Cor Vasa 2025, 67(3):393-401 | DOI: 10.33678/cor.2025.059

Pelvic venous disease

Mária Rašiováa, Martin Koščoa, Marek Hudáka, Veronika Pavlíkováa, Marta Bavoľárováb
a Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Šafárik University, Košice, Slovakia
b Department of Internal Medicine, Štefan Kukura Hospital, Michalovce, Slovakia

Pelvic venous disease is the second most common cause of chronic pelvic pain in women after endometriosis and accounts for 10-20% of gynecological consultations. Its main cause in women is reflux and incompetence of the left ovarian vein. In men, pelvic venous disease can manifest as varicocele and is often the result of venous obstruction in the iliocaval region. This article provides an overview of the symptoms, signs, dia- gnosis, and treatment of the most common causes of pelvic venous disease.

Keywords: Compression, Incompetence, Obstruction, Pelvic venous disease,

Received: October 18, 2024; Revised: March 26, 2025; Accepted: March 28, 2025; Prepublished online: June 2, 2012; Published: June 20, 2025  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Rašiová M, Koščo M, Hudák M, Pavlíková V, Bavoľárová M. Pelvic venous disease. Cor Vasa. 2025;67(3):393-401. doi: 10.33678/cor.2025.059.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Knuttinen MG, Xie K, Jani A, et al. Pelvic venous insufficiency: imaging diagnosis, treatment approaches, and therapeutic issues. AJR Am J Roentgenol 2015;2004:448-458. Go to original source... Go to PubMed...
    2. Bałabuszek K, Toborek M, Pietura R. Comprehensive overview of the venous disorder known as pelvic congestion syndrome. Ann Med 2022;54:22-36. Go to original source... Go to PubMed...
    3. De Maeseneer MG, Kakkos SK, Aherne T, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg 2022;63:184-267. Go to original source... Go to PubMed...
    4. Meissner MH, Khilnani NM, Labropoulos N, et al. The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. J Vasc Surg Venous Lymphat Disord 2021;9:568-584. Go to original source... Go to PubMed...
    5. Meissner MH, Gibson K. Clinical outcome after treatment of pelvic congestion syndrome: sense and nonsense. Phlebology 2015;30(1 Suppl):73-80. Go to original source... Go to PubMed...
    6. Chait J, Sen I, Kalra M. Nutcracker Syndrome: How to Diagnose It and When/How Should It Be Treated in the Pelvic Venous Disease Population. Tech Vasc Interv Radiol 2021;24:100734. Go to original source... Go to PubMed...
    7. Jeanneret C, Beier K, von Weymarn A, Traber J. Pelvic congestion syndrome and left renal compression syndrome - clinical features and therapeutic approaches. Vasa 2016;45:275-282. Go to original source... Go to PubMed...
    8. Ribeiro FS, Puech-Leão P, Zerati AE, et al. Prevalence of left renal vein compression (nutcracker phenomenon) signs on computed tomography angiography of healthy individuals. J Vasc Surg Venous Lymphat Disord 2020;8:1058-1065. Go to original source... Go to PubMed...
    9. Kashef E, Evans E, Patel N, et al. Pelvic venous congestion syndrome: female venous congestive syndromes and endovascular treatment options. CVIR Endovasc 2023;6:25. Go to original source... Go to PubMed...
    10. Chronic Pelvic Pain: ACOG Practice Bulletin, Number 218. Obstet Gynecol. 2020;135:e98-e109. Go to original source... Go to PubMed...
    11. Bendek B, Afuape N, Banks E, Desai NA. Comprehensive review of pelvic congestion syndrome: causes, symptoms, treatment options. Curr Opin Obstet Gynecol 2020;32:237-242. Go to original source... Go to PubMed...
    12. Antignani PL, Lazarashvili Z, Monedero JL, et al. Diagnosis and treatment of pelvic congestion syndrome: UIP consensus document. Int Angiol 2019;38:265-283. Go to original source... Go to PubMed...
    13. Khan TA, Rudolph KP, Huber TS, Fatima J. May-Thurner syndrome presenting as pelvic congestion syndrome and vulvar varicosities in a nonpregnant adolescent. J Vasc Surg Cases Innov Tech 2019;5:252-254. Go to original source... Go to PubMed...
    14. Gültaşli NZ, Kurt A, Ipek A, et al. The relation between pelvic varicose veins, chronic pelvic pain and lower extremity venous insufficiency in women. Diagn Interv Radiol 2006;12:34-38.
    15. Phillips D, Deipolyi AR, Hesketh RL, et al. Pelvic congestion syndrome: etiology of pain, diagnosis, and clinical management. J Vasc Interv Radiol 2014;25:725-733. Go to original source... Go to PubMed...
    16. Hiromura T, Nishioka T, Nishioka S, et al. Reflux in the left ovarian vein: analysis of MDCT findings in asymptomatic women. AJR Am J Roentgenol 2004;183:1411-1415. Go to original source... Go to PubMed...
    17. Mangla A, Hamad H. May-Thurner Syndrome. [Updated 2024 Mar 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554377/
    18. Knuttinen MG, Naidu S, Oklu R, et al. May-Thurner: diagnosis and endovascular management. Cardiovasc Diagn Ther 2017;7(Suppl 3):S159-S164. Go to original source... Go to PubMed...
    19. Nasser F, Cavalcante RN, Affonso BB, et al. Safety, efficacy, and prognostic factors in endovascular treatment of pelvic congestion syndrome. Int J Gynaecol Obstet 2014;125:65-68. Go to original source... Go to PubMed...
