Application of the SVP Classification System in Patients with Pelvic Venous Disorders

Introduction, Objectives, and/or Purpose:: In 2021, the American Vein and Lymphatic Society convened a multi-disciplinary group to develop a valid and reliable discriminative instrument for the classification of people suffering from a pelvic venous disorders (PeVD) referred to as the Symptoms-Varices-Pathophysiology (SVP) system. Limited data exists regarding the utility of this instrument in the care of patients with PeVD. The goal of this investigation is to apply the SVP classification system to a group of patients treated for PeVDs.

Methods: From January 2018 to January 2019, we retrospectively reviewed the records of 102 patients treated for a PeVD at the Center for Vascular Medicine. Age, race, gender, medical/surgical histories, CEAP classification and intervention types were assessed and patients were categorized according to their SVP classification. The prevalence of each S and V class, their association with gonadal or iliac vein obstructive lesions and the prevalence of lower extremity varicosities was evaluated.

Results: The average age of the entire cohort was 56.9±12.9 and women constituted 74% of all patients. Overall, 59% of patients demonstrated S2 disease secondary to dyspareunia, post-coital pain or dysmenorrhea, 37% demonstrated S0 disease primarily due to leg symptoms caused by a symptomatic iliac vein stenosis (IVS), 17% were S2,3a and 4% were S3a. S2 alone was observed in 6% and 55% demonstrated S2 and lower extremity symptoms (Symptomatic C2 disease). V0 disease was observed in 78% of patients secondary to the high incidence of IVS. V2 disease secondary to ovarian vein reflux was observed in 23%. In patients with ovarian vein reflux, 95% had a concomitant iliac vein stenosis: (74% in the common iliac vein, 24% in the external iliac vein and 2% in the internal iliac vein). In addition, 35% of the entire cohort demonstrated lower extremity varicosities.

Conclusion(s): In our patient cohort, the majority of patients demonstrated pelvic origin pain without varicosities, S2V0 disease, or isolated leg symptoms not related to extra-pelvic varices, S0 disease, secondary a symptomatic iliac vein stenosis. S2 or V2 disease secondary to isolated ovarian vein reflux was rarely observed. Finally, 35% of patients with pelvic vein lesions also presented with lower extremity varicosities. The high incidence of IVS may be secondary to referral and practice patterns and the high incidence of lower extremity varices requires further investigation to determine the prevalence of pelvic source escape veins.