Phlebologie 2003; 32(02): 37-44
DOI: 10.1055/s-0037-1617358
Original Atikel
Schattauer GmbH

Das weibliche Beckenvenensyndrom – eine Übersicht

The female pelvic venous syndrome – an overviewLe syndrome veineux du bassin féminin: vue d’ensemble
A. H. Scultetus
1   Uniformed Services University of the Health Sciences, Department of Surgery (Chairman: Norman M. Rich, MD, FACS), Bethesda, Maryland 20814, USA
,
J. L. Villavicencio
1   Uniformed Services University of the Health Sciences, Department of Surgery (Chairman: Norman M. Rich, MD, FACS), Bethesda, Maryland 20814, USA
,
N. M. Rich
1   Uniformed Services University of the Health Sciences, Department of Surgery (Chairman: Norman M. Rich, MD, FACS), Bethesda, Maryland 20814, USA
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
30. Dezember 2017 (online)

Zusammenfassung

Chronische Beckenschmerzen sind eine häufige Beobachtung bei mehrfachgebärenden Frauen im reproduktionsfähigen Alter. Seit Einführung neuer diagnostischer Methoden wurden Störungen der Beckenvenenzirkulation immer öfter als mögliche Ursache erkannt. Trotzdem sind die komplexen venösen Beckenvenensyndrome nicht ausreichend erforscht, Diagnose und Behandlung sind nicht standardisiert. Aufgrund unserer Erfahrungen mit 66 Patientinnen und einer umfangreichen Literaturrecherche geben wir eine Übersicht über Pathophysiologie, Diagnose und Behandlung von Beckenvenenzirkulationsstörungen.

Summary

Chronic pelvic pain is a common complaint among parous women at the reproductive age. With the advent of more sophisticated diagnostic methods, disorders of the pelvic venous circulation have been more frequently recognized as its possible origin. However, the pelvic venous syndromes are complex and not very well understood. Diagnostic and therapeutic methods are not standardized. Based on our experience with 66 patients and an extensive review of the literature we present an overview of the pathophysiology, diagnosis and management of pelvic venous disorders.

Résumé

Les douleurs pelviennes sont fréquemment rapportées par les multipares en âge de reproduction. Grâce aux progrès récents de la méthodologie diagnostique, les troubles de la circulation veineuse du petit bassin sont de plus en plus fréquemment reconnus comme cause possible de ces douleurs. Toutefois les syndrômes veineux pelviens sont complexes et encore incomplètement compris. Les méthodes diagnostiques et thérapeutiques ne sont pas standardisées. Sur la base de notre expérience chez 66 patientes et d’une analyse approfondie de la littérature, nous revoyons ici la physiopathologie, les méthodes diagnostiques, et le traitement des troubles veineux pelviens.

