Center for Pelvic Vein Obstructions | Specialists and Information

Pelvic vein obstructions (obstruction = narrowing) fall within the field of phlebology, which deals with the diagnosis and treatment of venous diseases.

The pelvic veins (vena iliaca) carry deoxygenated venous blood from the legs and drain into the vena cava. The vena cava carries the blood to the right ventricle.

If there is a narrowing in one of the pelvic veins, blood flow is no longer adequate.

Such narrowings are caused by:

• Deposits
• blood clots (thrombosis) or
• pressure on the blood vessel from a tumor or another vessel

This leads to a backup of blood in the legs, causing various symptoms such as swelling or pain in the legs.

A Center for Pelvic Vein Obstructions is a clinic that specializes in the treatment of narrowing of the pelvic veins.

Since treatment is often surgical, the center may be affiliated with a vascular surgery clinic. These centers are equipped with state-of-the-art technology for the diagnosis and treatment of pelvic vein narrowing.

These procedures, some of which are complex, require a high degree of specialized expertise, such as that possessed by angiologists and vascular surgeons.

Angiologists are experts in vascular medicine. They have completed six years of advanced training to become board-certified specialists in internal medicine and angiology.

They are therefore specialists in the diagnosis and treatment of diseases of the veins, arteries, capillaries, and lymphatic vessels. Treatments can be conservative or surgical.

Vascular surgery is a branch of general surgery. Vascular surgeons have typically completed a six-year residency to become board-certified specialists in vascular surgery.

They are specialists in all interventional procedures related to diseases, injuries, infections, or malformations of the vascular system.

The specialists at the Center for Pelvic Vein Obstructions treat both acquired and congenital narrowings and blockages of the pelvic veins.

A common congenital condition is pelvic vein compression syndrome, also known as May-Thurner syndrome or iliac vein compression syndrome.

In this condition, the pelvic artery, which crosses over the left pelvic vein, compresses it. This causes damage to the inner wall of the vein and the formation of a type of “venous spur.” As a result of this obstruction to blood flow, the risk of thrombosis in the left pelvic and leg veins increases significantly.

However, a narrowing of the pelvic veins can also occur as a result of thrombosis. In thrombosis, a blood clot completely blocks the vein. Even if doctors remove or dissolve the blood clot, a blockage may persist.

An acute narrowing or occlusion of the pelvic veins is often the result of thrombosis. A blood clot forms due to damage to the vessel wall and changes in blood flow patterns.

A slowing of blood flow or turbulence at sites of pre-existing vascular changes can also be causes. Prolonged sitting (for example, on long-haul flights) or lying down (for example, in a hospital) can also increase the risk of developing thrombosis.

The following symptoms may indicate pelvic vein obstruction:

• Varicose veins
• Swelling of the legs
• Calf cramps
• Brown discoloration of the legs
• Rapid fatigue in the extremities
• Non-healing ulcers on the legs

Typical symptoms of pelvic vein stenosis include calf cramps @ Oporty786 /AdobeStock

In addition to the patient interview (medical history) and physical examination (swelling, pain, discoloration), vascular ultrasound is the most important imaging method. It is also known as Doppler duplex sonography.

The ultrasound device uses special color images to visualize blood flow in the veins. This allows the doctor to identify the course of blood vessels within the tissue, diagnose narrowing and calcifications, and measure their extent.

Vascular ultrasound @ Evgeniy Kalinovskiy /AdobeStock

Intravascular ultrasound is a modern method for assessing obstructions in the pelvic venous system. In this procedure, doctors insert a miniaturized ultrasound probe into the vascular system.

However, ultrasound does not always provide a sufficient view of all vascular areas. In such cases, computed tomography (CT) or magnetic resonance imaging (MRI) may be appropriate. Phlebography is the X-ray imaging of veins using a contrast agent.

The vessels are particularly well visualized on CT and MRI scans when a contrast agent is administered. Experts refer to these procedures as CT angiography (CTA) and MR angiography (MRA), respectively.

During intravascular ultrasound, doctors insert an ultrasound probe into a blood vessel @ Microgen /AdobeStock

Following a diagnosis of pelvic vein stenosis, anticoagulation (inhibition of blood clotting) is initiated. Regular use of medication reduces the risk of thrombus formation and the danger of pulmonary embolism.

If a blood clot is already present, doctors dissolve and remove it. 

There are essentially three options for this:

1. Medication to dissolve the blood clot (systemic fibrinolysis)
2. Removal of the blood clot via a catheter (catheter-directed fibrinolysis)
3. Surgical thrombus removal (thrombectomy)#

Minimally invasive vascular surgery @ Kaspars Grinvalds /AdobeStock

A vascular surgeon can often correct a narrowing or blockage of a pelvic vein through a minimally invasive procedure. 

To do this, the surgeon makes a small incision in the groin and inserts a venous stent. This is a small tube that widens the vessel and can safely remain in the body for life.

Using X-ray guidance, the doctor guides the catheter with the stent to the narrowed area and releases it there (angioplasty). 

Depending on the severity of the condition, the surgeon may place several stents in succession to permanently open a longer segment of the pelvic vein that has narrowed.