Definition of pelvic venous disease and the new SVP classification

Abstract

Chronic pelvic pain (CPP) is often diagnosed by gynecologists. In recent years, the realization that venous insufficiency in the pelvic or retroperitoneal area can also cause CPP has led to the involvement of vascular physicians in the diagnosis and treatment. Differentiating pelvic venous disease (PeVD) from gynecological, internal or even orthopedic complaints poses a challenge. A comprehensive study of the patient"s medical history and a detailed description of symptoms are of paramount importance. The symptoms of PeVD depend on the veins involved. Whereas pelvic pain is mainly an expression of an insufficiency of the ovarian vein and/or the internal iliac vein, left flank pain and hematuria are caused by an obstruction of the renal vein. Symptoms may also be associated with atypical varicose veins in the vulva, perineum, or legs. Anatomical gaps, pelvic escape points, allow them to communicate with the branches of the insufficient internal iliac veins and with the ovarian. As an effective tool for reporting PeVD patient populations the symptoms-varicespathophysiology (SVP) classification was published in 2021. It is thought to be the initial point of both the treatment standard and identifying homogenous patient populations for clinical trials.