Clinical profile of female patients with pelvic venous disorders: A comparative study of symptomatic and asymptomatic forms

Diagnosis of pelvic venous disorders (PeVD) is complicated by non-specific symptoms, deep location of the pelvic veins, and low awareness of the disease among clinicians. Aim To study clinical manifestations of PeVD and reveal their determinants by comparing symptomatic and asymptomatic patients. Methods This prospective, cross-sectional, observational study consecutively enrolled 287 females with PeVD verified by duplex ultrasound. Characteristics of the venous-origin chronic pelvic pain (VO-CPP) and other PeVD symptoms and signs, as well as pelvic venous reflux duration and distribution were studied. Results Predictors for symptomatic PeVD were asthenic habitus and body mass index <19 kg/m 2 (OR 5.8, p < 0.05). Clinical manifestations included symptoms of pelvic venous insufficiency (PVI) regardless of the presence of left renal vein (LRVC) or left common iliac vein compression (LCIVC). VO-CPP was identified in 90.5% of patients mostly as a dull, aching pain (60.5%) located in the hypogastrium (51.0%), which increased after load and in the second phase of the menstrual cycle (72.4%) and decreased in the lying position (78.6%). Severe VO-CPP was most prevalent in patients with LCIVC (33.7%). Heaviness in the hypogastrium and dyspareunia were common (60.5% and 56.7% patients) and significantly affected sociopsychological status. Dyspareunia and VO-CPP were associated with type II/III reflux and multi-collector venous lesions. Significant LRVC and LCIVC were predictors for severe PeVD with OR 22.0 and 6.2, respectively (both p < 0.05). Vulvar, gluteal and thigh varicosities were detected in 29% of patients along with internal iliac vein reflux in 79.3% of them. Headaches, orthostatic tachycardia and hypotension were detected in 46.2%, 40.1%, and 32.8% of symptomatic cases. Conclusion Symptomatic course of PeVD is characterized by various clinical manifestations of PVI, with its most common and severe symptom – VO-CPP, and multiple lesions of pelvic and retroperitoneal veins, with prolonged reflux in two or more pelvic venous collectors.