Evaluation of pelvic varicose veins using color Doppler ultrasound: comparison of results obtained with ultrasound of the lower limbs, transvaginal ultrasound, and phlebography

Abstract

Introduction: Pelvic varicose veins, one of the main causes of chronic pelvic pain and dyspareunia, are an important source of reflux for lower limb varicose veins, especially in recurrent cases. Color Doppler ultrasound of the lower limbs and transvaginal ultrasound are the noninvasive diagnostic methods most commonly used to assess pelvic venous insufficiency, whereas phlebography is still considered as the gold standard. Objectives: To determine the prevalence of lower limb varicose veins originating from the pelvis in a group of female patients and to determine the agreement between results obtained via color Doppler ultrasound of the lower limbs, transvaginal ultrasound, and phlebography. Methods: The sample comprised female patients referred to a vascular laboratory for lower limb screening. Patients diagnosed with deep venous thrombosis were excluded. Data analysis included kappa coefficient of agreement, McNemar' s test, sensitivity and specificity values. Results: Of a total of 1,020 patients, 124 (12.2%) had findings compatible with reflux of pelvic origin. Among these patients, 51 (41.2%) were recurrent cases. A total of 249 were submitted to transvaginal ultrasound. There was significant agreement between lower limb ultrasonographic findings and transvaginal findings. Phlebography was performed in 54 patients. The comparison between transvaginal ultrasound and phlebography was associated with a 96.2% sensitivity and 100% specificity. Conclusions: The authors draw attention to the relatively high prevalence of lower limb varicose veins originating from the pelvis, suggesting an important but underdiagnosed cause of recurrent varicose veins.

Our experience with subfascial perforator vein ligation by Cockett and Dodd in perforator incompetence of varicose veins

“…This male preponderance in our study could be because of social reasons due to which less number of women seek medical intervention for this problem. In this study left side involvement was seen more frequently, similar to other studies 7,8 . The venous drainage through the pelvis follows a more tortuous course in the left lower limb.…”

Management of Varicose Veins of the Lower Extremities: A 10-year Institutional Experience

“…Both were involved in 11 patients (22.92%), (Table 3). In other studies, the superficial veins of the GSV were involved in 72.4%, closely followed by perforator incompetence [25,26]. In our study, the sites of perforator incompetence were studied in detail ( Figure 2).…”

Associations of anterior accessory or thigh posterior tributary and great saphenous reflux patterns in early stages of chronic venous valvular insufficiency

“…1,3,6,7,12 Advances in duplex-Doppler ultrasonography have contributed to CVVI understanding, diagnosis, treatment and followup. 2,[8][9][13][14][15][16][17][18][19][20][22][23][24] International consensuses occurred to minimize confusion in past phlebologic literature. 1,5,10 Description of patient populations studied improved but studies of even more specific sample populations, based on gender for example, 25 should be promoted.…”

“…16 Reflux in gluteal, lateral or anterior thigh, or pubic veins raise suspicion of pelvic varicosities, particularly in the presence of symptoms of pelvic congestion syndrome. 17 Patients with suspected pelvic varicosities were not included in this analysis.…”