Pelvic Venous Insufficiency (PVI)
Studies show 30 percent of patients with chronic pelvic pain have pelvic venous insufficiency as the sole cause of their pain and an additional 15 percent have PVI along with another pelvic condition. Pelvic venous insufficiency is similar to varicose veins in the legs, but located in the ovarian and pelvic veins. In both cases, the valves in the veins that help return blood to the heart against gravity become weakened and don’t close properly. This allows blood to flow backwards and pool in the vein causing pressure and bulging veins. In the pelvis, varicose veins can cause pain and affect the uterus, ovaries and vulva.
Women with pelvic venous insufficiency are typically less than 45 years old, in their child bearing years, and have been pregnant in the past. Women are more at risk if they have had two or more pregnancies, hormonal increases or dysfunction, fullness of leg veins, or polycystic ovaries. The pain is usually felt in the lower abdomen and lower back and is dull and aching. It often increases during menstruation, pregnancy, while standing, at the end of the day, or following intercourse. Other symptoms include irritable bladder, abnormal menstrual bleeding or vaginal discharge, and varicose veins on vulva, buttocks or thigh.
The diagnosis is often missed because women lie down for a pelvic exam, relieving pressure from the ovarian veins, so that the veins no longer bulge with blood as they do while a woman is standing. Women who experience pelvic pain that worsens throughout the day when standing, should seek a second opinion with an AMI Interventional Radiologist. Patients should ask their primary physician or gynecologist for a referral. Once abnormalities and inflammation have been ruled out by a thorough pelvic exam, PVI can be diagnosed at AMI through several minimally invasive methods including, pelvic venography, MRI scan, CT scan, pelvic ultrasound, or transvaginal ultrasound. Once a PVI diagnosis is made, a minimally invasive procedure known as catheter-directed embolization can be performed by an Interventional Radiologist.