Editing Chronic venous disorders (section)

== Aetiology ==

* Varicose veins
* Incompetent perforator
* Deep venous reflux
** '''Pelvic congestion syndrome'''
*** Pelvic pain, perineal heaviness, urgency of micturition and post-coital pain, caused by ovarian and/or pelvic vein reflux and/or obstruction
*** May be associated with vulvar, perineal or lower extremity varices
*** Type 1: reflux secondary to pelvic and ovarian vein incompetence
*** Type 2: secondary to obstruction of outflow
*** Type 3: secondary to a local compression phenomenon
*** Condition often disappears after menopause
*** Diagnose based on a 6mm-diameter ovarian vein on DUS
*** CT venogram can be useful - look for pelvic varices, exclude other lesions
*** Management:
**** Medroxyprogesterone acetate 30mg daily for 6 months has been shown to be effective in the short term, but not curative
**** Different surgical techniques have been described, including vein ligation
**** Embolisation of refluxing veins is first-line treatment now for refluxing veins
**** PCS secondary to obstruction should be treated with stents
* Deep venous obstruction
** Thrombotic
** Trauma
** Radiation
** External compression
*** Retroperitoneal fibrosis
*** May-Thurner syndrome (compression of left CIV by right CIA)
*** Tumours
*** Aneurysms
*** Abnormal muscle bands (popliteal vein entrapment)
*** Fibrous bands or ligaments (soleal arch syndrome or femoral vein compression by the inguinal ligament)
* Inadequate muscle pump function