Endovascular treatment of pelvic venous congestion syndrome in a patient with duplication of the inferior vena cava and unusual pelvic venous anatomy: literature review

Chronic pelvic pain affects approximately one-third of all women and is responsible for about 20% of all gynecological consultations. The authors report a rare case of symptomatic pelvic venous congestion in the presence of duplication of the inferior vena cava and inter-iliac communication through the right hypogastric vein that was treated via an endovascular approach with embolization of varicose pelvic veins. The published literature is reviewed.

Keywords:
pelvic venous congestion; inferior vena cava duplication; pelvic varicose veins

Authorship

Marcelo Fernandes Lima

Instituto de Flebologia Avançada, Manaus, AM, Brasil.Instituto de Flebologia AvançadaBrasilManaus, AM, BrasilInstituto de Flebologia Avançada, Manaus, AM, Brasil.

http://orcid.org/0000-0003-0224-0940

Ilídio Almeida Lima

Universidade Federal do Amazonas – UFAM, Manaus, AM, Brasil.Universidade Federal do AmazonasBrasilManaus, AM, BrasilUniversidade Federal do Amazonas – UFAM, Manaus, AM, Brasil.

http://orcid.org/0000-0002-1516-023X

Vanessa Heinrich-Oliveira

Hospital das Clínicas, Universidade de São Paulo – USP, São Paulo, SP, Brasil.Universidade de São PauloBrasilSão Paulo, SP, BrasilHospital das Clínicas, Universidade de São Paulo – USP, São Paulo, SP, Brasil.

http://orcid.org/0000-0002-2413-6629

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Correspondence Marcelo Fernandes Lima Rua Marquês de Baependi, Q-B, casa 13 - Condomínio Laranjeiras CEP 69058-130 - Manaus (AM), Brasil Tel.: +55 (92) 98121-5656 E-mail: mlima_vascular@yahoo.com

Author information MFL - Vascular and endovascular surgeon; board-certified by SBACV/AMB. IAL - Vascular surgeon and vascular sonographer; board-certified by SBACV/AMB. VHO - Obstetrician-gynecologist; board-certified by FEBRASGO; board-certified in Human Reproduction by Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP).

Author contributions Conception and design: MFL, IAL, VHO Analysis and interpretation: MFL, IAL, VHO Data collection: MFL, IAL, VHO Writing the article: MFL Critical revision of the article: MFL, IAL, VHO Final approval of the article*: MFL, IAL, VHO Statistical analysis: N/A. Overall responsibility: MFL *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

SCIMAGO INSTITUTIONS RANKINGS

Instituto de Flebologia Avançada, Manaus, AM, Brasil.Instituto de Flebologia AvançadaBrasilManaus, AM, BrasilInstituto de Flebologia Avançada, Manaus, AM, Brasil.

Universidade Federal do Amazonas – UFAM, Manaus, AM, Brasil.Universidade Federal do AmazonasBrasilManaus, AM, BrasilUniversidade Federal do Amazonas – UFAM, Manaus, AM, Brasil.

Figures

Figures (11)

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Figure 1
Angiotomography in venous phase, showing duplication of the inferior vena cava, forming a single vessel from the outflow of the left renal vein onwards.

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Figure 2
Angiotomography in venous phase, showing duplication of the inferior vena cava, forming a single vessel from the outflow of the left renal vein onwards.

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Figure 3
Angiography showing independent iliac systems and presence of an interiliac vein.

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Figure 4
Formation of a single vessel with a junction between the two inferior vena cavas, after the outflow of the left renal vein.

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Figure 5
Presence of an interiliac vein communicating between the right and left iliac systems, with a considerable number of large caliber pelvic varicose veins.

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Figure 6
Selective catheterization of the interiliac vein and access to the right iliac system.

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Figure 7
Deployment of fibered coils in tributary veins of the right iliac venous system after injection of polidocanol foam 1%.

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Figure 8
Selective catheterization of venous trunks feeding the varicose veins originating from the left internal iliac venous system.

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Figure 9
Deployment of fibered coils in tributary veins of the left iliac venous system after injection of polidocanol foam 1%.

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Figure 10
Postoperative control angiography showing occlusion of the pelvic varicose veins.

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Figure 11
The Morita et al.¹⁰10 Morita S, Higuchi M, Saito N, Mitsuhashi N. Pelvic venous variations in patients with congenital inferior vena cava anomalies: classification with computed tomography. Acta Radiol. 2007;48(9):974-9. http://dx.doi.org/10.1080/02841850701499409. PMid:17957511.
http://dx.doi.org/10.1080/02841850701499... classification of pelvic variants of inferior vena cava anomalies.

Figure 1 Angiotomography in venous phase, showing duplication of the inferior vena cava, forming a single vessel from the outflow of the left renal vein onwards.

Figure 2 Angiotomography in venous phase, showing duplication of the inferior vena cava, forming a single vessel from the outflow of the left renal vein onwards.

Figure 3 Angiography showing independent iliac systems and presence of an interiliac vein.

Figure 4 Formation of a single vessel with a junction between the two inferior vena cavas, after the outflow of the left renal vein.

Figure 5 Presence of an interiliac vein communicating between the right and left iliac systems, with a considerable number of large caliber pelvic varicose veins.

Figure 6 Selective catheterization of the interiliac vein and access to the right iliac system.

Figure 7 Deployment of fibered coils in tributary veins of the right iliac venous system after injection of polidocanol foam 1%.

Figure 8 Selective catheterization of venous trunks feeding the varicose veins originating from the left internal iliac venous system.

Figure 9 Deployment of fibered coils in tributary veins of the left iliac venous system after injection of polidocanol foam 1%.

Figure 10 Postoperative control angiography showing occlusion of the pelvic varicose veins.

Figure 11 The Morita et al.¹⁰10 Morita S, Higuchi M, Saito N, Mitsuhashi N. Pelvic venous variations in patients with congenital inferior vena cava anomalies: classification with computed tomography. Acta Radiol. 2007;48(9):974-9. http://dx.doi.org/10.1080/02841850701499409. PMid:17957511.
http://dx.doi.org/10.1080/02841850701499... classification of pelvic variants of inferior vena cava anomalies.

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Endovascular treatment of pelvic venous congestion syndrome in a patient with duplication of the inferior vena cava and unusual pelvic venous anatomy: literature review

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[1] Conflicts of interest: No conflicts of interest declared concerning the publication of this article.