Woman & Pelvic Venous Insufficiency (PVI)
What is PVI?
Pelvic venous insufficiency (PVI), occurs when a patient has broken valves inside their gonadal (ovarian) veins. Previously, this disease was referred to as Pelvic Congestion Syndrome; however, the term PVI identifies the root cause of the patient's symptoms.
Instead of ovarian veins bringing blood up and out of the pelvis, the leaky valves cause the blood to be pulled by gravity in the wrong direction. This causes swelling in the pelvic veins.
What are the symptoms of PVI?
PVI tends to present as chronic cramping and pelvic pain.
While this condition is not exclusive to women, PVI is often a misdiagnosis in women. More than 30% of women in a gynecologist's office report feeling Chronic Pelvic Pain (CPP). However, 10% or more of these women with CPP have no diagnosis of their condition. "The American College of Gynecology and Obstetrics have no mention of pelvic venous insufficiency (PVI) as a cause on their website's patient information page" (Vein Therapy News, Aggarwal, p 26).
How is PVI Treated?
There is no universal and ultimate decision on the best course of treatment for PVI. Most insurance companies still consider Pelvic Vein Reflux to be "investigational."
One "investigational" treatment that is gaining popularity through clinical effectiveness is The BlueLeaf System by InterVene. This is a new system which is gaining popularity in treating deep vein reflux.
"The system allows a physician to fashion new valves from the inner layer of the vein wall. The resulting "autogenous" values aim to reduce retrograde blood flow and alleviate the symptoms associated with elevated venous pressures" (Vein Therapy News, Aggarwal, p 27).
The question then becomes: how do we change this mindset? Up to 40% of women have ovarian reflux. Patterns must be identified to link PVI to Chronic Venous Insufficiency. Venous reflux in ovarian veins in the pelvis can give rise to venous reflux exhibited in the greater saphenous veins (GSV) more distally. Therefore, women with venous insufficiency in their GSV should consider being tested for PVI.
What is the best way to diagnose PVI?
Historically, Pelvic Congestion Syndrome has been diagnosed with CT scan or MRI. Recently, studies have shown that CT/MRI may misdiagnose or overestimate the size of the vessels. The best method for measuring ovarian vein sizes and reflux is by using both a transabdominal and a transvaginal ultrasound.
Why is it so important to properly diagnose PVI?
When a patient presents with deep pain in her pelvis with long periods of sitting or standing, her symptoms can sometimes be dismissed as CPP. After years of medicating with pain pills, these patients may undergo a partial hysterectomy. Unfortunately, because of the misdiagnosis, these women will continue to experience pain even after the surgery.
If you experience chronic pelvic pain, and your gynecologist has not been able to pinpoint a diagnosis for you, consider contacting a vascular surgeon.
Aggarwal, Manu. “First Step: Recognition - Pelvic Venous Insufficiency, Reflux Recognition, Diagnosis.” Vein Therapy News, Sept. 2019, pp. 26–27.