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

Publication ,  Conference
Stern, JR; Patel, VI; Cafasso, DE; Gentile, NB; Meltzer, AJ
Published in: Ann Vasc Surg
July 2017

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.

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Published In

Ann Vasc Surg

DOI

EISSN

1615-5947

Publication Date

July 2017

Volume

42

Start / End Page

305.e13 / 305.e16

Location

Netherlands

Related Subject Headings

  • Young Adult
  • Varicocele
  • Ultrasonography, Interventional
  • Treatment Outcome
  • Stents
  • Regional Blood Flow
  • Phlebography
  • Pain
  • May-Thurner Syndrome
  • Male
 

Citation

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ICMJE
MLA
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Stern, J. R., Patel, V. I., Cafasso, D. E., Gentile, N. B., & Meltzer, A. J. (2017). Left-Sided Varicocele as a Rare Presentation of May-Thurner Syndrome. In Ann Vasc Surg (Vol. 42, pp. 305.e13-305.e16). Netherlands. https://doi.org/10.1016/j.avsg.2016.12.001
Stern, Jordan R., Virendra I. Patel, Danielle E. Cafasso, Nicole B. Gentile, and Andrew J. Meltzer. “Left-Sided Varicocele as a Rare Presentation of May-Thurner Syndrome.” In Ann Vasc Surg, 42:305.e13-305.e16, 2017. https://doi.org/10.1016/j.avsg.2016.12.001.
Stern JR, Patel VI, Cafasso DE, Gentile NB, Meltzer AJ. Left-Sided Varicocele as a Rare Presentation of May-Thurner Syndrome. In: Ann Vasc Surg. 2017. p. 305.e13-305.e16.
Stern, Jordan R., et al. “Left-Sided Varicocele as a Rare Presentation of May-Thurner Syndrome.Ann Vasc Surg, vol. 42, 2017, pp. 305.e13-305.e16. Pubmed, doi:10.1016/j.avsg.2016.12.001.
Stern JR, Patel VI, Cafasso DE, Gentile NB, Meltzer AJ. Left-Sided Varicocele as a Rare Presentation of May-Thurner Syndrome. Ann Vasc Surg. 2017. p. 305.e13-305.e16.
Journal cover image

Published In

Ann Vasc Surg

DOI

EISSN

1615-5947

Publication Date

July 2017

Volume

42

Start / End Page

305.e13 / 305.e16

Location

Netherlands

Related Subject Headings

  • Young Adult
  • Varicocele
  • Ultrasonography, Interventional
  • Treatment Outcome
  • Stents
  • Regional Blood Flow
  • Phlebography
  • Pain
  • May-Thurner Syndrome
  • Male