Pelvic vein incompetence: clinical perspectives

Area of Science:

• Gynecology
• Vascular Medicine
• Pain Management

Background:

• Chronic pelvic pain (CPP) affects numerous premenopausal women, leading to significant healthcare costs and diagnostic challenges.
• Up to 55% of women with CPP remain undiagnosed, with management focusing on symptom control rather than definitive treatment.
• Pelvic vein incompetence (PVI) is a potential, yet understudied, cause of CPP, particularly in women with symptoms similar to lower limb varicose veins.

Purpose of the Study:

• To explore the potential association between pelvic vein incompetence (PVI) and chronic pelvic pain (CPP).
• To review the current understanding of PVI development and its symptomatic presentation.
• To discuss evolving treatment modalities for PVI.

Main Methods:

• Literature review examining studies on PVI and CPP.
• Analysis of PVI pathophysiology, drawing parallels with lower limb venous insufficiency.
• Overview of historical and contemporary treatment approaches for PVI.

Main Results:

• The quality of evidence linking PVI to CPP is generally low, necessitating further investigation.
• Symptomatic PVI presents as a dull pelvic ache, exacerbated by standing/sitting and relieved by recumbency.
• Endovascular techniques offer lower-risk, lower-cost treatment options for PVI compared to older surgical methods.

Conclusions:

• PVI is a plausible contributor to CPP in women, especially when other causes are excluded.
• High-quality randomized controlled trials are lacking to establish definitive treatment guidelines for PVI.
• Endovascular interventions represent a promising, less invasive approach to managing PVI.