Abstract
The causes of chronic pelvic pain (CPP) in patients with pelvic venous disorder (PeVD) are not completely understood. Various authors consider dilation of pelvic veins (PeVs) and pelvic venous reflux (PVR) as the main mechanisms underlying symptomatic forms of PeVD. The aim of this study was to assess relationships of pelvic vein dilation and PVR with clinical manifestations of PeVD. This non-randomized comparative cohort study included 80 female patients with PeVD who were allocated into two groups with symptomatic (n = 42) and asymptomatic (n = 38) forms of the disease. All patients underwent duplex scanning and single-photon emission computed tomography (SPECT) of PeVs with in vivo labeled red blood cells (RBCs). The PeV diameters, the presence, duration and pattern of PVR in the pelvic veins, as well as the coefficient of pelvic venous congestion (CPVC) were assessed. Two groups did not differ significantly in pelvic vein diameters (gonadal veins (GVs): 7.7 ± 1.3 vs. 8.5 ± 0.5 mm; parametrial veins (PVs): 9.8 ± 0.9 vs. 9.5 ± 0.9 mm; and uterine veins (UVs): 5.6 ± 0.2 vs. 5.5 ± 0.6 mm). Despite this, CPVC was significantly higher in symptomatic versus asymptomatic patients (1.9 ± 0.4 vs. 0.7 ± 0.2, respectively; p = 0.008). Symptomatic patients had type II or III PVR, while asymptomatic patients had type I PVR. The reflux duration was found to be significantly greater in symptomatic versus asymptomatic patients (median and interquartile range: 4.0 [3.0; 5.0] vs. 1.0 [0; 2.0] s for GVs, p = 0.008; 4.0 [3.0; 5.0] vs. 1.1 [1.0; 2.0] s for PVs, p = 0.007; and 2.0 [2.0; 3.0] vs. 1.0 [1.0; 2.0] s for UVs, p = 0.04). Linear correlation analysis revealed a strong positive relationship (Pearson’s r = 0.78; p = 0.007) of CPP with the PVR duration but not with vein diameter. The grade of PeV dilation may not be a determining factor in CPP development in patients with PeVD. The presence and duration of reflux in the pelvic veins were found to be predictors of the development of symptomatic PeVD.
Highlights
The dilation of pelvic veins and reflux in them are associated with the presence of chronic pelvic pain (CPP) in 60–76% of patients with pelvic venous disease (PeVD) [1,2,3,4,5]
Ganeshan et al reported that PeV dilation of greater than 8 mm can be a criterion for the diagnosis of PeVD [6]
The linear correlation between PeV diameters and the presence of clinical manifestations of PeVD was weak (r = 0.18), which indicates a minor influence of this factor. These findings suggest that in symptomatic patients, the pathological process involves a greater number of refluxing pelvic veins, as compared to asymptomatic patients
Summary
The dilation of pelvic (parametrial, uterine and gonadal) veins and reflux in them are associated with the presence of chronic pelvic pain (CPP) in 60–76% of patients with pelvic venous disease (PeVD) [1,2,3,4,5]. According to the UIP consensus document, the dilation of pelvic veins (PeVs) is defined as an increase in their diameter of greater than 5 mm, and the pelvic venous reflux (PVR) is considered pathological if it lasts for greater than 1 s [2]. PVR of greater than 2 s in several pelvic venous collecting pools was found to be associated with severe CPP [4]. Whiteley et al have repeatedly pointed out that the presence of reflux and its duration are major determinants of the severity of the Diagnostics 2022, 12, 145.
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