ABSTRACT
Reflux can occur in internal iliac venous tributaries, but only about 10% of these have venous valves, so that there is reflux in the veins even in healthy subjects, and the clinical relevance of pelvic vein reflux is frequently uncertain. Computed tomography (CT) or MR venography can differentiate primary pelvic venous congestion from other causes of pelvic pain and help plan for treatment. Disease can affect the hepatic arterial and portal venous circulation passing to the liver, the intrahepatic circulation or the hepatic venous circulation leaving the liver. Inferior mesenteric – veins of the haemorrhoidal plexus connect superior haemorrhoidal veins in the portal venous system with middle and inferior haemorrhoidal veins which drain into the internal iliac vein. Transjugular intrahepatic portosystemic shunt (TIPS) has largely replaced surgical shunting, with percutaneous insertion of a stent between a large branch of the hepatic and portal venous systems.
