Sage Journals: Discover world-class research

Abstract

Aim

To consider if it is essential to perform embolization in the treatment of leg varices due to pelvic venous insufficiency.

Methods

Review of the current literature concerning treatment options of leg varicose veins of pelvic origin.

Results

Pelvic venous insufficiency, vulvar and pudendal varicose veins as well as pelvic congestive syndrome are under diagnosed entities. Embolization of ovarian and pelvic veins is well established in patients with pelvic congestive syndrome. In varicose veins of pelvic origin but without pelvic congestive syndrome, comparative studies comparing the outcome of embolization or treatment of varicose veins by sclerotherapy or phlebectomy alone are missing. Foam sclerotherapy or phlebectomy shows good results in patients with varicose veins of pelvic origin.

Conclusions

Embolization is not essential in the treatment of leg varices of pelvic origin without pelvic congestive syndrome. Foam sclerotherapy or phlebectomy shows good results in patients with vulvar or pudendal varicose veins. Randomized comparative studies using embolization of incompetent pelvic veins or sclerotherapy of varicose veins with pelvic origin should be performed.

Keywords

Pudendal varicose veins vulvar varicose veins pelvic venous insufficiency pelvic congestive syndrome sclerotherapy

Get full access to this article

View all access options for this article.

References

Bell

Kane

Liang

. Vulvar varices: an uncommon entity in surgical pathology. Int J Gynecol Pathol 2007; 26: 99–101.

Geier

Barbera

Mumme

. Reflux patterns in the ovarian and hypogastric veins in patients with varicose veins and signs of pelvic venous incompetence. Chir Ital 2007; 59: 481–488.

Greiner

Gilling-Smith

. Leg varices originating from the pelvis: diagnosis and treatment. Vascular 2007; 15: 70–78.

Durham

Machan

. Pelvic congestion syndrome. Semin Intervent Radiol 2013; 30: 372–380.

Aslam

Flexer

Figueiredo

. Successful embolization of vulval varices arising from the external pudendal vein. J Surg Case Rep 2014. Epub, DOI: 10.1093/jscr/rjt129.

Creton

Hennequin

Kohler

. Embolisation of symptomatic pelvic veins in women presenting with non-saphenous varicose veins of pelvic origin–three-year follow-up. Eur J Vasc Endovasc Surg 2007; 34: 112–117.

Ramelet

. Phlebectomy. Technique, indications and complications. Int Angiol 2002; 21(Suppl): 46–51.

Dortu

Constancias-Dortu

. Treatment of varicose veins of the lower limbs by ambulatory phlebectomy (Muller's method): technique, indications and results. Ann Chir 1997; 51: 761–772.

Moschner-Kunert

Rabe

Zabel

. Pudendal varicose veins. Vasa Suppl 1991; 33: 113–113.

10.

Sukovatykh

Rodionov

Sukovatykh

. Diagnosis and treatment of atypical forms of varicose disease of pelvic veins. Vestn Khir Im I I Grek 2006; 167: 43–45.

11.

Paraskevas

. Successful ultrasound-guided foam sclerotherapy for vulval and leg varicosities secondary to ovarian vein reflux: a case study. Phlebology 2011; 26: 29–31.

12.

Marsh

Holdstock

Harrison

. Pelvic vein reflux in female patients with varicose veins: comparison of incidence between a specialist private vein clinic and the vascular department of a National Health Service District General Hospital. Phlebology 2009; 24: 108–113.

13.

Chung

M-H

Huh

C-Y

. Comparison of treatments for pelvic congestion syndrome. Tohoku J Exp Med 2003; 201: 131–138.

14.

Kim

Malhotra

Rowe

. Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol 2006; 17: 289–297.

15.

Maleux

Stockx

Wilms

. Ovarian vein embolization for the treatment of pelvic congestion syndrome: long term technical and clinical results. J Vasc Interv Radiol 2000; 11: 859–864.

16.

Gloviczki

Comerota

Dalsing

. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53(Suppl): 2S–48S.

17.

Smith

. The outcome of treatment for pelvic congestion syndrome. Phlebology 2012; 27: 74–77.

18.

Ratnam

Marsh

Holdstock

. Pelvic vein embolisation in the management of varicose veins. Cardiovasc Intervent Radiol 2008; 31: 1159–1164.

19.

Greiner

Dadon

Lemasle

. How does the patho-physiology influence the treatment of pelvic congestion syndrome and is the result long-lasting? Phlebology 2012; 27: 58–64.