Pelvic Venous Disorders: An Update in Terminology, Diagnosis, and Treatment

Meghan R Clark, Amy Taylor
In: Seminars in Interventional Radiology · 2023 · vol. 40(04) , pp. 362–371 · doi:10.1055/s-0043-1771041 · PMID:37575340 · W4385718491
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review updates terminology, diagnosis, and treatment for pelvic venous disorders, encompassing conditions like nutcracker and May-Thurner syndromes that cause chronic pelvic pain and lower extremity varicosities.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This review article focuses on pelvic venous disease (PeVD) as a cause of chronic pelvic pain (CPP), describing updated terminology and a standardized Systems-Varices-Pathophysiology (SVP) classification system for categorizing patients. It synthesizes the population-level context of CPP prevalence and diagnostic complexity, and highlights that PeVD is characterized by CPP plus pelvic and/or extrapelvic varicosities arising from obstruction and/or reflux in pelvic veins such as the left renal, ovarian, and iliac veins. The paper emphasizes that catheter venography is the gold standard but notes the lack of published consensus diagnostic imaging criteria and validated disease-specific definitions, which limits clinical trial evidence; it also states the SVP tool is for classification, not for assessing severity or treatment response. Relevance to endometriosis: the paper describes CPP as often associated with overlapping conditions including endometriosis, and it discusses the broader diagnostic challenge of identifying the correct etiology of CPP, of which venous causes (PeVD) are one possibility.

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Abstract

Pelvic venous disorder (PeVD) is a term that encompasses all the interrelated causes of chronic pelvic pain (CPP) and perineal/lower extremity varicose veins of pelvic venous origin historically known as nutcracker syndrome, pelvic congestion syndrome, and May-Thurner syndrome, resulting in a more precise diagnosis that accounts for the underlying pathophysiology and anatomy. PeVD manifests as CPP with associated vulvar and lower-extremity varicosities, left flank pain and hematuria, and lower extremity pain and swelling secondary to obstruction or reflux in the left renal, ovarian, or iliac veins. This article will focus specifically on the most current nomenclature, evaluation, and management of CPP of venous origin.

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chronic_pelvic_pain

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europepmc
last seen: 2026-06-04T01:30:01.192114+00:00
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