Pelvic Veins

Pelvic Veins

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The Anatomy of the Pelvic Veins

The veins of the pelvis drain deoxygenated blood and return it to the heart, through three major vessels - the external iliac vein, internal iliac vein and common iliac vein (these correspond the major pelvic arteries). In this article, we will explore their anatomy, tributaries and clinical correlations.

External Iliac Vein

The external iliac vein is a continuation of the femoral vein, which is the major vessel responsible for draining blood from the lower limb. It arises when the femoral vein crosses underneath the inguinal ligament and ascends along the medial aspect of the external iliac artery, before joining with the internal iliac vein to form the common iliac vein. During its short course, the external iliac vein receives the inferior epigastric and deep circumflex iliac veins.

Internal Iliac Vein

The internal iliac vein is responsible for the majority of pelvic venous drainage, and receives numerous tributaries from veins that drain the pelvic region. It is formed near the greater sciatic foramen, ascending anteriorly to the sacroiliac joint, before combining with the external iliac vein to form the common iliac vein.

The internal iliac vein is particularly noteworthy in that its tributaries correspond with the branches of the internal iliac artery, with the exception of the iliolumbar vein, which drains into the common iliac vein. These tributaries include the superior and inferior gluteal veins, which drain the buttock and upper thigh; the internal pudendal vein, which drains the reproductive organs and part of the rectum (via the inferior rectal vein); the obturator vein; the lateral sacral veins, which drain part of the sacrum; the middle rectal vein, which drains the bladder, prostate (in males only) and part of the rectum; the vesical veins, which drain the urinary bladder via the vesical venous plexus; the uterine and vaginal veins, which drain the female reproductive organsvia the vaginal and uterine venous plexuses.

Common Iliac Vein

The common iliac vein is formed at the upper margin of the pubic symphysis by the union of the external and internal iliac veins. It receives two additional tributaries, namely the iliolumbar vein, which drains the L4 and L5 vertebrae, and the iliopsoas muscle; and the middle sacral veins, which drain part of the sacrum. The left and right common iliac veins combine at L5 to become the inferior vena cava, which empties into the inferior aspect of the right atrium.

Clinical Relevance - Pelvic Congestion Syndrome

The veins in the pelvis, particularly the ovarian veins in women, are prone to valve failure that may cause them to become dilated and tortuous (similar to varicose veins of the leg). This can cause intense pain within the pelvis, known as pelvic congestion syndrome. Due to the complex nature of the pelvic anatomy, it is impossible to dissect out the affected vein, and therefore treatment is typically approached via pelvic venous embolisation.

Pelvic venous embolisation is a technique whereby a venous catheter with a guide wire is fed through, a contrast dye is used and affected vessels are embolised (blocked) with various substances, such as metal coils. Due to the rich venous anastomoses in the pelvis, one smaller vein can be tied off without compromising venous return.

Pelvic Veins and Pelvic Congestion Syndrome

The pelvic veins are located in the pelvis of the human body and are part of the venous drainage system. They are formed from the union of the external iliac vein and the internal iliac vein, which combine to form the common iliac vein. In addition, femoral veins and tributaries of the ovarian, obturator, and vesical veins drain into the pelvic veins.

Pelvic congestion syndrome is a condition caused by dilated pelvic veins, which can cause intense pain in the pelvis. Due to the wealth of structures in the pelvis, it is not possible to successfully dissect out a vein. Therefore, pelvic venous embolisation is performed instead. This involves using a venous catheter to feed a guide wire into the pelvis, as well as using contrast dye to identify the affected veins. These vessels are then embolised, or blocked, with different substances such as metal coils. Because of the rich venous anastomoses in the pelvis, it is usually possible to tie off a smaller vein without compromising venous return.

Treating pelvic vein conditions can involve venous embolisation and venous catheter insertion. Symptoms of the condition can also be relieved through lifestyle modifications, such as avoiding long periods of standing and elevating the hips during sleep. There are also other medications that can be prescribed to help alleviate the pain and discomfort associated with the condition.

If you believe you may be suffering from pelvic vein conditions or pelvic congestion syndrome, it is important to consult a qualified doctor or specialist. After taking a thorough medical history, performing a physical exam and possibly ordering additional medical tests, the doctor will be able to give you an accurate diagnosis and recommend a suitable treatment plan.

Depending on the severity of the condition, pelvic vein treatment can involve small procedures such as venous embolisation. If lifestyle modifications and medications do not help to reduce symptoms, a more invasive procedure such as venous catheter insertion may be necessary. In some cases, surgery may be recommended to remove any existing blockages or to repair damaged veins.

Venous embolisation and venous catheter insertion are minimally invasive procedures that can be used to treat pelvic vein conditions. Lifestyle modifications and medications can also help to alleviate the pain and discomfort associated with pelvic congestion syndrome. A qualified doctor or specialist can make a diagnosis and recommend an appropriate treatment plan based on the severity of the condition.

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