Iliac vein compression syndrome: outcome of endovascular treatment with long-term follow-up

Objective

To retrospectively evaluate technical success and long-term outcome of endovascular treatment in patients with iliofemoral deep vein thrombosis (DVT) due to iliac vein compression syndrome (IVCS).

Materials and methods

Between March 2003 and September 2006, 36 consecutive patients (26 women [72%], 10 men, mean age 50 ± 18 years) with acute or chronic iliofemoral deep vein thrombosis due to iliac vein compression syndrome were evaluated for outcome of endovascular treatment. Stent patency was estimated by using the Kaplan–Meier method.

Results

Technical success was achieved in 34 of 36 patients (94%). Six patients with acute or subacute thrombosis had chronic occlusion of the left common iliac vein. Rethrombosis of the stents was observed in four patients. Primary and secondary patency rates were 85 and 94% at 1 year, and 80 and 82% at 4 years. Resolution of symptoms was achieved in 17 of 20 patients (85%) with acute and subacute DVT, and 4 of 16 patients (25%) with chronic DVT. Major complication was seen in one patient (3%).

Conclusion

Intimal changes in the left common iliac vein are mostly chronic in nature even in patients with acute DVT secondary to IVCS. Endovascular treatment with stent placement has a high technical success rate and good long-term patency in the treatment of acute and chronic DVT due to IVCS. Symptomatic improvement seems to be better in patients with acute than chronic DVT due to IVCS.     

磁共振血管成像在髂静脉受压综合征中的诊断价值

目的探讨磁共振血管成像(MRA)在髂静脉受压中的应用价值。方法对39例临床怀疑髂股静脉病变的患者进行2D-TOFMRA检查。结果MRA发现髂静脉受压24例,其中左侧髂总静脉受压17例,左侧髂总静脉和右侧髂外静脉同时受压4例,单纯右侧髂外静脉受压3例。结论2D-TOFMRA作为一种无创性检查,是诊断髂静脉受压的有效方法,有一定的临床价值。     

Computed tomography findings in 10 cases of iliac vein compression (May-Thurner) syndrome

OBJECTIVE: To present the computed tomography (CT) findings for the iliac veins of 10 patients who had left-sided lower extremity deep vein thrombosis due to iliac vein compression syndrome. MATERIALS AND METHODS: The CT findings for 10 cases of left-sided acute or chronic deep vein thrombosis caused by iliac vein compression syndrome were retrospectively evaluated. The patients were five women and five men (mean age+/-S.D., 49.9+/-15.6 years). In each patient with iliac vein compression syndrome, the diagnosis of the compression was established by venography performed during endovascular treatment. Diameter of the left common iliac vein was also measured in 14 control subjects without any lower extremity venous disease for comparison. RESULTS: In all 10 cases, CT images in the transverse plane demonstrated the left common iliac vein being compressed by the overlying right common iliac artery. The mean diameter at the origin of the left common iliac vein (3.5 mm) in patients group was much smaller than the mean diameter of the same vein (11.5 mm) in the control group (p<0.01). The mean percent stenosis of the left common iliac vein due to compression by the artery was 68%. CONCLUSION: Pelvic CT images in the transverse plane are useful for detecting iliac vein compression by the overlying right common iliac artery in patients with left-sided deep vein thrombosis. Radiologists should be aware of this imaging finding of iliac vein compression by the artery where the inferior vena cava bifurcates into the common iliac veins.     

“Right-Sided” May-Thurner Syndrome

The May-Thurner syndrome is a well-known anatomical anomaly where the left common iliac vein (LCIV) is compressed between the right common iliac artery and the fifth vertebral body. This report describes the case of a “right-sided” May-Thurner syndrome where the right common iliac vein (RCIV) is compressed by the left common iliac artery in a patient with a left-sided inferior vena cava (IVC). A 26-year-old woman was admitted to our institution with acute edema of the right lower limb. The diagnosis of May-Thurner syndrome was done by CT scan and confirmed by phlebography. An endovascular treatment with stenting was carried out, with good patency and clinical result at 12-month follow-up.     