    20. Franceschi C, Bahnini A. Points de fuite pelviens viscéraux et varices des membres inférieurs. Phlébologie 2004;57:37-42.
    21. Kolber MK, Cui Z, Chen CK, et al. Nutcracker syndrome: diagnosis and therapy. Cardiovasc Diagn Ther. 2021;11:1140-1149. Go to original source... Go to PubMed...
    22. KW, Cho JY, Kim SH, et al. Diagnostic value of computed tomographic findings of nutcracker syndrome: correlation with renal venography and renocaval pressure gradients. Eur J Radiol 2011;80:648-654. Go to original source... Go to PubMed...
    23. Basile A, Failla G, Gozzo C. Pelvic Congestion Syndrome. Semin Ultrasound CT MR 2021;42:3-12. Go to original source... Go to PubMed...
    24. Arnoldussen CW, de Wolf MA, Wittens CH. Diagnostic imaging of pelvic congestive syndrome. Phlebology 2015;30(1 Suppl):67-72. Go to original source... Go to PubMed...
    25. Beard RW, Highman JH, Pearce S, Reginald PW. Diagnosis of pelvic varicosities in women with chronic pelvic pain. Lancet 1984;2:946-949. Go to original source... Go to PubMed...
    26. Labropoulos N, Borge M, Pierce K, Pappas PJ. Criteria for defining significant central vein stenosis with duplex ultrasound. J Vasc Surg 2007;46:101-107. Go to original source... Go to PubMed...
    27. Narese D, Bracale UM, Vitale G, et al. What the young physician should know about May-Thurner syndrome. Transl Med UniSa 2016;12:19-28.
    28. Park SJ, Lim JW, Ko YT, et al. Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. AJR Am J Roentgenol 2004;182:683-688. Go to original source... Go to PubMed...
    29. Ignacio EA, Dua R, Sarin S, et al. Pelvic congestion syndrome: diagnosis and treatment. Semin Intervent Radiol 2008;25:361-368. Go to original source... Go to PubMed...
    30. Heilijgers F, Gloviczki P, O'Sullivan G, et al. Nutcracker syndrome (a Delphi consensus). J Vasc Surg Venous Lymphat Disord 2025;13:101970. Go to original source... Go to PubMed...
    31. Wu Z, Zheng X, He Y, et al. Stent migration after endovascular stenting in patients with nutcracker syndrome. J Vasc Surg Venous Lymphat Disord 2016;4:193-199. Go to original source... Go to PubMed...
    32. Gavrilov SG, Vasilyev AV, Krasavin GV, et al. Endovascular interventions in the treatment of pelvic congestion syndrome caused by May-Thurner syndrome. J Vasc Surg Venous Lymphat Disord 2020;8:1049-1057. Go to original source... Go to PubMed...
    33. Lakhanpal G, Kennedy R, Lakhanpal S, et al. Pelvic venous insufficiency secondary to iliac vein stenosis and ovarian vein reflux treated with iliac vein stenting alone. J Vasc Surg Venous Lymphat Disord 2021;9:1193-1198. Go to original source... Go to PubMed...
    34. Gora KB, Wozniak S. Evaluation of effectiveness of pharmacological treatment in pelvic congestion syndrome. Ginekol Pol 2023. doi: 10.5603/GP.a2023.0078. Go to original source... Go to PubMed...
    35. Gavrilov SG, Karalkin AV, Moskalenko YP, Grishenkova AS. Efficacy of two micronized purified flavonoid fraction dosing regimens in the pelvic venous pain relief. Int Angiol 2021;40:180-186. Go to original source... Go to PubMed...
    36. Tsukanov YT, Tsukanov AY, Levdanskiy EG. Secondary Varicose Small Pelvic Veins and Their Treatment with Micronized Purified Flavonoid Fraction. Int J Angiol 2016;25:121-127. Go to original source... Go to PubMed...
    37. Gavrilov SG, Moskalenko YP, Karalkin AV. Effectiveness and safety of micronized purified flavonoid fraction for the treatment of concomitant varicose veins of the pelvis and lower extremities. Curr Med Res Opin 2019;35:1019-1026. Go to original source... Go to PubMed...
    38. Sator-Katzenschlager SM, Scharbert G, Kress HG, et al. Chronic pelvic pain treated with gabapentin and amitriptyline: a randomized controlled pilot study. Wien Klin Wochenschr 2005;117:761-768. Go to original source... Go to PubMed...
    39. O'Brien MT, Gillespie DL. Diagnosis and treatment of the pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord 2015;3:96-106. Go to original source... Go to PubMed...
    40. Gloviczki P, Comerota AJ, Dalsing MC, et al. Society for Vascular Surgery; American Venous Forum. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011;53(5 Suppl):2S-48S. Go to original source... Go to PubMed...
    41. De Gregorio MA, Guirola JA, Alvarez-Arranz E, et al. Pelvic venous disorders in women due to pelvic varices: treatment by embolization: experience in 520 patients. J Vasc Interv Radiol 2020;31:1560-1569. Go to original source... Go to PubMed...
    42. Liu J, Han L, Han X. The Effect of a Subsequent Pregnancy After Ovarian Vein Embolization in Patients with Infertility Caused by Pelvic Congestion Syndrome. Acad Radiol 2019;26:1373-1377. Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content


    Cor et Vasa

    You are accessing a site intended for medical professionals, not the lay public. The site may also contain information that is intended only for persons authorized to prescribe and dispense medicinal products for human use.

    I therefore confirm that I am a healthcare professional under Act 40/1995 Coll. as amended by later regulations and that I have read the definition of a healthcare professional.


    No
    Yes