SIR 2024
Women's Health
Abinaya Ramakrishnan, BA
Medical Student
David Geffen School of Medicine at UCLA
Financial relationships: Full list of relationships is listed on the CME information page.
Jessie K. Stewart, MD (she/her/hers)
Assistant Professor, Interventional Radiology
David Geffen School of Medicine at UCLA
Financial relationships: Full list of relationships is listed on the CME information page.
PeVD is a spectrum of disorders which may involve the common iliac veins, internal iliac veins, and/or ovarian veins. This includes pelvic congestion syndrome, which may affect nearly 30% of women and often occurs in premenopausal multiparous women. There are several pathophysiologic processes that may result in PeVD, including venous compression and incompetence of venous valves, which may often occur after the increased venous capacitance of pregnancy. PeVD commonly causes chronic pelvic pain that can present as unilateral or bilateral, often worsened with prolonged standing or sitting, which causes engorgement of pelvic varices. While medical management is often initially pursued, interventional treatments, such as ovarian or internal iliac vein embolization or venous stenting, as well as surgical management techniques may be pursued. The goal of this educational abstract is to not only review the pathophysiology and presentation of PeVD, but to also discuss current research about both the condition and treatment options, including ovarian vein embolization.
Clinical Findings/Procedure Details:
In this exhibit, we will discuss (1) relative anatomy of the pelvic region vessels for better understanding of the potential sites for varices and venous reflux; (2) the variable presentations of PeVD with ovarian vein reflux, iliac vein reflux, iliac vein compression, and renal vein compression anatomy; (3) common and uncommon presentations of PeVD including commonly missed signs and symptoms; (4) the state of PeVD research, especially in regards to ovarian vein embolization as a treatment modality; and (5) data necessary for the acceptance of PeVD as a condition but also to understand the most effective treatment strategy for patients.
Conclusion and/or Teaching Points:
PeVD is a significantly debilitating but treatable condition that often goes undiagnosed. Thus, there is a growing need for skilled interventionalists who can recognize the pathophysiology and symptoms of patients who present with PeVD and provide percutaneous treatments such as ovarian vein embolization. In conjunction, there is an imminent need to produce extensive, rigorous research in the PeVD space to better understand the effectiveness of different treatment options and also dispute medical policies of United States medical insurance carriers.