A center for pelvic vein obstructions (obstruction = narrowing) treats congenital or acquired narrowing of the pelvic veins. Such constrictions or obstructions can lead to painful leg swelling or venous ulcers, for example. The treatment of pelvic veins is part of vascular medicine, also known as angiology in medical jargon. Strictly speaking, this is the specialist field of phlebology.
Pelvic vein obstructions (obstruction = narrowing) belong to the specialist field of phlebology, which deals with the detection and treatment of diseases of the veins as a whole.
Theiliac veins transport the venous, oxygen-poor blood from the legs and flow into the venacava, which in turn transports the blood to the right ventricle. If there is a constriction in one of the pelvic veins, the blood can no longer be transported to a sufficient extent.
Such constrictions are caused either by deposits, blood clots(thrombosis) or pressure exerted on the blood vessel, for example by a tumor or another vessel. This leads to a backflow into the legs, which can cause various symptoms such as swelling or pain in the legs.
A pelvic vein obstruction center is a clinic that specializes in the treatment of patients with narrowing of the pelvic veins. As treatment is often surgical, the center may be affiliated with a vascular surgery clinic. The centers have state-of-the-art technical equipment for the diagnosis and treatment of pelvic vein stenoses. The sometimes complex procedures require a high level of specialist expertise, such as that of angiologists and vascular surgeons.
Angiologists are experts in vascular medicine. They have completed six years of further training as specialists in internal medicine and angiology and are therefore considered specialists in the diagnosis and conservative, including interventional (surgical) treatment of diseases of the veins, arteries, capillaries and lymphatic vessels.
Vascular surgery is classified as surgery. Vascular surgeons have normally also completed six years of further training to become a specialist in vascular surgery. They are specialists in all interventional procedures, both diagnostic and therapeutic, due to diseases, injuries, infections or malformations of the vascular system.
The specialists at the Pelvic Vein Obstruction Center deal with both acquired and congenital narrowing and occlusion 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 left iliac vein is compressed by theiliac artery. This causes damage to the inner wall of the vessel and a kind of "venous spur". As a result of this obstruction of the outflow, the risk of thrombosis in the left pelvic and leg veins increases significantly.
However, a narrowing of the pelvic veins can also occur as part of a thrombosis. In a thrombosis, a blood clot completely blocks the vein. Even if the blood clot can be removed or dissolved, an obstruction may remain.
Acute narrowing or acute obstruction of the pelvic veins is also frequently the result of thrombosis. A blood clot occurs as a result of damage to the vessel wall and changes in the flow behavior of the blood, such as slowing of the blood flow or turbulence in existing vascular changes. Prolonged sitting (e.g. on long-haul flights) or lying down (e.g. in hospital) can promote the development of a thrombosis.
The following symptoms may indicate a pelvic vein obstruction:
In addition to the patient interview (medical history) and physical examination (swelling, pain, color changes), vascular ultrasound is the most important imaging examination method in phlebology, also known as Doppler duplex sonography. The ultrasound device uses special color images to visualize the blood flow in the veins. This enables the doctor not only to recognize the vascular courses in the tissue, but also to diagnose constrictions and calcifications and measure their extent.
A modern method for assessing obstructions in the pelvic vein area is intravascular ultrasound, in which a miniaturized ultrasound probe is inserted into the vascular system.
However, not all vascular areas can always be adequately visualized using ultrasound. In these cases, computed tomography (CT) or magnetic resonance imaging (MRI) may be useful. Phlebography is the X-ray imaging of the veins using a contrast medium.
The vessels can be seen particularly well in CT and MRI scans using a contrast agent. This is referred to as CT angiography (CTA) or MR angiography (MRA).
Once a pelvic vein obstruction has been diagnosed, the first step is anticoagulation (inhibition of blood clotting), i.e. regular medication is taken to reduce the risk of a thrombus forming and the risk of a pulmonary embolism.
If a thrombus already exists, it is dissolved or removed. There are three main options for this:
The vascular surgeon can often repair a narrowing or occlusion of a pelvic vein in a minimally invasive procedure. To do this, he punctures the groin and inserts a venous stent . This is a small tube that dilates the vessel and can remain in the body for life without any problems.
Under X-ray control, he guides the catheter with the stent to the constriction and releases it there (known as angioplasty). Depending on the severity, the surgeon can also place several stents in succession to permanently open up a prolonged narrowing of the pelvic vein.
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