Chapter 29: Pelvic Venous Disorders

INTRODUCTION

The vasculature of the human body is variegated and complex. In 1616, William Harvey improved upon the works of Ibn al-Nafis and Michael Servetu with his description of a continuous circulatory system. In An Anatomical Exercise on the Motion of the Heart and Blood in Animals, Harvey eloquently and historically linked the veins and arteries in circuit with the heart. Beginning with these early writings, the pelvic veins and their disorders have been less well understood and often enigmatic in their pathologic presentation, partly because of to the variety and complexity of the descriptions of pelvic venous anatomy. The more recent focus on and understanding of this portion of the vasculature is exemplified by the revision of pelvic venous terminology within this decade after its early characterization in the 1800s.

Diseases of the pelvic veins have much to do with the heterogeneous anatomy of these vessels, with imaging advancements leading to vast improvements in diagnosis and directed treatment. Pelvic venous disease has been well described in women given the complex anatomy of the female genital system and the social and emotional association with conception and birth. This chapter focuses on the intricate anatomy and physiology of the pelvic venous system, including a description of congenital abnormalities, iatrogenic injuries, thrombotic disorders, and maladies associated with pregnancy.

PELVIC VEIN ANATOMY

The pelvic veins and plexuses have great variability in unions, pathways, and size. Although the pelvic vein anatomy was first described in the 1800s by Brechet and Bock, it was Batson (for whom the vertebral venous system is named) who recognized the correlation between the spread of disease and the venous system.¹ Richet described pelvic varicosities, a currently well-publicized women's health issue, as early as 1857.² Bajka et al³ extended our understanding of not just the complexity of the venous system but also cleverly visualized the entire human anatomy in their Virtual Human Female (VHF) wherein segmentation software created detailed digital images from cryosections of human cadavers. Adjustments in terminology were made in 2004 so that the daily clinical terminology became standardized.⁴ The 21st World Congress of the International Union of Angiology with the participation of International Union of Phlebology, the International Federation of Anatomical Association, and the Federative International Committee for Anatomical Nomenclature met in Rome to refine vein terminology, especially that of the pelvic veins. The description of the pelvic veins has undergone much refining through the years. An understanding of the origin of the pelvic veins and tributaries is necessary for the pathophysiology of disease entities in upcoming sections of this chapter.

Superficial

The pelvic veins are formed from the superficial and deep veins of the lower extremities (Tables 29-1 and 29-2). The superficial veins originate as the superficial dorsal digital veins and join together to form the common digital veins, which then collectively ...