Pelvic Venous Disorders

Abstract Venous disorders of the abdomen and pelvis are part of the spectrum of chronic venous disease and often play a role in lower extremity disease. The anatomy, pathophysiology, and treatment of pelvic venous disease are only beginning to be understood. Rather than being a disparate group of syndromes (e.g., May- Thurner, pelvic congestion, and nutcrackers syndromes), it is becoming clear that although much more complex, the abdominal and pelvic venous systems should be approached in a systematic way similar to the lower extremities. Reflux and/or obstruction in various components of the abdominal and pelvic veins often results in similar clinical symptoms, posing complex diagnostic and therapeutic questions. It is useful to consider the venous circulation of the pelvis to consist of three multiple interconnected venous systems—the left renal and ovarian veins, the iliac veins (common, external, and internal), and the lower extremity veins. The spectrum of pelvic venous disorders includes four clinical presentations—chronic pelvic pain, pelvic source varices of the leg, symptoms related to renal venous hypertension, and leg swelling. Venography has been the historical gold standard for the diagnosis of pelvic venous disorders. Improving the care of women with these disorders will require a better understanding of abdominal and pelvic venous anatomy; improved comprehension of the relative importance of pelvic venous reflux and obstruction in individual patients; validation of diagnostic protocols, particularly with respect to ultrasound; robust clinical trials evaluating the management of pelvic venous reflux and obstruction; and validated patient-centered outcome measures.