Iliac vein compression syndrome: Outcome of endovascular treatment with long-term follow-up

ObjectiveTo retrospectively evaluate technical success and long-term outcome of endovascular treatment in patients with iliofemoral deep vein thrombosis (DVT) due to iliac vein compression syndrome (IVCS).Materials and methodsBetween March 2003 and September 2006, 36 consecutive patients (26 women [72%], 10 men, mean age 50 ± 18 years) with acute or chronic iliofemoral deep vein thrombosis due to iliac vein compression syndrome were evaluated for outcome of endovascular treatment. Stent patency was estimated by using the Kaplan–Meier method.ResultsTechnical success was achieved in 34 of 36 patients (94%). Six patients with acute or subacute thrombosis had chronic occlusion of the left common iliac vein. Rethrombosis of the stents was observed in four patients. Primary and secondary patency rates were 85 and 94% at 1 year, and 80 and 82% at 4 years. Resolution of symptoms was achieved in 17 of 20 patients (85%) with acute and subacute DVT, and 4 of 16 patients (25%) with chronic DVT. Major complication was seen in one patient (3%).ConclusionIntimal changes in the left common iliac vein are mostly chronic in nature even in patients with acute DVT secondary to IVCS. Endovascular treatment with stent placement has a high technical success rate and good long-term patency in the treatment of acute and chronic DVT due to IVCS. Symptomatic improvement seems to be better in patients with acute than chronic DVT due to IVCS.     

髂静脉受压综合征与单侧下肢肿胀

目的探讨髂静脉受压综合征在单侧下肢肿胀病因诊断中的意义及其介入治疗价值。方法左下肢肿胀者32例,经下肢静脉造影确诊为髂静脉受压,所有32例均以左股静脉为穿刺入路,以10或12mm直径的球囊对髂静脉受压或闭塞段行预扩张,然后置入直径为10～16mm的自膨式支架。所有病例术后口服抗凝药治疗6个月。结果所有病例左下肢肿胀均于术后2d内逐渐消失,无严重并发症发生。27例随访资料显示支架通畅率为100%,无深静脉栓塞发生。结论早期发现和治疗髂静脉受压能防止发生下肢深静脉血栓。     

Síndrome de Cockett o de May-Thurner o síndrome de compresión de la vena ilíaca

Iliac vein compression syndrome (also known as May-Thurner syndrome or Cockett's syndrome) is a rare clinical entity in which the left common iliac vein is compressed when it passes between the right common iliac artery and the spine. The sustained compression and trauma caused by the pulsatile force of the artery on the vein damage the intima and lead to the formation of membranes or bands in the vascular lumen that hinder or obstruct the flow of blood in the vein, favoring thrombus formation. The current treatment strategy of choice is endovascular vein patch angioplasty and stenting with the aim of improving the caliber of the lumen and enabling normal venous drainage. We present two cases of May-Thurner syndrome and review the clinical and CT findings.     

CT血管成像对髂静脉受压综合征及继发血栓形成的诊断价值

目的 探讨CTA对髂静脉受压综合征(IVCS)及继发血栓形成的临床应用价值.方法 回顾性分析80例正常对照组和经DSA证实的31例IVCS患者的CTA资料,测量2组受压髂静脉的前后内径,计算受压程度,并采用t检验和Wilcoxon秩和检验进行比较.以DSA为诊断标准,统计IVCS的CTA诊断符合率.结果 对照组受压左髂总静脉前后内径女性组为(7.0±2.5)mm,小于男性组(8.1±2.5)mm;t值=2.42,P＜0.05);左髂总静脉受压程度男性组(0～61.36%,中位数为26.82%)与女性组(0～65.41%,中位数为28.75%)差异无统计学意义(Z=-0.59,P＞0.05).对照组受压左髂总静脉前后内径为(7.6±2.0)mm,受压程度为0～65.41%,中位数为27.65%;IVCS组受压髂静脉前后径为(2.7±1.1)mm,髂静脉的受压程度为55.18%～100.00%,中位数为76.12%,受压髂静脉前后内径小于对照组(t=12.78,P＜0.05),受压程度大于对照组(Z=-8.18,P＜0.05).31例IVCS中,左髂总静脉受压28例,右侧髂总静脉受压2例,另1例左右髂总静脉分别受到左右髂总动脉压迫.15例继发髂股静脉血栓形成,CTA诊断结果均与DSA结果相符合.结论 CTA能准确测量受压髂静脉前后内径并判断受压程度,CTA还能清楚显示IVCS的继发髂股静脉血栓形成,是诊断IVCS的有效方法.     

