VI. Pelvic venous disease session
VI. Pelvic venous disease session
How to decide when pelvic venous reflux is clinically relevant and pelvic congestion syndrome
Neil Khilnani (New York, NY, US)
Pelvic venous reflux can be due to lower extremity and vulvar varicose veins. The symptoms can be lower limb swelling and/or claudication, left flank pain and/or hematuria. The new nomenclature for pelvic venous disorders consists of ovarian vein reflux, iliac vein reflux, renal vein compression, and iliac vein compression. The pathophysiology is clearly defined and inter-related and it can have an origin related to pelvic congestion, Nutcracker syndrome, and May-Turner syndrome. Pelvic venous disorders are relevant when it affects quality of life and it is necessary to treat to restore the health. In patients with pelvic venous reflux that is proven based on venogram data, pelvic pain predicts a pelvic venous disorder. The patient defines significance. Pelvic varicosities are often asymptomatic but can be the source of lower limb and vulvar varicosities. A total of 515 women with pelvic venous disorder, which was documented by venogram data, had lower extremity varicose veins that were mostly related to typical lower limb sources. Approximately 10% of lower extremity varicose veins have a pelvic origin, which are linked to pelvic escape points. There is little evidence to support primary embolization or stenting in varicose veins with a pelvic source. Only minimal improvement can be achieved for leg symptoms and lower extremity veins, but one study showed benefit for vulvar veins. Although there is not much literature supporting primary treatment of lower limb and vulvar varicose veins, these lower limb veins need treatment
