.avsg.2016.12.001

Conference Location

  • Netherlands