Pelvic congestion syndrome (PCS) occurs in primary and secondary forms. The primary form is failure of the valves in the ovarian and internal iliac veins. The secondary form occurs when there is a blocked or compressed vein and the blood flow is diverted in to the pelvic veins. The most common cause is iliac vein compression followed by left renal vein compression (nutcracker phenomena).
It is extremely important to understand the different variants of PCS as the treatment is different. The example below is from a patient with PCS secondary to iliac vein compression. The left common iliac vein is compressed by the right common iliac artery (May Thruner Syndrome). This results in the blood leaving the left flow to drain through the pelvic veins leading to PCS. Treatment in this situation is directed at relieving the iliac vein compression by stenting and venoplasty.
Unusual cause of extremity pain in a diabetic patients
64 year old male, type 1 diabetes, with a prior femoral to politeal bypass graft and a subsequent poplileal to tibial bypass graft.
101 year old female, admitted to the hospital with foot and toe pain. Patient had a cool pulseless foot.