Purpose:
The Symptoms-Varices-Pathophysiology (SVP) classification is a tool used for standardization and long-term assessment of Pelvic Venous Disorders (PeVD). This was developed by American Vein and Lymphatic Society (AVLS) multidisciplinary. PeVD encompasses a group of syndromes associated with chronic pelvic pain of venous origin. These include compressive pathologies such as May-Thurner syndrome, non-thrombotic iliac vein lesion (NIVL), nutcracker syndrome, pelvic congestion syndrome, and pelvic dumping syndrome. The recognition of PeVD has grown in importance, yet the absence of a valid and dependable classification system has constrained progress in the field. All patients with pelvic pain >6m and/or unexplained leg symptoms should be evaluated for PeVD. Also, patients with rapid venous disease progression, neovascularization, or recurrent varicose veins after venous closure should be assessed for PeVD.
Instructions for Use:
Use the SVP classification system to categorize the PeVD based on the presence and severity of symptoms, extent of varices, and underlying pathophysiology. For documentation all five domains (S,V,P – A,H,E) have to be reported. The P domain should be based on (A) anatomic segment, (H) hemodynamics, (E) etiology. If multiple segments are involved, each segment should be specified by a semicolon (please refer to examples). To be used at baseline and for longitudinal follow up.
Symptoms-Varices-Pathophysiology (SVP) Classification:
Examples
- Asymptomatic female presenting with NIVL of the left common iliac vein associated with internal iliac reflux should be designated as S0, V0, P L CIV, O, NT; L IIV, R, NT.
- Pelvic congestion syndrome with chronic pelvic pain due to bilateral ovarian reflux: S2, V2, P BGV, R,NT
- Nutcracker syndrome with flank pain and hematuria: S1, V1, P L RV, O, NT
- May-Thurner syndrome with left lower extremity edema: S0, V0, P L CIV, O, NT
Significance of the SVP Classification
The SVP instrument enhances clinical decision-making, establishes disease-specific outcome measures, and adequately categorizes patient groups for clinical trials.
Pros and cons of SVP
- First-in-class classification tool for PeVD.
- Allows for longitudinal assessment of clinical outcomes.
- Not an instrument for diagnosis or disease prognosis
- SVP does not include a quality-of-life assessment.
SVP in comparison with other similar tools.
The most used classification of lower extremity venous disease Clinical-Etiologic-Anatomic-Physiologic (CEAP) and the classification for PeVD is SVP. Prior to the SVP classification and the concept of PeVD, myriad of syndromes such as mentions above were evaluated and managed as stand-alone conditions. SVP instrument promotes clinical communication, enables more targeted treatment, and facilitates the development of patient-reported outcome measures and clinical trials.
References
- Meissner, M. H., et al. (2021). The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 9(3), 568-584.
- Bałabuszek, K., Toborek, M., & Pietura, R. (2022). Comprehensive overview of the venous disorder known as pelvic congestion syndrome. Annals of Medicine, 54(1), 22-36.
- Gavrilov, S., et al. (2021). Stratification of pelvic venous reflux in patients with pelvic varicose veins. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 9(5), 1417-1424.