What is it?
Pelvic varicocele is a pathologic dilation of the veins in the pelvic region that may be primary or secondary. Primary one is related to altered flow of pelvic veins or dilation of periuterine veins secondary to pregnancy; secondary one is due to pathologic compression of major veins. The most identified compression points are at the level of the left iliac vein (May-Thurner syndrome) and at the level of the left renal vein (Nutcracker syndrome). Pelvic varicocele is a condition that almost exclusively affects women, due to the anatomy of the female pelvis. In women, pelvic varicocele particularly affects the ovarian veins and internal iliac veins. The symptoms may also involve other organs of the pelvis creating chronic inflammation and configuring the syndrome of pelvic congestion.
Which are the symptoms?
Pelvic varicocele causes chronic venous stagnation leading to a range of symptoms with inflammation that can involve adjacent pelvic organs. Typical manifestations are as follows: feeling of discomfort or pain in the pelvic region and lower abdomen; feeling of heaviness/swelling in the lower limbs; irritable bowel resulting in the appearance of all the symptoms associated with the so-called irritable bowel syndrome; pain during sexual intercourse (dyspareunia).
- Leg pain
- Swelling and burning in the legs
- Protruding veins
- Feeling of heaviness in the legs
- Night cramps
- Itching legs
- Venous ulcer
- Pelvic Pain
- Irritable bowel
- Pain during sexual intercourse
How is it diagnosed?
Diagnosis is based primarily on the patient's objective examination and medical history. With imaging examinations, it is possible to define the location of venous return obstruction point and the severity of venous insufficiency.
How is it treated?
Today, the treatment for pelvic varicocele consists of a minimally invasive endovascular treatment that corresponds to percutaneous embolization of the pelvic vein. This procedure involves, at the level of the veins with varicocele, the release of embolizing substances or the placement of small metal coils in order to close these venous vessels and thus prevent their pathological dilation. In case of secondary pelvic varicocele caused by compression of the iliac vessels or left renal vein, combination of endovascular treatments with stents or surgical treatments can be indicated.
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