Treatment of a Common Iliac Aneurysm by Endovascular Exclusion Using the Amplatzer Vascular Plug and Femorofemoral Crossover Graft

We report our initial experience using the Amplatzer Vascular Plug II (AVP2) in the treatment of a left common iliac aneurysm. Following investigation by computerized tomographic angiography and catheter angiography, a 79-year-old man was found to have a markedly tortuous iliac system, with a left common iliac artery aneurysm that measured 48 mm in maximal diameter. Due to the patient’s age and comorbidities the surgical opinion was that conventional open repair was not suitable. However, due to the tortuous nature of the aneurysm and iliac vessels, standard endovascular repair, using either a bifurcated or an aorto-uni-iliac stent graft, was also not possible. A combined approach was used by embolizing the ipsilateral internal iliac artery using coils and excluding the aneurysm using two AVP2 occlusion devices, followed by femorofemoral crossover grafting. Total aneurysm occlusion was achieved using this method and this allowed the patient to have a much less invasive surgical procedure than with conventional open repair of common iliac aneurysms, thus avoiding potential comorbidity and mortality.     

Atypical iliac vein compression in patients with symptomatic May–Thurner syndrome

PURPOSEWe aimed to investigate the incidence, etiology, treatment, and clinical course of atypical iliac vein compressions (AIVCs) among patients with May–Thurner syndrome (MTS).METHODSA total of 173 patients who presented with MTS were retrospectively analyzed at a single center. Computed tomographic venography (CTV) was used to diagnose MTS. An AIVC was defined as the compression of the left common iliac vein (LCIV) by structures other than the right common iliac artery (RCIA) or the compression of other venous structures in the pelvic cavity instead of the LCIV. The patients with AIVC were categorized into the LCIV compression group (category A) and non-LCIV compression group (category B).RESULTSTen patients with AIVC were identified (5.8%; male/female, 5/5), five in category A and five in category B. The median age of patients was 76 years (range, 51–94 years), and the median follow-up duration was 388 days (range, 12–4694 days). In category A, the LCIVs were compressed by the left common iliac artery (LCIA) (n=2), uterine leiomyoma (n=1), LCIA aneurysm (n=1), and RCIA aneurysm (n=1). In category B, the right common iliac veins were compressed by the RCIA (n=4) and L5 osteophyte (n=1). Endovascular treatment, including balloon angioplasty and stent placement, was performed in six patients, three from each group. Three patients underwent conservative treatment due to their advanced age and comorbidities. Endovascular aneurysm repair was performed in one patient with RCIA aneurysm. Follow-up images were available for six patients, and all of them had patent venous flow.CONCLUSIONThe AIVC had an incidence of 5.8% (10/173) among symptomatic MTS patients and wide spectrum of etiologies. Pathogenesis-tailored endovascular treatments are safe and effective.

May–Thurner syndrome (MTS) manifests with clinical symptoms such as unilateral lower extremity edema, pain, varicosities, and venous ulcer due to the compression of the left common iliac vein (LCIV) between the right common iliac artery (RCIA) and the fifth vertebral body predisposing one to deep vein thrombosis (DVT) and chronic venous insufficiency (1). Many anatomical variations of MTS, called as atypical iliac vein compressions (AIVCs) in this article, including right-sided MTS (2), compression of the LCIV by the ipsilateral internal iliac artery (3), and compression of the distal inferior vena cava (IVC) and LCIV by the RCIA have been sporadically reported (4). However, the incidence of AIVC has not been investigated, and the anatomic potential etiology of AIVC remains unknown because of the lack of a study with a large population sample. The treatment of choice for AIVC is also not well established because there are only few case reports regarding the management of AIVC. However, most previous cases have been treated by balloon angioplasty and endovascular stenting at the corresponding locations.The purpose of this study was to investigate the incidence of AIVC among patients with symptomatic MTS and to evaluate the safety and efficacy of endovascular treatments for AIVC. Anatomical causes of AIVC were also identified and classified.     

