Retrospective Case Series in Patients With Suspected Pelvic Venous Disorder: The Use of Ultrasound in Diagnosis and Treatment of Complex Pelvic Venous Disease

Pelvic venous disorders encompass a broad range of conditions associated with pelvic venous insufficiency, often presenting in multiparous women as chronic pelvic pain and heaviness, vulvar and lower extremity varicosities, and other symptoms of venous congestion. Differential diagnoses of chronic pelvic pain include dysmenorrhea, pelvic venous disorders, endometriosis, and irritable bowel syndrome. Pathophysiology and treatment can vary significantly in pelvic venous disorder. Duplex imaging is an essential first-line tool in diagnosing and treating pelvic venous disorder. We performed a retrospective review of 3 multiparous female patients with suspected pelvic venous disorder, with an emphasis on the usage of duplex imaging for diagnosis and treatment. The first case involved a 32-year-old female gravida 3 with pelvic pain and varicosities postpartum. Transabdominal ultrasound revealed left ovarian vein reflux with retrograde flow and left renal vein compression. She underwent left ovarian vein embolization with significant improvement in symptoms. The second case involved a 42-year-old female gravida 2 with deep pelvic pressure and pelvic varicosities, symptoms worsening at night. Venography and intravascular ultrasound revealed left common iliac vein compression, left ovarian vein dilation, and left renal vein compression. She underwent left ovarian vein coil embolization, vein stenting, and sclerotherapy, which improved pelvic pain, but left flank pain persisted. She was referred out for surgical intervention. The third case involved a 29-year-old female gravida 4 with severe left pelvic pain around ovulation. Transabdominal ultrasound revealed left ovarian vein reflux with spontaneous retrograde flow, left renal vein compression, and left common iliac vein compression. After further diagnostic imaging, the patient underwent bilateral ovarian vein embolization with some improvement. These 3 cases demonstrate the complexity of pelvic venous disorder and the important role that duplex imaging plays in initial evaluation of patients with suspected pelvic venous disorder.