Differences in Clinical Presentation of Chronic Pelvic Pain Caused by Iliac Vein Obstruction Impacts Referral Pathway, Time to Diagnosis, and Post-stenting Pain Resolution.

OBJECTIVE

Iliac venous stenting improves chronic pelvic pain (CPP) caused by iliac vein obstruction (IVO). Signs and symptoms vary, but this pain is reproducible and easily identifiable. However, patients can experience significant delays in diagnosis and treatment. This study aimed to determine associations between the referral history, clinical presentation, pain characteristics, and stenting outcomes among women with CPP due to IVO.

METHODS

This was a retrospective analysis of prospectively collected data of women who were referred to a vascular surgeon with signs and symptoms of IVO, including CPP, and who underwent iliac venous stenting. Associations between clinical presentation (signs, symptoms, pain severity), medical and referral history, and stenting outcomes were compared between three patient groups based on number of other specialist consultations prior to stenting (none, one, or at least two).

RESULTS

Data were for 113 women (46.5 ± 15.7 years) who had CPP for 6.3 ± 6.6 years with initial severity of 6.7 ± 2.3 (out of 10). CPP was reproducible for all women, with exercise, standing, and intercourse being the most common triggers. More than two thirds had lower limb pain, oedema, and varicose veins. At a median of 7 years post-stenting, the latest pain score was 0.8 ± 1.6, and approximately 80% had full pain resolution. Women who had seen at least two other specialists had the worst initial pelvic pain, the most prescription pain medication, back pain, other abdominopelvic signs and symptoms, and previous interventions, and the fewest varicose veins. These women had 8.5 ± 7.9 years to diagnosis, but 99% still had significant improvement in, and 66% had full resolution of, their pelvic pain.

CONCLUSION

All patients had a reproducible pattern of venous origin pelvic pain, but those with worse CPP, more abdominopelvic symptoms, and less varicose veins had a more complex and delayed referral pathway and the lowest pain resolution.