Hemodynamic and Radiological Classification of Ovarian Veins System Insufficiency

Abstract

Ovarian veins system insufficiency is one of the most common reasons for pelvic venous insufficiency (PVI). PVI is a hemodynamic phenomenon responsible for the occurrence of venous insufficiency of the lower extremities and recurrent varicose veins in nulliparous and parous women, as well as for a set of symptoms described as pelvic congestion syndrome (PCS). In the years 2017–2019, 535 patients admitted to our center with symptoms of venous insufficiency of the lower extremities, underwent complete ultrasound diagnostics (color-duplex ultrasound) of the venous system of the abdomen, pelvis and lower limbs, as well as extended imaging diagnostics using computed tomography (CT) or magnetic resonance (MR) venography. On the basis of the obtained results, the authors proposed a 4-grade hemodynamic and radiological classification (grades I-IV) defining the stratification of ovarian veins insufficiency. Using the above mentioned classification approx. 32% patients were identified as Grade I and I/II, approximately 35% revealed morphological and hemodynamic changes corresponding to Grade II and II/III, approximately 25% were classified as Grade III, whereas the remaining 8% were assessed as Grade IV. The described classification allows for the grading of ovarian veins insufficiency based on transparent radiological criteria, making it easy to use in everyday clinical practice. According to the authors, the proposed classification could facilitate communication between diagnostic physicians, specialists dealing with the treatment of venous insufficiency and gynecologists, who admit patients with symptoms suggesting venous insufficiency of the pelvis.

The analysis of selected morphological and hemodynamic parameters of the venous system and their presumable impact on the risk of recurrence after varicose vein treatment

“…According to recent studies and the presented data, approximately 25-35% patients may reveal various anatomical abnormalities with a "collateral effect" in their abdominal or pelvic veins; however, the majority of cases result from pregnancy-induced overload and subsequent impairment of left ovarian and iliac veins axes [44][45][46][47]. Noteworthy, both anatomical variants and/or pregnancy-induced PVI may be the origin of perineal reflux, which, depending on the direction of its propagation, may result in the development of "atypical" varicose veins (usually located in lateral or posterior aspects of the thigh) or which, via the branches of the posterior accessory the saphenous vein (PASV), may contribute to the overload and subsequent insufficiency of the GSV.…”

“…Accordingly, to improve the long-term results of CVD treatment, we postulate to extend the basic examination protocol of the vein system by including the screening of the pelvic vein insufficiency. Furthermore, we indicate the necessity of the revision in the current strategy of CVD treatment, which should consider the pelvic and abdominal veins as the prevalent source of reflux in the leg venous system, at least in multiparous women [19,20,47]. When confirmed, PVI treatment should be considered as one of the due targets in that strategy.…”

Pelvic venous insufficiency: Lipid peroxidation levels in ovarian venous blood

“…1,6,7, 20 . The ovarian vein (v. ovarica) begins in the area of the ovarian gate from a large number of veins exiting the gland 21 . These veins form a plexus pampiniformis ovarii in the mesentery of the ovary.…”

New Perspectives in Phlebology and Lymphology

“…As PVI and abdominal vein obstruction may relevantly impact the treatment of VV disease and its recurrence rate [ 1 , 4 , 7 ], greater attention should be paid to this peculiar morpho-hemodynamic condition through the combination of CDU with other radiological diagnostic tools, such as computed tomography/magnetic resonance-based venography. Actually, in the presence of lower limb VV related also to abdomino-pelvic vein insufficiency, this combined approach may offer some advantages [ 8 ].…”