RS12 - Stenting for Symptomatic Left Renal Vein Compression Is Safe and Effective on Long-Term Follow Up

Objectives: The ideal treatment for left renal vein (LRV) compression continues to be debated, with several available open and endovascular options. Concerns about percutaneous stenting have been raised due to risk of stent migration, fracture, and erosion. This study aims to assess the long-term safety, patency, and effectiveness of LRV stenting.

Methods: A retrospective institutional chart review of all patients undergoing LRV stenting for LRV compression between 2010 and 2024 was conducted. Baseline characteristics, operative details, complications, re-interventions, and symptom resolution were collected. Standard descriptive statistics and survival analysis were used.

Results: A total of 44 patients were identified. Forty-three patients with complete follow up were included in the analysis. A total of 13 patients underwent LRV transposition for compression in the same time frame. Mean age was 42.6 years (range: 17.9-79.1) with an average body mass index of 22.2 kg/m2 (range: 15.2-42.5). Most of the patients were female (42/43) and white (41/43). The average clinical follow-up was 43.9 months (range: 0.9 to 153.7). Thirty patients had a concomitant diagnosis of pelvic congestion syndrome. Seven patients underwent stenting for recurrence after LRV transposition. Pelvic or lower abdominal pain was the most common presenting symptom (35/43), followed by flank pain (25/43) and hematuria (18/43). Thirty-nine patients received a single stent, while four had two stents at index procedure. The stent size ranged from 8-16mm in diameter (median 14mm) and 30-60mm in length (median 40mm). Dedicated venous stents were used in the majority of patients starting in 2020. IVUS was used in the majority of patients (32/43,74.4%). Sixteen patients underwent concomitant gonadal vein embolization. No major peri-operative complications were reported. Seven patients required re-intervention for stenosis or compression. Stent migration of 2 mm was reported in one patient, while another patient required stent explant due to persistent pain. No stent erosion, embolization, or vein pseudoaneurysm occurred (Table I). The primary patency was 86.5% at 12 months and 76.1% at 24, 36, and 48 months, while the primary-assisted patency remained at 100% (Fig 1). Symptom resolution was achieved in 88% (38/43) of patients up to 4 years follow up (22 complete, 16 partial). Two patients eventually underwent auto-transplantation, and two others underwent nephrectomy due to persistent pain despite patent stents.

Conclusions: LRV stenting for compression results in high symptom resolution and patency with no catastrophic stent complications at up to 4 years follow up. It should continue to be a treatment option if the expertise is available.