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Objective: To assess the incidence of pelvic vein thrombosis (PVT) and outcomes of anticoagulant therapy for PVT in patients with pelvic venous disorders (PeVDs). Methods: This prospective cohort study included 588 female patients with PeVDs underwent clinical examination followed by duplex ultrasound of the pelvic veins in 2021-2023. Patients with PVT were administered with anticoagulant therapy in an outpatient setting using low molecular weight heparins at a therapeutic dose. Results: PVT was detected in 7.6% of patients with PeVDs and was symptomatic in 28.8% of them. The majority of asymptomatic patients had thrombosis in only one of the parametrial veins (90.6%). Anticoagulant therapy resulted in the PVT symptoms relief in all patients within 10 days and recanalization of the pelvic veins in 1-3 months. Conclusion: In our study, PVT was diagnosed in 7.6% of patients with PeVDs. Anticoagulant therapy is effective and safe in resolving PVT symptoms. [ABSTRACT FROM AUTHOR]

Mechanisms of the development of pain in chronic venous diseases, including pelvic congestion syndrome, are not studied in detail so far. The existing hypotheses of the occurrence of venous pelvic pain do not allow to answer the question why some patients have no pain syndrome, while others have very pronounced pain despite the same morphofunctional changes in the pelvic veins. This review presents current hypotheses of the venous pelvic pain development, data on some vasoactive neuropeptides (endothelin, calcitonin gene-related peptide, and substance P), their role in the modulation of vascular tone and sensation of pain, and possible association between neurogenic inflammation and venous pelvic pain, as well as provides rationale for studying the activity of these neurotransmitters in the treatment of pelvic congestion syndrome and pelvic pain. [ABSTRACT FROM AUTHOR]

Objective: Concomitant varicose veins of the pelvis (VVP) and lower extremities (VVLE) frequently coexist. This study evaluated the effectiveness and safety of micronized purified flavonoid fraction (MPFF) in the treatment of patients with both conditions.Methods: Female outpatients with concomitant VVP and VVLE received MPFF 1000 mg once daily for 2 months (Group 1), or 1000 mg twice daily for 1 month followed by 1000 mg once daily for 1 month (Group 2), based on pelvic pain intensity. Change in pain intensity during treatment was evaluated on a 10 cm visual analog scale. All patients underwent transvaginal and transabdominal duplex ultrasound scanning, radionuclide phlebography of the lower extremities, and emission computer tomography of the pelvic veins at inclusion and end of treatment.Results: In Group 1 (N = 35), MPFF was associated with a twofold reduction in pain syndrome severity (pelvic, perineal and lower leg pain) in all patients after 1 month, and a reduction in chronic pelvic pain (CPP) from 3.4 ± 1.2 to 0.83 ± 0.18 cm at 2 months. Leg pain significantly decreased from 2.8 ± 0.6 at baseline to 0.94 ± 0.11 after 2 months. In Group 2 (N = 30), MPFF decreased CPP severity from 6.3 ± 0.8 to 1.2 ± 0.12, perineal pain from 3.6 ± 0.9 to 0.88 ± 0.22 and leg pain from 4.6 ± 0.5 to 0.9 ± 0.1. Radionuclide phlebography confirmed the clinical improvement in both treatment groups, with a substantial increase in linear blood flow velocity in the internal iliac veins (∼10% in Group 1 and 35% in Group 2) and a reduction in mean transit times of the radiopharmaceutical. MPFF also reduced blood stasis in the pelvic venous plexuses. Gastralgias were reported in two patients but resolved rapidly and did not lead to treatment withdrawal.Conclusion: Phlebotropic treatment with MPFF is an effective and safe method of conservative therapy in patients with concomitant VVP and VVLE. [ABSTRACT FROM AUTHOR]

Background: Instrumental diagnosis of pelvic-perineal reflux is based on the use of ultrasound and radiological methods; however, the volume of their use represents a stumbling block for various researchers. The study aimed to determine the diagnostic value and reasonability of ovarian and pelvic venography in female patients with pelvic varicose veins (PVV) and vulvar varicosities (VV)., Methods: A total of 62 women with PVV were examined and allocated into two groups with or without the pelvic congestion syndrome (PCS) symptoms. Patients of group 1 with the PCS symptoms (N.=30) had concomitant VV (13.3%) and valvular incompetence of the left (83.3%) or right (16.7%) gonadal veins, parametrial (100%) and uterine (70%) veins, according to the duplex ultrasound scanning (DUS). Patients of group 2 without the PCS symptoms (N.=32) had valvular incompetence of the left gonadal vein (9.4%), parametrial (100%), uterine (3.1%) and vulvar veins (100%), according to the DUS. All patients underwent ovarian and pelvic venography (OPV) for imaging of the pelvic-perineal reflux., Results: In group 1, dilation and valvular incompetence of the gonadal and parametrial veins were confirmed by the OPV in 100% of patients. The imaging of the obturator vein (OV) was obtained in 6.6% patients and internal pudendal vein (IPV) in 6.6% patients; no reflux of the contrast agent in the vulvar veins was observed. In group 2, the OPV confirmed the valvular incompetence of the left gonadal vein in 9.4% patients and parametrial vein in 100% patients. The contrast agent in the OV was found in 9.4%, and in the IPV in 6.3% patients, while no reflux of the contrast agent in the dilated vulvar veins was observed., Conclusions: Pelvic venography is a not mandatory component of the examination of women with pelvic and vulvar varicose veins without varicose veins of the lower extremities, who do not have symptoms of the PCS and valvular incompetence of the gonadal veins according to the DUS.