Anatomical, Pathophysiological, and Clinical Aspects of Extra-Pelvic Varicose Veins of Pelvic Origin

Venous hypertension in the pelvic veins can result in the development of varicosities in the perineum, and sometimes also in the lower extremities. These varicose veins are anatomically and functionally different from typical varicosities associated with an incompetence of the saphenous veins. Since the pelvic cavity is anatomically separated from the lower extremity and perineum by muscles and skeleton, there are only a few routes through which pelvic veins can communicate with extra-pelvic veins. These routes should primarily be examined during diagnostic workout. In this review article, clinical anatomy concerning varicose veins of pelvic origin is presented, and the anatomically-driven diagnostics for these atypical varicose veins are discussed. Focus on ultrasonographic detection of the escape points, which are located at the sites where the incompetent intra-pelvic and extra-pelvic veins are connected-such as the perineal veins, veins running alongside the round ligament of the uterus, the obturator vein, as well as the inferior and superior gluteal veins-is emphasized.