Expanding on the Symptoms of Pelvic Venous Insufficiency (PVI): Improvement or Resolution of Non-reproductive Organ-related Symptoms After PVI Venous Interventions

Introduction, Objectives, and/or Purpose: Chronic pelvic pain (CPP) affects 30% of all women and accounts for 20% of outpatient GYN appointments, and PVI accounts for 30% of cases of CPP. International Association for the Study of Pain defines CPP as “Chronic persistent pelvic pain perceived in the structures related to [both sexes]. [Non-GYN symptoms are] suggestive of lower urinary track, bowel.” Still, general understanding of PVI symptoms remains limited to the reproductive system in both sexes for majority of vascular specialists. Our experience and literature reports show associative findings of chronic inflammation from venous congestion effect on adjacent nerves, hip and lower back , genitourinary, and possibly pelvic lymphatic system. The purpose of this study is to suggest that PVI affects several other systems present in the pelvis.

Methods: A single-center 289 pts with Non-Thrombotic Iliac Vein Lesion (NIVL) treated with iliac venous stenting were analyzed for improvement and resolution of symptoms other than lower extremity and reproductive symptom. A literature review was conducted on papers reporting PVI presenting with non-gynecological symptoms.

Results: Of 289 patients with NIVL, 72 (25%) pts reported symptoms that are unrelated to reproductive system. Recurrent UTI or persistent UTI-like symptoms were present in 29 pts (40%), and improvement or resolution of symptoms (IORS) were seen in 17 pts (57%). Lower back or hip pain unexplained by spine evaluation was present in 31 pts (43%) with IORS in 12 pts (40%). GI symptoms including abdominal pain, bloating, constipation, nausea, vomiting as well as diagnosis of Irritable Bowel Syndrome were reported in 17 pts (23%) with IORS in 10 patients (60%). Headaches and migraines were present in 11 pts (16%) with IORS in 5 pts (45%). Being always being tired, or having diagnosis of chronic fatigue syndrome were present in 11 pts (16%), and IORS in 5 pts (45%). A literature review demonstrated above non-reproductive system symptoms of CPP improvement after PVI interventions which demonstrated, but not limited to, gastrointestinal, urinary, and hip and back symptoms similar to our findings.

Conclusion(s): PVI is a significant etiology of chronic pelvic pain. A combined findings from our experience and a literature review, demonstrates that subset of patients with PVI interventions have broader symptomatic relief than ones limited to the reproductive system. Inclusion of these symptoms as a part of PVI would be useful in better understanding of broader symptoms of PVI. Multidisciplinary collaboration is important for accurate identification and diagnosis leading to appropriate therapeutic options.