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Pelvic venous disease and lymphatic dysfunction: evaluating the evidence for a proposed continuum
Otmar R Wikkeling1, Marie J VAN Rijn2, Marianne E Witte3
1Division of Vascular Surgery, Department of Surgery, Nij Smellinghe Hospital, Drachten, the Netherlands - owikkeling@heelkundefriesland.nl.
The Journal of Cardiovascular Surgery
|June 25, 2026
Summary
Current evidence does not link pelvic venous disease (PeVD) and lymphedema. While a venous-lymphatic interaction is plausible, more integrated studies are needed to justify routine PeVD interventions for lymphedema.
Area of Science:
- Vascular Medicine
- Lymphology
- Medical Research Methodology
Background:
- Pelvic venous disease (PeVD) and lymphedema are typically viewed as separate conditions.
- Their coexistence in chronic edema patients suggests a potential venous-lymphatic interaction.
- This review examines the evidence supporting such a relationship.
Purpose of the Study:
- To systematically review literature on pelvic venous disorders and lymphatic dysfunction.
- To evaluate the evidence for a venous-lymphatic interaction in chronic edema.
- To distinguish between established evidence, indirect associations, and hypotheses.
Main Methods:
- Systematic-style literature review.
- Evaluation of published data on pelvic venous reflux, central venous obstruction, and lymphatic pathophysiology.
- Critical assessment of imaging and treatment outcomes.
Main Results:
- Evidence primarily from observational studies and reviews.
- Pelvic venous disease treatment shows variable outcomes for pain and edema.
- Objective lymphatic dysfunction is common in chronic venous disease, but pelvic venous impact is unevaluated.
Conclusions:
- No causal link established between pelvic venous disease and lymphedema.
- Venous-lymphatic interaction is biologically plausible but hypothesis-driven.
- Routine pelvic venous intervention for lymphedema is not evidence-based; integrated studies are needed.
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