[Multiple venous compression syndromes in sequential evolution: a case report with intravascular ultrasound guided...

Venous compression syndromes, such as nutcracker syndrome (NCS) and May-Thurner syndrome (MTS), are rare entities with a complex diagnosis due to their nonspecific symptoms. The coexistence of multiple compression syndromes is exceptional. We present the case of a 38-year-old woman with a history of chronic abdominal and pelvic pain, initially diagnosed with symptomatic NCS associated with pelvic congestion syndrome, successfully treated with venous angioplasty and stent placement guided by intravascular ultrasound (IVUS) with improvement of the symptoms after the treatment. Four years later, the patient developed symptomatic MTS, which worsened the pelvic congestion and required a new endovascular intervention with placement of a dedicated venous stent, also optimized with IVUS. This case highlights the rarity of sequential progression from NCS to MTS and underscores the importance of maintaining a high index of suspicion in young women with chronic pelvic pain. We here in report a case of pelvic congestion syndrome caused by sequential NCS and MTS, resolved with IVUS-optimized endovascular treatment at both stages.