Interventionelle Therapie des Beckenvenensyndroms

Zusammenfassung

Hintergrund Das Beckenvenensyndrom ist eine unterdiagnostizierte Ursache für chronischen Beckenschmerz bei Frauen. Ursächlich ist eine venöse Insuffizienz der Becken- oder Ovarialvenen, die zur Ausbildung von meist periuterinen und periovarialen Varizen führt. Es handelt sich um eine unbehandelt fortschreitende Erkrankung, die Schwellungen, Dyspareunie und Dysmenorrhoe und weitere, teils unspezifische Symptome verursachen kann, die die Lebensqualität der Patientinnen beeinträchtigen. Die interventionelle Therapie stellt einen zentralen Bestandteil der Behandlung des Beckenvenensyndroms dar, wobei verschiedene Techniken sowohl zur Diagnosestellung als auch zur Behandlung zur Verfügung stehen.

Methode Die folgende Arbeit gibt einen Überblick über den pathophysiologischen Hintergrund, die Diagnostik und vor allem die interventionellen Behandlungsoptionen des Beckenvenensyndroms.

Ergebnisse Bei dem Beschwerdebild des Beckenvenensyndroms mangelt es bisher an einer einheitlichen Nomenklatur und an international anerkannten Diagnosekriterien als auch an randomisierten kontrollierten Studien, die den klinischen Erfolg belegen. In klinischen Studien hat sich die endovaskuläre Therapie des Beckenvenensyndroms jedoch als sichere und wirksame Therapie erwiesen. In dieser Übersicht werden die verschiedenen interventionellen Techniken zur Behandlung des Beckenvenensyndroms dargestellt, darunter die Embolisation, das Stenting und die Sklerotherapie.

Schlussfolgerung Die Bedeutung des Beckenvenensyndroms erlangt zunehmend Aufmerksamkeit. Rezente Fortschritte, wie die Entwicklung der Symptome-Varizen-Pathophysiologie (SVP)-Konsensusklassifikation geben einen Anstoß zur Vereinheitlichung der Nomenklatur und sind der erste Schritt zur Systematisierung des Krankheitsmanagements. Interventionelle Therapien bieten eine sichere und maßgeschneiderte minimalinvasive Therapieoption für Patientinnen mit Beckenvenensyndrom.

Kernaussagen 

• Beckenvenensyndrom ist ein unterdiagnostiziertes Erkrankungsbild mit oft verzögerter Diagnosestellung und lähmenden Symptomen.

• Bisher war die Nomenklatur des Beckenvenensyndroms durch Begriffe wie May-Thurner-Syndrom/Nussknacker-Syndrom ungenau.

• Interventionelle Ansätze sind wirksame Techniken mit zentralem Stellenwert in der Beckenvenensyndrom-Therapie.

Zitierweise

• Dewald CL, Becker LS, Meyer BC. Interventional Therapy of Pelvic Venous Disorders (PeVD) . Fortschr Röntgenstr 2024; 196: 921 – 927

Keywords

pelvic venous disorders (PeVD) - pelvic congestion syndrome - nutcracker syndrome - may thurner syndrome - endovascular therapy

Publication History

Received: 14 September 2023

Accepted: 23 November 2023

Article published online:
19 February 2024

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