Getting Tested

Understanding Testing for Pelvic Venous Disease, Compressions, and Venous Insufficiency

When it comes to diagnosing Pelvic Venous Disease (PVD), vein compressions, and venous insufficiency, proper testing is essential. Many patients, especially those with POTS or unexplained symptoms, are sent to OB-GYNs, cardiologists, or neurologists who are not trained to evaluate vascular conditions. Because of this, many venous issues go undiagnosed.

A vascular specialist must interpret imaging scans to accurately diagnose these conditions. Testing requires contrast-enhanced imaging, as standard ultrasound often fails to detect vein compressions or reflux. Below are the key diagnostic tests used in evaluating pelvic venous disease and compressions:

Key Diagnostic Tests

1. CT Venography (CTV)

  • What It Is: A contrast-enhanced CT scan that provides a detailed view of the veins, arteries, and potential compressions.

  • Why It’s Used: Detects May-Thurner Syndrome (MTS), Nutcracker Syndrome (NCS), and Pelvic Congestion Syndrome (PCS).

  • Limitations: While effective, it may not detect subtle compressions or reflux that occur only under specific conditions (e.g., standing vs. lying down).

2. Venogram

  • What It Is: A real-time X-ray using contrast dye injected into the veins to assess blood flow and look for reflux or obstructions.

  • Why It’s Used: Can reveal pelvic varicosities, slow-moving blood (reflux), and compressions that ultrasound may miss.

  • Limitations: It provides 2D imaging, which may not always reveal the full extent of compressions.

3. Intravascular Ultrasound (IVUS) – The Gold Standard

  • What It Is: A specialized catheter-based ultrasound placed directly inside the vein to measure the true diameter and severity of compression.

  • Why It’s Used: IVUS is considered the most accurate test for detecting vein compressions such as May-Thurner, Nutcracker, and other iliac or renal vein syndromes.

  • Limitations: It requires an invasive procedure but provides the highest level of detail.

Why Ultrasound Alone is Not Enough

Many patients first undergo a Doppler ultrasound, which can sometimes detect pelvic varicosities or venous reflux, but it is not sufficient for diagnosing compressions. Here’s why:

  • Ultrasound is limited in viewing deep pelvic veins.

  • It cannot accurately assess the degree of compression or reflux.

  • Contrast-enhanced imaging is required for a full diagnosis.

Why You Need a Vascular Specialist

Your OB-GYN, cardiologist, or neurologist may not have the expertise to diagnose vascular-related POTS, pelvic congestion, or compressions. Only a vascular specialist or interventional radiologist can accurately interpret these scans and determine if treatment (such as embolization or stenting) is needed.

Key Takeaways

✅ If you have POTS or unexplained symptoms, don’t stop at traditional specialists—seek a vascular evaluation.

✅ Testing for venous disease requires contrast imaging. Ultrasound alone is not enough.

✅ IVUS is the most accurate test for detecting compressions.

✅ A vascular specialist must interpret your imaging to ensure a proper diagnosis.

If you suspect you have Pelvic Venous Disease or compressions, advocate for the right testing and make sure a vascular specialist is involved in your diagnosis!