 
  • Literatur

  • 1 Ahlberg NE, Bartley O, Chidekel N. Retrograde contrast filling of the left gonadal vein. Acta Radiol 1965; 3: 385-92.
  • 2 Baron HC, Shams J, Wayne M. Iliac compression syndrome treated with stent placement. J Vasc Surg 1995; 21: 510-4.
  • 3 Beard RW, Highman JH, Pearce S. et al. Diagnosis of pelvic varicosities in women with chronic pelvic pain. Lancet 1984; 2: 946-9.
  • 4 Beard RW, Kennedy RG, Gangar KF. et al. Bilateral oophorectomy and hysterectomy in the treatment of intractable pelvic pain associated with pelvic congestion. Br J Obstet Gynaecol 1991; 98: 988-92.
  • 5 Beard RW. Chronic pelvic pain. Br J Obstet Gynaecol 1998; 105: 8-10.
  • 6 Belardi P, Viacava A, Lucertini G. Iliac vein insufficiency syndrome. Clinical contribution. Minerva Cardioangiol 1998; 46: 211-4.
  • 7 Capasso P, Simons C, Trotteur G. et al. Treatment of symptomatic pelvic varices by ovarian vein embolization. Cardiovasc Intervent Radiol 1997; 20: 107-11.
  • 8 Coakley FV, Varghese SL, Hricak H. CT and MRI of pelvic varices in women. J Comp Ass Tomogr 1999; 23: 429-34.
  • 9 Collett BJ, Cordle CJ, Stewart CR. et al. A comparative study of women with chronic pelvic pain, chronic non-pelvic pain and those with no history of pain attending general practitioners. Br J Obstet Gynecol 1998; 105: 87-92.
  • 10 Cotte G. Les troubles functionelles de l’appareil genital de la femme. Paris: Masson et Cie.; 1928
  • 11 Cordts PR, Eclavea A, Buckley PJ. et al. Pelvic congestion syndrome: Early clinical results after transcatheter ovarian vein embolization. J Vasc Surg 1998; 28: 862-8.
  • 12 Deska T, Mumme A, Geier B. et al. Videoskopische Ligatur der linken vena ovarica bei pelvinoeser Insuffizienz. Phlebologie 2001; 30: 120-3.
  • 13 Desimpelaere JH, Seynaeve PC, Hagers YM. et al. Pelvic congestion syndrome: demonstration and diagnosis by helical CT. Abdom Imaging 1999; 24: 100-2.
  • 14 Dixon JA, Mitchell WA. Venographic and surgical observations in vulvar varicose veins. Surg Gynecol Obstet 1970; 131: 458-64.
  • 15 Dwarakanath LS, Persad PS, Khan KS. Role of laparoscopy in the management of chronic pelvic pain. Hosp Med 1998; 59: 627-31.
  • 16 Edwards RD, Robertson IR, MacLean AB. et al. Case report: Pelvic pain syndrome – successful treatment of a case by ovarian vein embolization. Clin Radiol 1993; 47: 429-31.
  • 17 Emge LA. The surgical treatment of varicose veins of the female pelvis. JAMA 1925; 85: 1690-3.
  • 18 Farquhar CM, Rogers V, Franks S. et al. A randomized controlled trial of medroxyprogesterone acetate and psychotherapy for the treatment of pelvic congestion. Br J Obstet Gynaecol 1989; 96: 1153-62.
  • 19 Fry RPW, Beard RW, Crisp AH. et al. Sociopsychological factors in women with chronic pelvic pain with and without pelvic venous congestion. J Psychosom Res 1997; 42: 71-85.
  • 20 Gasparini D, Geatti O, Orsolon PG. et al. Female “varicocele”: two cases diagnosed by labeled red blood cell angioscintigraphy and treated by percutaneous phlebography and embolization. Clin Nucl Med 1998; 23: 420-2.
  • 21 Giacchetto C, Corroneo GB, Marincolo F. et al. Ovarian varicocele: ultrasonic and phlebographic evaluation. J Clin Ultrasound 1990; 18: 551-5.
  • 22 Giannoukas AD, Dacie JE, Lumley JSP. Recurrent varicose veins of the both lower limbs due to bilateral ovarian vein incompetence. Ann Vasc Surg 2000; 14: 397-400.
  • 23 Gidro-Frank L, Gordon T, Taylor HC. Pelvic pain and female identity:A survey of emotional factors in 40 patients. Am J Obstet Gynecol 1960; 79: 1184-1202.
  • 24 Hegenscheid F, Schubert M. Beckenvarikosis – eine therapierbare Ursache des chronischen Unterbauchschmerzes der Frau?. Zentralb Gynäkol 1990; 112: 1157-62.
  • 25 Hobbs JT, Vandendriessche M. Management of pelvic venous congestion. In: Bergan JJ, Kistner RL. (eds). Atlas of venous surgery. Philadelphia: W.B. Saunders; 1992: 273-7
  • 26 Hobbs JT. The pelvic congestion syndrome. Br J Hosp Med 1990; 43: 199-206.
  • 27 Hodgkinson CP. Physiology of the ovarian veins during pregnancy. Obstet Gynecol 1953; 1: 26-37.
  • 28 Hodgson TJ, Reed MWR, Peck RJ. et al. Case report: the ultrasound and Doppler appearances of pelvic varices. Clin Radiol 1991; 44: 208-9.
  • 29 Howard FM. The role of laparoscopy as a diagnostic tool in chronic pelvic pain. Baillière’s Best Pract Res Clin Obstet Gynaecol 2001; 14: 467-94.
  • 30 Kamm MA. Chronic pelvic pain in women – gastroenterological, gynaecological or psychological?. J Colorect Dis 1997; 12: 57-62.
  • 31 Kennedy A, Hemmingway A. Radiology of ovarian varices. Br J Hosp Med 1990; 44: 38-43.
  • 32 Lea Thomas M, Fletcher EWL, Andress MR. et al. The venous connections of vulval varices. Clin Radiol 1967; 18: 313-5.
  • 33 Lechter A, Lopez G, Martinez C. et al. Anatomy of the gonadal veins: a reappraisal. Surgery 1991; 109: 735-9.
