Pelvic Venous Insufficiency: Underdiagnosed and Often Mistaken for Other Conditions

By Russell Becker, DO, Vascular Surgeon

Individuals with peripheral vascular disease (PVD) have blood flow disruptions usually in the feet and legs, but it can also occur in the brain, arms, heart and pelvic region. When the blood vessels are narrowed or damaged, the blood flow becomes obstructed, and other complications can coincide.

Pelvic Venous Insufficiency (PVI)
Various forms of venous issues affect 25 million Americans, but PVI tends to get misdiagnosed. When our veins are working correctly, they pump blood back to the heart. Valves in the veins are made to open and close in one direction if these valves or the wall of the veins are damaged, the blood is unable to work against gravity, and the result is a pooling of the blood. With PVI, this blood congestion is in the pelvic region. This pooling is called stasis and can present significant risks to health. When blood begins to flow backwards and pool in the vein, it causes severe pain, pressure and bulging veins.

According to a study published in the American Journal of Roentgenology, Pelvic venous congestion is a commonly overlooked condition that can be severely painful and debilitating for many women. The term “pelvic congestion syndrome” is characterized by chronic, dull pelvic pain, pressure, and heaviness that persist for more than 6 months with no other cause. These symptoms are thought to be attributable to dilated, and congested veins. Because the pelvic varicosities are not externally visible, the diagnosis can be overlooked. Symptoms are exacerbated with menses, prolonged standing, and activities that increase abdominal pressure. The symptoms are worse at the end of the day.1

PVI is the standardized definition that specifically refers to the pathophysiologic mechanism of retrograde flow through incompetent ovarian and pelvic veins. The pathogenesis of PVI is multifactorial. Predisposing factors for the development of PVI include a family history of varicose veins, hormonal influences, previous pelvic surgery, a retroverted uterus, and multiple pregnancies Specifically, the increased demand on venous return as a result of pregnancy and hormonal influences leads to chronic venous distention that can render the valves incompetent, leading to reflux of blood down the ovarian veins and into the internal iliac veins of the pelvis. The accumulation of blood within the pelvic veins can cause further engorgement, thrombosis, and mass effect on nearby nerves, which can lead to worsening pelvic pain.1

PVI Symptoms
• Intense pain
• Abnormal menstrual bleeding
• Vaginal discharge
• Backache
• Depression
• Fatigue
• Increased urination
• Irritable bowel symptoms
• Painful menstruation
• Swelling of the vagina or vulva
• Abdominal and ovarian tenderness
• Hip pain
• Varicose veins around the vulva, buttocks, and legs

Treatment
Proper Diagnosis is critical. Physical examination, transvaginal doppler ultrasound, pelvic venogram, CT scan and MRI can effectively diagnose the condition. The most effective treatment is a minimally invasive surgical procedure called pelvic vein embolization (PVE). This procedure blocks off certain varicose veins that are causing the congestion and pain. Because lower extremity venous insufficiency is often a comorbidity, once the PVI is treated, the lower venous issues typically subside as well.

PVE is a minimally invasive treatment that closes off faulty veins so they can no longer enlarge with blood, which relieves the pain and pressure. A catheter is guided through. the femoral vein and into the damaged vein(s). In opposition of a stent, which opens an artery, the catheter delivers coils that clot the blood and seal the deficient vein. There is also a foam agent that can be used as a “glue” to close tiny veins that were not treatable in the past.

Russell Becker, DO, Vascular Surgeon
Dr. Becker received his fellowship training in vascular and endovascular surgery at Wayne State University in Detroit. He is board-certified by the American Osteopathic Board of Surgery, he’s a fellow of the American College of Osteopathic Surgeons, and he retains active memberships with the Society for Vascular Surgery and the Florida Vascular Society.

Dr. Becker has experience and interest in all areas of vascular and endovascular surgery, including treatment of conditions like carotid artery disease, hemodialysis access creation and maintenance, and diseases of the veins.

Beyond performing surgery, Dr. Becker is a well published author of vascular surgery literature. He has previously served as an investigator in numerous new and developing clinical device trials and has been a part of the clinical faculty in vascular surgery at Michigan State University College of Human Medicine in East Lansing, Michigan.

Vascular Center of Naples
5490 Bryson Dr. Suite 201
Naples, FL 34109
239-431-5884
www.vascularcenternaples.com