Compression of the left common iliac vein in asymptomatic subjects and patients with left iliofemoral deep vein thrombosis

PURPOSE: To retrospectively evaluate compression of the left common iliac vein as demonstrated at computed tomography (CT) in patients with iliofemoral deep vein thrombosis due to iliac vein compression syndrome (IVCS) and compare compression ratios with those of asymptomatic subjects. MATERIALS AND METHODS: Between March 2003 and June 2007, compression of the left common iliac vein by the right common iliac artery, as demonstrated with CT, in 34 patients (25 women and nine men; mean age, 51 years; age range, 21-79 years) with IVCS was retrospectively evaluated. Compression ratios were compared with those of 34 age- and sex-matched asymptomatic subjects. A t test was used to compare the compression ratios. RESULTS: The percentages of compression of the left common iliac vein were 45%-100% (mean, 74% +/- 17) for patients with IVCS and 0%-68% (mean, 28% +/- 20) for control subjects (P < .05). Of the 34 patients with IVCS, 11 (32%) had less than 70% compression and 23 (68%) had at least 70% compression. CONCLUSIONS: There was considerable overlap between the degree of compression in patients with IVCS and control subjects. Compression of the left common iliac vein was significantly more prominent in patients with lower extremity deep vein thrombosis due to IVCS when compared with control subjects. Compression in excess of 70% as demonstrated at CT can be helpful for identifying possible underlying IVCS in patients with a left lower extremity deep vein thrombosis.     

Intravascular ultrasound in the diagnosis and treatment of iliac vein compression (May-Thurner) syndrome

Intravascular ultrasound (IVUS) imaging and venography of the left common femoral and iliac veins were performed in 16 patients. The studies were evaluated for the anatomic cause of obstruction and how IVUS influenced endovascular management. IVUS demonstrated the cause of vessel compression in all 16 patients. Other findings, such as associated thrombus and guide wire localization within the residual vessel lumen, can modify the approach to intervention in as many as 50% of patients. IVUS is a useful adjunct in the diagnosis and endovascular management of iliac vein compression syndrome.     

髂静脉受压综合征及继发血栓形成的介入治疗

目的 探讨髂静脉受压综合征(ICS)及继发深静脉血栓形成(DVT)的介入治疗效果.方法 回顾性分析125例经DSA明确诊断为ICS及继发DVT的患者资料,其中单纯ICS患者39例,ICS继发DVT患者86例.对不伴有新鲜血栓的髂静脉受压及髂静脉狭窄、闭塞的患者行经皮腔内血管成形术和自膨支架置入术,对伴有髂、股静脉新鲜血栓的髂静脉受压患者在置入下腔静脉滤器后行经导管血栓抽吸、机械性血栓消融、腔内血管成形、支架置入术及经导管溶栓.采用卡方检验对单纯ICS患者及ICS继发DVT患者出院时和出院后6个月的治疗有效率和优良率进行比较.结果 39例单纯ICS患者中,38例实施了腔内成形和支架置入术;86例继发有DVT的ICS中,83例实施了各种腔内介入治疗.ICS患者及ICS继发DVT患者出院时的治疗有效率分别为97.4%(38/39)和96.5%(83/86),出院后6个月分别为96.3%(26/27)和90.2%(46/51),差异均无统计学意义(X2值分别为0.000和0.266,P值均>0.05);ICS患者及ICS继发DVT患者出院时的治疗优良率分别为94.9%(37/39)和79.1%(68/86),出院后6个月分别为92.6%(25/27)和68.6%(35/51),差异均有统计学意义(X2值分别为3.879和4.441,P值均<0.05).结论 介入治疗ICS及继发DVT安全、有效,并且应尽早发现和处理ICS.     

Endovascular management of iliac vein compression (May-Thurner) syndrome

PURPOSE: To evaluate the feasibility of endovascular techniques in treating venous outflow obstruction resulting from compression of the iliac vein by the iliac artery of the left lower extremity (May-Thurner syndrome). MATERIALS AND METHODS: A retrospective analysis of 39 patients (29 women, 10 men; median age, 46 years) with iliac vein compression syndrome (IVCS) was performed. Nineteen patients presented with acute deep vein thrombosis (DVT) and 20 patients presented with chronic symptoms. All patients presented with leg edema or pain. In the acute group, patients were treated with catheter-directed thrombolysis (120,000-180,000 IU urokinase/h) and angioplasty followed by stent placement. In the chronic group, patients were treated with use of angioplasty and stent placement alone (n = 8), or in combination with thrombolysis (n = 12). Patients were then followed-up with duplex ultrasound and a quality-of-life assessment. RESULTS: Initial technical success was achieved in 34 of 39 patients (87%). The overall patency rate at 1 year was 79%. Symptomatically, 85% of patients were completely or partially improved compared with findings before treatment. Thirty-five of 39 patients received stents. The 1-year patency rate for patients with acute symptoms who received stents was 91.6%; for patients with chronic symptoms who received stents, the 1-year patency rate was 93.9%. Five technical failures occurred. Major complications included acute iliac vein rethrombosis (< 24 hours) requiring reintervention (n = 2). Minor complications included perisheath hematomas (n = 4) and minor bleeding (n = 1). There were no deaths, pulmonary embolus, cerebral hemorrhage, or major bleeding complications. CONCLUSION: Endovascular reconstruction of occluded iliac veins secondary to IVCS (May-Thurner) appears to be safe and effective.     

