Pelvic Venous Reflux Diseases

Review Article

J Fam Med. 2020; 7(1): 1190.

Pelvic Venous Reflux Diseases

Arbid EJ* and Antezana JN

South Charlotte General and Vascular Surgery, 10512 Park Road Suite111, Charlotte, USA

*Corresponding author: Elias J. Arbid, South Charlotte General and Vascular Surgery, 10512 Park Road Suite111, Charlotte, NC 28120, USA

Received: November 19, 2019; Accepted: January 07, 2020; Published: January 14, 2020


Varicose veins and chronic venous insufficiency are common disorders of the venous system in the lower extremities that have long been regarded as not worthy of treatment, because procedures to remove them were once perceived as worse than the condition itself. All too frequently, patients are forced to learn to live with them, or find "creative" ways to hide their legs. The treatment of varicose veins is most successful when the point of superficial reflux in the leg, particularly at the saphenofemoral junction is eliminated. The endo-venous ablation procedure decreases the elevated venous pressure even in secondary varicosities leading to their resolution. The relatively simple office-based procedure allows patients to return to work early with minimal morbidity and has long-lasting results. Remaining varicosities are then eliminated with phlebectomy or chemical ablation.

Yet, it remains widely unrecognized that 15-20% of patients who present with superficial venous disease have a more proximal source of reflux in the pelvis and may require evaluation and treatment of their “pelvic reflux disease” as well [1,2]. More importantly, unidentified and untreated PVR can be a major cause of recurrent leg varicose veins in up to 30% of patients [3], and in 35% of patients who present with non-saphenous venous reflux [4]. Our lack of understanding of the common occurrence of pelvic venous reflux as well as the close interplay between chronic pelvic pain, pelvic varices, with chronic superficial venous insufficiency in lower extremities and varicose veins has hindered our ability to treat many patients effectively. Patients are often told that their vulvar and thigh varicose veins (particularly if occurring following a pregnancy) will get better by themselves, and patients are never informed that these varicosities may well be secondary to pelvic venous reflux [5,6]. Noteworthy is the fact that many patients with unusual varicosities in the gluteal, flank, and posterior thighs may have a normal venous duplex examination with no traditional truncal or saphenous reflux. Therefore, it is not surprising that many patients are not referred and are not able to get appropriate treatment of their pelvic venous reflux disease. Lastly, even doctors who have some knowledge of pelvic congestion syndrome often think that the condition is restricted to females and do not diagnose pelvic reflux disease in males. Of particular significance is the presentation of a young male patient with a painful left varicocele in whom further evaluation is mandatory to rule out left renal vein thrombosis or compression by a renal tumor.

Anatomic Considerations

Each ovary is drained by a plexus forming one major vein measuring normally 5mm in size. The left ovarian plexus drains into left ovarian vein, which empties into left renal vein; the right ovarian plexus drains into the right ovarian vein, which drains into the anterolateral wall of the inferior vena cava (IVC) just below the right renal vein. An interconnecting plexus of veins drains the ovaries, uterus, vagina, bladder, and rectum (Figure 1).