Insights into pelvic venous disorders

Abstract

Pelvic venous disorders (PeVD), sometimes referred to as pelvic congestion syndrome (PCS), widely impact affected patients–mainly young women’s quality of life, causing puzzling, uncomfortable symptoms sometimes requiring months or years to get an explanation, while simply remaining undiagnosed in other cases. Because pelvic pain is a non-specific symptom, an appropriate diagnosis requires a careful patient workup, including a correlation between history and non-invasive imaging. Invasive imaging is frequently required to confirm the diagnosis and plan treatment. Current therapeutic approaches principally rely on minimally invasive techniques delivered through endovascular access. However, while comprehensive descriptive classifications such as the symptoms-varices-pathophysiology (SVP) classification exist, universally accepted guidelines regarding therapy to apply for each SVP category are still lacking. This review strongly focuses on PeVD imaging and discusses available therapeutic approaches with regard to pathophysiological mechanisms. It proposes a new classification scheme assisting clinical decision-making about endovascular management to help standardize the link between imaging findings and treatment.

Vascular Diseases in Women: Do Women Suffer from Them Differently?

“…This spectrum of clinical manifestations presents as various combinations of anatomical zones, etiology, and hemodynamic disturbances. Therefore, to avoid misdiagnosis and missing rare cases, we need to consider patient symptoms based on the main elements of PCS, including anatomical zones, etiology, and hemodynamic disturbances [144,146].…”

“…Based on the SVP classification, which includes symptoms (S), varices (V), and a pathophysiologic domain, which is a composite anatomic-hemodynamicetiologic domain (P), the inferior vena cava, left renal vein, gonadal veins, iliac veins, and pelvic escape veins are anatomic segments of this classification. Also, the underlying pathological hemodynamic can be reflux or obstruction, and the etiology can be thrombotic, non-thrombotic, or congenital [144,146]. In addition, there are other factors involved in the pathogenesis of PCS, including estrogen, inflammation, vasoactive peptides such as endothelin, calcitonin gene-related peptide (CGRP) and substance P (SP), and nociceptive mechanism, which activates the autonomic nervous system by sexual and non-sexual stimuli, and neuropathic and psychogenic mechanisms [147,148].…”

“…The third group of symptoms is subdivided into symptoms localized to the external genitalia or lower extremities, including reflux-related symptoms, symptoms related to posteromedial thigh, sciatic/tibial nerve varices, and venous claudication associated with iliocaval venous obstruction. Also, renal hilar varices, pelvic varices, and pelvic origin extra-pelvic varices are varices classifications related to the anatomical zones [142,144,146].…”

Apples and oranges in pelvic venous disorders: Heterogeneity and best practice

“…Identifying the different hemodynamic patterns and features, together with their correlation to the clinical manifestations, remains of fundamental importance to deliver proper recommendations for the management of different conditions grouped by the pelvic venous disorders terminology, but that remain characterized by different pathophysiology and clinical scenarios [19,20].…”

Is there a place for a (Virtual) European Network and reference centers on Pelvic Venous Disease (PeVD)? Thinktank?

“…However, such an initiative would likely require careful planning, funding, and support to be successful. Here are some considerations for the creation of a network and reference centers [3][4][5][6].…”