Pelvic Pain? It may be your VEINS!

Kaila Simpson was 24 when she started her career as a sales associate for a tech company. Following that, she did sales for several startups and then, 3½ years ago, she landed at an IT research and advisory firm in Fort Myers.

“My job involves working with tech CEOs on their strategic initiatives,” Kaila, 30, details. “We discuss their growth goals, and I align them with my company’s resources so they can apply our insights to their products, marketing and sales strategies. I typically work with five to eight clients a week.”

A native of Bright, Indiana, 45 minutes outside of Cincinnati, Kaila is highly successful in her professional life. Conversely, she’s been struggling for some time in her personal life. She was dealing with endometriosis and polycystic ovary syndrome, two gynecological conditions that can cause severe pelvic pain, and then began experiencing pelvic and back pain that went beyond what is typical for those disorders.

“In addition to abdominal pain and painful intercourse, I was also having a lot of pain in my pelvic area that radiated into my lower back,” she describes. “I got a sharp, stabbing pain persistently four times a day: in the morning, at midday, in the afternoon and at night. It was a pain that would make me buckle over. On a scale of one to 10, it was a solid 10! The rest of the time my pain was an eight out of 10.

“I like to run and dance, but with the pain, I didn’t run as much because I couldn’t take a lot of impact. Dancing took a back seat as well, but I was able to keep swimming.”

‘My OB-GYN did a CT scan and saw a cluster of varicose veins in my pelvis. He told me I had something called pelvic congestion syndrome and referred me to Dr. Magnant to identify what was causing it and to determine a treatment plan.”

Joseph G. Magnant, MD, is a board-certified vascular surgeon at Vein Specialists in Fort Myers and Bonita Springs. He is dedicated to the modern and comprehensive evaluation of leg vein disorders and pelvic venous congestion and uses the most advanced minimally invasive treatments.

“For many years, most pelvic pain in women was attributed to endometriosis until proven otherwise,” Dr. Magnant notes. “What’s new today is that we’re able to diagnose patients, specifically young women such as Kaila, with iliac vein compression, or what is called May-Thurner syndrome, or MTS. It’s one of the most common causes of pelvic congestion syndrome.

May-Thurner Syndrome

“With MTS, the right common iliac artery anatomically crosses in front of the left common iliac vein, from left to right. On the other side of that vein is the lumbar spine. In a certain percentage of patients, there’s significant compression of the vein against the spine by the artery, which blocks blood flow through the vein resulting in increased pelvic venous pressure.

“The left common iliac vein drains the left leg and pelvis, and its compression results in painful symptoms in the legs, back and pelvis. In addition, when blood is unable to get out of the left leg, new collateral blood vessels form to shunt the blood from the left side of the pelvis and leg to the right side of the pelvis into the right iliac vein. Those collaterals are essentially pelvic varicose veins and can wrap around the pelvic organs such as the ovaries, vagina, uterus, bladder and bowel. These are the same areas often affected by endometriosis.

“That’s why it’s so important for physicians not to just label patients as having “idiopathic” pelvic pain or “psychogenic” pelvic pain and leave it at that. We have found that many of those patients we have evaluated have treatable causes for their symptoms, further emphasizing the importance of considering pelvic congestion syndrome due to iliac vein compression or MTS in this group of patients.”

Diagnostic Findings

To determine the underlying cause of Kaila’s pain, Dr. Magnant performed an extensive evaluation that included two ultrasound procedures. The first was an iliac vein duplex scan, which is performed through the skin of her abdomen to examine the pelvic veins.

“This scan allows us to look deep inside the pelvis and visualize venous blockages,” Dr. Magnant informs. “There are certain criteria we follow to determine if there’s significant narrowing of the veins. Kaila met all the criteria.

“Her left common iliac vein was compressed more than 50 percent. It had an hourglass deformity, where it’s big on the two ends, but in the middle, where it’s being squeezed against the spine, it’s small. It was like a five-lane highway being narrowed down to one lane with increased velocity of the blood flow in the middle. She also had varicose veins in her pelvis. These three findings are consistent with MTS as the cause of pelvic congestion syndrome.”

The second scan was an intravascular ultrasound, or IVUS. During IVUS, a catheter the size of a pen tip is placed through an IV into a vein in the thigh and fed through the venous system into the inferior vena cava, the large vein that carries deoxygenated blood from the lower half of the body back to the heart.

“Since the procedure, my lower back pain has gone away.” – Kaila

“When we pulled the catheter back into Kaila’s left common iliac vein, we could see that the blood vessel was compressed almost like a pancake, as the artery pressed it against the spine,” Dr. Magnant describes. “We then measured blood flow in both the normal vein channel and the compressed channel and learned that Kaila had a reduction in flow in the 80 to 90 percent range.”

Once Dr. Magnant determined that Kaila had a significant blockage, he opted to proceed with a balloon angioplasty to stretch the scarred and compressed vein and improve the blood flow.

“We placed a special balloon through the narrowed area and expanded it to stretch out that area of the vein,” Dr. Magnant explains. “But stretching the area is not sufficient treatment as the vein often collapses under the continued pressure of the artery, so a stent is always required to prevent this from occurring. The stent serves as a strut, or internal brace, to keep the vein from collapsing against the pressure of the artery.”

“I’m Dancing Again”

Once Kaila received this IVUS stent treatment from Dr. Magnant, her pain decreased significantly within just a few short days. Soon, she resumed many of the activities she had put on hold because of her pelvic congestion symptoms.

“Since the procedure, my lower back pain has gone away and the painful intercourse has vastly improved,” she reports.

“Thanks to Dr. Magnant, I’m back running again. I can just about do a 5K right now, and I’m working up to a 10K. I’m also dancing again, and it’s awesome. Dr. Magnant is phenomenal. He gave me an in-depth explanation of what we were going to do and why we were going to do it, and it solved the problem.”

© FHCN article by Patti DiPanfilo. mkb
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    • Vein Specialists

      Vein Specialists is 100 percent dedicated to identifying and treating vein disorders. Led by Dr. Joseph G. Magnant, they understand that the venous system varies between patients and consists of both deep and superficial venous systems and a net... Read More

    • Joseph G. Magnant, MD, FACS, RPVI

      Joseph G. Magnant, MD, FACS, RPVI, is a Fellow of the American College of Surgeons and is board certified by the American Board of Surgery in vascular surgery. He earned his medical degree from Medical College of Virginia. He completed a g... Read More