Abstract
<jats:p>Chronic venous insufficiency (CVI) of the lower limbs and pelvic venous disorders, including pelvic congestion syndrome (PCS), are often discussed as separate entities, yet both belong to the broader spectrum of chronic venous disease and share the same core mechanisms: reflux, venous hypertension, outflow obstruction, collateralization, endothelial dysfunction, and progressive microcirculatory injury. In women, pelvic venous disorders may manifest not only as venous-origin chronic pelvic pain but also as vulvar, perineal, gluteal, and recurrent lower-limb varicosities, so failure to recognize a pelvic source can undermine technically adequate leg procedures. This chapter reviews the anatomy, hemodynamics, clinical presentation, diagnostic pathway, and contemporary management of CVI and pelvic venous disorders with a practical emphasis on pathophysiology, clinical decision-making, surgery, and endovascular therapy. Lower-limb duplex ultrasound remains the first-line test for CVI, whereas pelvic ultrasound, cross-sectional venous imaging, catheter venography, and intravascular ultrasound refine diagnosis in pelvic venous disorders and mixed reflux-obstruction phenotypes. Management of CVI is built on compression, skin care, and selective intervention for superficial reflux, perforator incompetence, ulcer disease, or iliofemoral outflow obstruction. Management of pain-dominant pelvic venous disorders has shifted toward endovascular treatment, particularly embolization of incompetent ovarian and internal iliac tributaries in appropriately selected patients, with iliac vein stenting reserved for obstruction-dominant patterns or mixed lesions in which physiology supports intervention. A phenotype-based strategy that identifies the dominant driver of symptoms is more rational than treating anatomy in isolation.</jats:p>