Anatomical abnormalities of the pelvic venous system and their implications for endovascular management of pelvic venous reflux

Phlebology. 2018 Sep;33(8):567-574. doi: 10.1177/0268355517735727. Epub 2017 Oct 23.


Background Pelvic venous reflux is often treated with pelvic vein embolisation; however, atypical pelvic venous anatomy may provide therapeutic challenges. Methods We retrospectively reviewed seven patient files and reported symptoms, diagnostic imaging, aberrant anatomy and means by which the interventional radiologist successfully completed the procedure. Any follow-up data were included if available. Results Four anatomical abnormalities were found: internal iliac veins draining into the contralateral common iliac vein, duplicated inferior vena cava, reverse-angle renal veins with atypical left ovarian vein drainage and direct drainage of the internal iliac vein to the inferior vena cava. All patients were successfully treated with pelvic vein embolisation. Conclusion Abnormal embryologic development may cause variable pelvic venous anatomy. Knowledge of this will enable interventional radiologists to successfully treat such patients.

Keywords: Anatomy; pelvic congestion syndrome; pelvic vein embolisation; pelvic vein reflux; varicose veins; venous reflux.

MeSH terms

  • Embolization, Therapeutic / methods*
  • Female
  • Humans
  • Iliac Vein / diagnostic imaging
  • Male
  • Pelvis / blood supply
  • Pelvis / diagnostic imaging
  • Renal Veins / diagnostic imaging
  • Retrospective Studies
  • Ultrasonography, Doppler, Duplex
  • Varicose Veins / diagnostic imaging
  • Varicose Veins / therapy*
  • Vena Cava, Inferior / diagnostic imaging