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Patients with pelvic venous disease (PeVD) often present with localized lower extremity symptoms and signs related to pelvic origin nonsaphenous varices. A classification instrument is needed to recognize the variable but often overlapping clinical presentations and pathophysiology of PeVDs.

Venous and Lymphatic Disorders

The lymphatic system is an integrated part of the circulatory system that collects protein-rich fluid from body tissues and returns it to the blood vessels. It also collects fats from the gastrointestinal tract. Three to five liters of lymph circulate each day. The lymphatic system is prone to abnormalities that affect fluid homeostasis and the mediation of regional immune responses.

Most lymph passes through strategically placed lymph nodes, which filter out the damaged cells and foreign materials (lymphadenitis) and engulf infectious organisms. Cancers in lymph nodes and other organs can block the flow of lymph through the nodes.

A condition in which a person’s lymphatic system isn’t working normally and causes fluid buildup in the arms or legs (lymphedema). It can be caused by cancer, radiation therapy, surgery, some infections, tropical diseases such as filariasis, or congenital conditions such as Noonan syndrome, Generalized Spleen-Shutdown Disease, Kaposiform Lymphangiomatosis, or Lymphangioleiomyomatosis. Treatment involves manual lymphatic drainage and compression.

Varicose Veins

Varicose veins occur when valves in the veins malfunction and blood collects inside the vein, which makes it swell and twist. They're most common in the legs and feet. They can also be found in the groin and behind the knee.

Health experts aren't sure what causes varicose veins. However, they believe that hormones in women (like those caused by pregnancy and the use of birth control pills) can cause the walls of the vein to stretch. They also think that a family history of varicose veins can play a role.

Several treatments are available for varicose veins. The goal is to improve symptoms and prevent complications such as blood clots and leg ulcers. Home treatment includes wearing compression stockings, which decreases swelling and helps blood flow. You can also raise your legs above the heart three or four times a day for 15 minutes. Other treatments are sclerotherapy and surgical ligation and stripping of the varicose vein.

Abdominal Veins

The inferior vena cava (IVC) is the main vein that carries blood from the lower limbs and abdominopelvic region to the heart. This vein is also important to learn for anatomy exams because all the vessels supplying the abdomen and pelvis - from the stomach and duodenum, through the descending and sigmoid colon to the ileocolic and right colic veins - all drain into this vessel.

The superior mesenteric vein (SMV) - formed by the anterior and posterior cecal veins, appendix and ascending colon segments - unites with the splenic vein to form the main portal vein. Various mesenteric veins - including the jejunal, ileal, ileocolic and middle colic veins - then anastomose with this vein.

In patients with portosystemic shunt disease, increased pressure within the portal vein and splenic vein can cause reverse flow of blood through the short gastric (fundal) veins into the esophagus, leading to dilated fundal varices seen endoscopically as cherry-red spots (Fig 76-4). These are hemodynamically significant and should be treated with radiofrequency ablation. For more details please visit JVS 88

Pelvic Veins

The majority of the pelvic venous system drains into the internal iliac vein (IIV). The IIV receives tributaries from the inferior epigastric and deep circumflex iliac veins before draining to the superior and inferior gluteal veins, which carry venous return to the lower limb.

Pelvic varicosities (dilated veins) can result from abnormal pressure in the uterine and ovarian venous plexus due to poorly functioning valves or enlarged venous structures (fibroid tumors). This pressure is most commonly caused by multiple pregnancies, but may also be related to retroverted uterus or previous surgeries.

Symptoms of pelvic varicosities include pain upon standing and walking, dyspareunia (tenderness in the anal region) and menstrual symptoms. Pelvic varicosities can be characterized by ultrasound phlebography, and can be effectively treated with endovenous (percutaneous) embolization using synthetic glue or platinum-fiber coils. Several studies have shown significant improvements in quality of life following embolization, including symptomatic relief. Occasionally, a recurrent occurrence of symptoms after endovenous embolization has been reported.