title: Pelvic congestion syndrome and left renal compression syndrome - clinical features and therapeutic approaches.
abstract: Knowledge of the anatomy of the pelvic, gonadal and renal veins is important to understand pelvic congestion syndrome (PCS) and left renal vein compression syndrome (LRCS), which is also known as the nutcracker syndrome. LRCS is related to PCS and to the presence of vulvar, vaginal and pudendal varicose veins. The diagnosis of the two syndromes is difficult, and usually achieved with CT- or phlebography. The gold standard is the intravenous pressure measurement using conventional phlebography. The definition of PCS is described as pelvic pain, aggravated in the standing position and lasting for more than 6 months. Pain in the left flank and microhaematuria is seen in patients with LRCS. Women with multiple pregnancies are at increased risk of developing varicose vein recurrences with pelvic drainage and ovarian vein reflux after crossectomy and stripping of the great saphenous vein. The therapeutic options are: conservative treatment (medroxyprogesteron) or interventional (coiling of the ovarian vein) or operative treatment (clipping of the ovarian vein). Controlled prospective trials are needed to find the best treatment.
authors.affiliation: 1 Angiology, Med. University Hospital, Kantonsspital Baselland, Bruderholz, Switzerland.
authors.forename: Christina
authors.initials: C
authors.lastname: Jeanneret
authors.affiliation: 2 Institute for Anatomy, Departement Biomedizin, Universität Basel, Switzerland.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Beier
authors.affiliation: 3 Radiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: von Weymarn
authors.affiliation: 4 Clinic for Venous Diseases, Bellevue, Kreuzlingen, Switzerland.
authors.forename: Jürg
authors.initials: J
authors.lastname: Traber
mesh_terms: D003251:Constriction, Pathologic / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D017699:Pelvic Pain / Q000209:etiology; D010388:Pelvis / Q000098:blood supply*; D012039:Regional Blood Flow; D012082:Renal Veins; D013577:Syndrome; D014648:Varicose Veins / Q000150:complications; D014680:Veins / Q000033:anatomy & histology; D014689:Venous Insufficiency / Q000175:diagnosis* / Q000628:therapy*
keywords: Gonadal veins; left renal vein compression syndrome; nutcracker syndrome; ovarian vein clipping; ovarian vein embolisation; pelvic congestion syndrome; venous reflux ovarian veins