SIR 2024
Women's Health
Victoria A. Risner, BS
Medical Student
UNC Chapel Hill
Financial relationships: Full list of relationships is listed on the CME information page.
Estefania Gonzales (she/her/hers)
Medical Student
UNC School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Nicole Keefe, MD (she/her/hers)
Assistant Professor, Program Director
University of North Carolina at Chapel Hill
Financial relationships: Full list of relationships is listed on the CME information page.
Priya Mody, MD (she/her/hers)
Assistant Professor
University of North Carolina at Chapel Hill
Financial relationships: Full list of relationships is listed on the CME information page.
Gloria Salazar, MD (she/her/hers)
Vice Chair Diversity and Health Equity
UNC
Financial relationships: Full list of relationships is listed on the CME information page.
Diagnostic criteria for Pelvic Venous Disorders (PeVD) include pelvic venous reflux with varices and/or obstruction identified via imaging studies. However, these findings can be seen in asymptomatic patients as well, emphasizing the need to identify possible factors that influence patients' development of symptomatic disease. This study aims to compare imaging patterns, medical history, and clinical markers in symptomatic and asymptomatic patients presenting with pelvic varices.
Materials and Methods:
In this retrospective study, female patients who had imaging studies between January 2013 and August 2023 were included. Patients who presented with para-uterine veins > 5mm in diameter in imaging studies and without a history of malignancy were included and categorized as controls (asymptomatic patients with vessel dilation) and PeVD (symptomatic patients with vessel dilation). Data collected included patient demographics, clinical markers, medical, surgical, and social history, and imaging findings suggestive of PEVD (ovarian vein dilatation, iliac/renal vein compression, pelvic varices). Statistical analyses were performed using T-tests, Chi-Square tests, and Fisher's Exact tests.
Results: Our preliminary analysis identified 60 controls and 55 PeVD patients. The prevalence of lower extremity varicose veins was significantly higher in the PeVD group (50.9% in symptomatic PeVD versus 15.0% in asymptomatic controls; OR: 5.77, p < 0.001). Furthermore, the prevalence of left iliac and renal vein compression at imaging was significantly higher in the symptomatic PeVD group (29.1% for iliac vein stenosis and 20.0% for renal vein stenosis) as compared to controls (1.7% for iliac and renal vein stenosis) (ORiliac vein stenosis: 23.68, p < 0.001; ORrenal vein stenosis: 14.48, p = 0.001). The prevalence of liver disease in asymptomatic controls (25%) was significantly higher compared to symptomatic patients (0%) (OR: 0.001, p < 0.001).
Conclusion:
Patients with PeVD had significantly higher rates of associated venous disease (superficial and deep) than control patients. Asymptomatic patients with imaging findings suggestive of PeVD had a significantly higher prevalence of liver disease. While these preliminary findings need further confirmation in larger cohorts, they underscore potential factors contributing to asymptomatic versus symptomatic PeVD development.