Iliac vein compression syndrome: Clinical,imaging and pathologic findings

May-Thurner syndrome (MTS) is the pathologic compression of the left common iliac vein by the right common iliac artery, resulting in left lower extremity pain, swelling, and deep venous thrombosis. Though this syndrome was first described in 1851, there are currently no standardized criteria to establish the diagnosis of MTS. Since MTS is treated by a wide array of specialties, including interventional radiology, vascular surgery, cardiology, and vascular medicine, the need for an established diagnostic criterion is imperative in order to reduce misdiagnosis and inappropriate treatment. Although MTS has historically been diagnosed by the presence of pathologic features, the use of dynamic imaging techniques has led to a more radiologic based diagnosis. Thus, imaging plays an integral part in screening patients for MTS, and the utility of a wide array of imaging modalities has been evaluated. Here, we summarize the historical aspects of the clinical features of this syndrome. We then provide a comprehensive assessment of the literature on the efficacy of imaging tools available to diagnose MTS. Lastly, we provide clinical pearls and recommendations to aid physicians in diagnosing the syndrome through the use of provocative measures.     

Percutaneous Treatment of Deep Vein Thrombosis in May-Thurner Syndrome

Background/Purpose May-Thurner syndrome is an uncommon disease entity in which the left common iliac vein is compressed by the right common iliac artery with subsequent development of deep vein thrombosis and chronic venous insufficiency. We report our experience on the treatment of extensive iliofemoral deep venous thrombosis due to May-Thurner syndrome using endovascular techniques. Methods The study group comprised 21 patients (8 men, 13 women; mean age 51 years) diagnosed with May-Thurner syndrome by venogram. Eighteen patients were treated with catheter-guided thrombolysis; 3 patients with short segment involvement did not require thrombolysis. After completion of the thrombolytic therapy, the residual venous narrowing was treated by balloon angioplasty and/or placement of a self-expandable stent. Results The mean total dose of urokinase was 4.28 ± 1.89 million units, and the mean duration of infusion was 72 ± 35 hr. Eighteen of the 21 patients received stent deployment. The mean diameter of the stents was 12.9 ± 2.0 mm. Initial technical successes with immediate symptom resolution were achieved in 20 of the 21 patients (95%). We performed a follow-up venogram 6 months after procedure and checked clinical symptoms at outpatient clinics (mean follow-up duration 10.8 months). Among the patients who received stent implantation, 2 had recurrent thrombotic occlusion during the follow-up period. Three patients, who did not receive stent implantation, all had recurrent thrombosis. There were no major bleeding complications except in 1 patient who developed retroperitoneal hematoma. Conclusion Catheter-guided thrombolysis and angioplasty with stent implantation is a safe and effective method for the treatment of May-Thurner syndrome.     

以下肢深静脉血栓为首发症状的恶性肿瘤患者28例临床分析

【摘要】　目的?分析以下肢深静脉血栓（DVT）为首发症状的恶性肿瘤患者的临床特点,探讨下肢DVT与肿瘤关系。方法?回顾性分析2013年5月至2018年5月收治的342例特发性（无明显诱因）DVT患者的临床资料。结果?住院及随诊期间诊断恶性肿瘤患者28例,占新诊断特发性DVT患者8.2%。结论?特发性DVT患者,尤其是多发血栓、溶栓效果欠佳伴凝血功能异常的患者应高度警惕恶性肿瘤的发生。     

Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome

PURPOSE: The authors report their experience on the treatment of acute extensive iliofemoral deep venous thrombosis (DVT) due to May-Thurner syndrome using endovascular techniques. MATERIALS AND METHODS: During a 1-year period, 10 symptomatic women (age range, 22-52 years; mean, 35.5 years) were referred for treatment. After ascending venography, an infusion catheter system was placed and urokinase was infused locally into the thrombus burden. After near complete clot dissolution (> or = 95%) or lytic stagnation, the residual left common iliac vein narrowing was treated by means of angioplasty and/or placement of Wallstent endoprosthesis. All patients continued to receive oral warfarin. Patients were followed-up by means of clinic visits, and stent patency was assessed by means of duplex Doppler sonography performed at 1, 3, 6, and 12 months, and then yearly thereafter. RESULTS: The total dose of urokinase used and the duration of infusion were 5.87 +/- 2.57 million units (range, 3.18-10.7) and 51.95 +/- 21.57 hours (range, 26.5-89), respectively. After completion of thrombolytic therapy, the iliac vein narrowing was successfully treated by deployment of a Wallstent endoprosthesis in all 10 patients because of failure of angioplasty. No major bleeding complications occurred. Initial clinical success was 100%, with complete resolution of symptoms in all patients. One patient, who was hypercoagulable and was receiving chemotherapy for metastatic adenocarcinoma, had recurrent symptomatic acute DVT 1 month after therapy. She underwent successful repeated lysis. The remaining nine patients were asymptomatic, with a mean follow-up of 15.2 months (range, 6-36 months). One asymptomatic patient, at 36-month follow-up ultrasound, had iliac vein occlusion and well-developed venous collaterals. Serial ultrasonography in all 10 patients showed no evidence of valvular insufficiency in the femoral and popliteal veins. CONCLUSION: Catheter-directed thrombolytic therapy for the treatment of acute extensive iliofemoral DVT due to May-Thurner syndrome is an effective method for restoring venous patency and provides relief of the acute symptoms. The underlying left common iliac vein lesion invariably needs to undergo stent placement.     

May-Thurner syndrome and surgery for scoliosis

May-Thurner syndrome consists of the compression of the left iliac vein by the right iliac artery. We present the case of a 13-year-old girl with severe scoliosis and May-Thurner syndrome that became evident during surgery to correct the scoliosis. An initial attempt to treat the scoliosis employed a posterior approach using Isola instrumentation; however, the procedure was aborted due to the presence of enormous dilated perimedullary veins and hemorrhage. Angiography and venography confirmed the diagnosis of May-Thurner syndrome. Given the patient's age, the condition was not treated with an endovascular stent. She is currently awaiting definitive treatment. This is the first case in the literature in which varicose dilatation of the perimedullary veins in the spinal canal interfered with the surgical treatment of scoliosis. This case underlines the potential difficulties of surgery in the presence of myriad dilated perimedullary veins. May-Thurner syndrome should be suspected in scoliotic patients with dilated perimedullary veins.     

左精索-髂外静脉分流联合精索静脉高位结扎术治疗胡桃夹综合征合并精索静脉曲张临床资料分析

 目的 总结胡桃夹综合征(nutcracker syndrome, NCS)合并中重度左侧精索静脉曲张(varicocele,VC)的临床特点及手术方法。方法 回顾性分析2012-07至2019-07民航总医院收治NCS伴有左侧VC患者8例。年龄15～54岁,平均25岁;平均体重指数18.3。临床表现为阴囊坠胀、疼痛,查体为中重度的左侧VC,精液分析示少精症或弱精症,尿常规示红细胞(+～+++)、蛋白(+～++)。彩超及腹部血管强化CT示腹主动脉与肠系膜上动脉夹角缩小压迫左肾静脉,平均夹角23.4°,左肾静脉的肾门处与受压处直径比较高,平均为5.1。所有患者均行左精索-髂外静脉分流术联合左精索静脉高位结扎术,术中于腹膜后将左侧精索静脉离断,近端与左髂外静脉端侧吻合,远端结扎。结果 手术均获成功,无切口感染、血栓形成等并发症。随访6个月,患者阴囊症状消失,尿潜血和尿蛋白转阴,阴囊彩超未探及精索静脉反流,术后的左肾静脉肾门处与受压处直径比、精子活力a+b级比率较术前有明显好转,差异有统计学意义(P<0.001),术后精子密度与术前相比无统计学差异。结论 NCS是临床少见疾病,常合并VC、血尿、蛋白尿,左精索-髂外静脉分流联合精索静脉高位结扎术治疗NCS合并VC是安全、有效的。