  • 34 Lechter A. Pelvic and vulvar varices: Pelvic congestion syndrome. In: Goldman MP, Weiss RA, Bergan JJ. (eds). Varicose veins and telangiectasias. Diagnosis and treatment. St Louis, Missouri: Quality Medical Publishing Inc.; 1999. (2nd ed.) 425-48.
  • 35 LePage PA, Villavicencio JL, Gomez ER. et al. The valvular anatomy of the iliac venous system and its clinical implications. J Vasc Surg 1991; 14: 678-83.
  • 36 Malleux G, Stockx L, Wilms G. et al. Ovarian vein embolization for the treatment of pelvic congestion syndrome: long-term technical and clinical results. J Vasc Interv Radiol 2000; 11: 859-64.
  • 37 Marhic C. Efficacité clinique et rheologique de la troxerutine en gynecologie obstetrique. Rev Fr Gynecol Obstet 1991; 86: 191-4.
  • 38 Mathias SD, Kuppermann M, Liberman RF. et al. Chronic pelvic pain: prevalence, healthrelated quality of life, and economic correlates. Obstet Gynecol 1996; 87: 321-7.
  • 39 Mathis BV, Miller JS, Lukens ML. et al. Pelvic congestion syndrome: a new approach to an unusual problem. Am Surg 1995; 61: 1016-8.
  • 40 McGowan LPA, Clark-Carter DD, Pitts MK. Chronic pelvic pain: a meta-analytic review. Psych Health 1998; 13: 937-51.
  • 41 Moyano Calvo JL, Teba del Pino F, Ganan RA. et al. Síndrome de la vena ovárica. Tratamiento por embolización percutánea y revisión del mismo. Arch Espan Urol 1993; 46: 802-6.
  • 42 Murray E, Comparato M. Uterine phlebography. Am J Obstet Gynecol 1968; 102: 1088-93.
  • 43 Nabatoff RA, Pincus JA. Management of varicose veins during pregnancy. Obstet Gynecol 1970; 36: 928-34.
  • 44 Ouvry PA, Davy A. Les varices vulvaires. Phlebologie 1991; 44: 375-80.
  • 45 Rasmussen OO, Hamilton Jakobsen B. Postpartum persisting pudendal varicose veins – effect of local excision. VASA 1987; 16: 352-3.
  • 46 Reginald PW, Adams J, Franks S. et al. Medroxyprogesterone acetate in the treatment of pelvic pain due to venous congestion. Br J Obstet Gynaecol 1989; 96: 1148-52.
  • 47 Reginald PW, Beard RW, Kooner JS. et al. Intravenous dihydroergotamine to relieve pelvic congestion with pain in young women. Lancet 1987; 8555: 351-3.
  • 48 Richardson GD, Beck TC, Mykytowycz M. et al. Pelvic congestion syndrome: Diagnosis and treatment. Austr N Zeal J Phlebol 1999; 3: 51-6.
  • 49 Richet NA. Traite practique d’anatomie medico-chirurgiale. Paris: E. Chamerot, Libraire Editeur,; 1857
  • 50 Rozenblit AM, Ricci ZJ, Tuvia J. et al. Incompetent and dilated ovarian veins: a common finding in asymptomatic parous women. Am J Radiol 2001; 176: 119-22.
  • 51 Ruehm SG, Wiesner W, Debatin JF. Pelvic and lower extremity veins: contrast-enhanced three-dimensional MR venography with a dedicated vascular coil-initial experience. Radiology 2000; 215: 421-7.
  • 52 Rundqvist E, Sandholm L-E, Larsson G. Treatment of pelvic varicosities causing lower abdominal pain with extraperitoneal resection of the left ovarian vein. Ann Chir Gynaecol 1984; 73: 339-41.
  • 53 Schubert G. Die Bedeutung der Varicocele der Frau. Abl Gynäk 1922; 46: 1643.
  • 54 Scultetus AH, Villavicencio JL, Gillespie DL. The nutcracker syndrome: Its role in the pelvic venous disorders. J Vasc Surg 2001; 34: 812-9.
  • 55 Sichlau MJ, Yao JST, Vogelzang RL. Transcatheter embolotherapy for the treatment of pelvic congestion syndrome. Obstet Gynecol 1994; 83: 892-6.
  • 56 Soysal ME, Soysal S, Vicdan K. et al. A randomized controlled trial of goserelin and medroxyprogesteron acetate in treatment of pelvic congestion. Hum Reprod 2001; 16: 931-9.
  • 57 Takebayashi S, Ueki T, Ikeda N. et al. Diagnosis of the nutcracker syndrome with color Doppler sonography: Correlation with flow patterns on retrograde left renal venography. Am J Roentgenol 1999; 172: 39-43.
  • 58 Tarazov PG, Prozorovskij KV, Ryzhkov VK. Pelvic pain syndrome caused by ovarian veins. Acta Radiol 1997; 38: 1023-5.
  • 59 Taylor HC. Pelvic pain based on a vascular and autonomic nervous disorder. Am J Obstet Gynecol 1954; 67: 1177.
  • 60 Tessler FN, Schiller VL, Perrella RR. et al. Transabdominal versus endovaginal pelvic sonography: prospective study. Radiology 1989; 170: 553-6.
  • 61 Topolanski-Sierra R. Pelvic phlebography. Am J Obstet Gynecol 1958; 76: 44-5.
  • 62 Venbrux AC, Lambert DL. Embolization of the ovarian veins as a treatment for patients with chronic pelvic pain caused by pelvic venous incompetence (pelvic congestion syndrome). Curr Opin Obstet Gynecol 1999; 11: 395-9.
  • 63 Villavicencio JL, Gillespie DL, Durholt S. et al. Diagnosis and treatment of the pelvic venous disorders: pelvic congestion and pelvic dumping syndromes. In: Raju S, Villavicencio JL. Surgical management of venous disease. Baltimore, Maryland: Williams and Wilkins; 1997. (1st ed) 462-83.
  • 64 Vin F. Varices vulvaires. J Malad Vasc 1990; 15: 406-9.
  • 65 Wiborny R, Pichler B. Endoscopic dissection of the uterosacral ligaments for the treatment of chronic pelvic pain. Gynaecol Endosc 1998; 7: 33-5.