The article presents the technique of duplex ultrasound study (DUS) of the pelvic veins in patients with pelvic venous disorders (PeVDs). It provides basics of anatomy of pelvic veins and describes hemodynamic and anatomical parameters that should be assessed during DUS of pelvic veins.
StoikoYMKirienkoAIZatevakhinII, et al.Russian clinical guidelines for the diagnostics and treatment of chronic venous diseases. J Venous Dis2018; 12: 146–240. (In Russ.) DOI: 10.17116/flebo20187031146.
2.
MeissnerMHKhilnaniNMLabropoulosN, et al.The symptoms-varices-pathophysiology classification of pelvic venous disorders: a report of the American vein & lymphatic society international working group on pelvic venous disorders. J Vasc Surg Venous Lymphat Disord2021; 9: 568–584. DOI: 10.1016/j.jvsv.2020.12.084.
3.
KnuttinenMGMachanLKhilnaniNM, et al.Diagnosis and management of pelvic venous disorders: AJR expert panel narrative review. AJR Am J Roentgenol2023; 221: 565–574. DOI: 10.2214/ajr.22.28796.
4.
WhiteleyAMTaylorDCDos SantosSJ, et al.Pelvic venous reflux is a major contributory cause of recurrent varicose veins in more than a quarter of women. J Vasc Surg Venous Lymphat Disord2014; 2: 411–415. DOI: 10.1016/j.jvsv.2014.05.005.
5.
LabropoulosNJasinskiPTAdrahtasD, et al.A standardized ultrasound approach to pelvic congestion syndrome. Phlebology2017; 32: 608–619. DOI: 10.1177/0268355516677135.
DielemanFHammingJFErbenY, et al.Nutcracker syndrome: challenges in diagnosis and surgical treatment. Ann Vasc Surg2023; 94: 178–185. DOI: 10.1016/j.avsg.2023.03.030.
8.
BrahmbhattAMacherJShettyAN, et al.Sonographic evaluation of pelvic venous disorders. Ultrasound Q2021; 37: 219–228. DOI: 10.1097/ruq.0000000000000576.
9.
GavrilovSGSazhinAVTemirbolatovMD. The strategy for the treatment of the patients with concomitant pelvic varicose veins and varicose veins of the lower extremities. Flebol2017; 11: 120–130. (In Russ.) DOI: 10.17116/flebo2017113120-130.
10.
WhiteleyMSDos SantosSJHarrisonCC, et al.Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women. Phlebology2015; 30: 706–713. DOI: 10.1177/0268355514554638.
11.
WhiteleyMS. Objective measurements of pelvic venous reflux and stratification of severity of venous reflux in pelvic congestion syndrome due to pelvic venous reflux. Curr Med Res Opin2017; 33: 2089–2091. DOI: 10.1080/03007995.2017.1332987.
12.
WhiteAMHoldstockJM. Ultrasound assessment of pelvic venous reflux. Indian J Vasc Endovasc Surg2018; 5: 234–243. DOI: 10.4103/ijves.ijves_84_18.
13.
WhiteleyMS. Pelvic venous pain due to pelvic congestion syndrome is becoming a primary diagnosis. J Vasc Surg Venous Lymphat Disord2021; 9: 1425. DOI: 10.1016/j.jvsv.2021.05.003.
14.
WhiteleyMS. Current best practice in the management of varicose veins. Clin Cosmet Invest Dermatol2022; 15: 567–583. DOI: 10.2147/ccid.s294990.
15.
GloviczkiPComerotaAJDalsingMC, et al.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 Surg2011; 53: 2S–48S. DOI: 10.1016/j.jvs.2011.01.079.
16.
AntignaniPLLazarashviliZMonederoJL, et al.Diagnosis and treatment of pelvic congestion syndrome: UIP consensus document. Int Angiol2019; 38: 265–283. DOI: 10.23736/s0392-9590.19.04237-8.
17.
GavrilovSMoskalenkoYPMishakinaNY, et al.Stratification of pelvic venous reflux in patients with pelvic varicose veins. J Vasc Surg Venous Lymphat Disord2021; 9: 1417–1424. DOI: 10.1016/j.jvsv.2021.04.019.
18.
GavrilovSGKaralkinAVMishakinaNY, et al.Hemodynamic and neurobiological factors for the development of chronic pelvic pain in patients with pelvic venous disorder. J Vasc Surg Venous Lymphat Disord2023; 11: 610.e3–618.e3. DOI: 10.1016/j.jvsv.2023.01.006.
19.
LamvuGCarrilloJOuyangC, et al.Chronic pelvic pain in women: a review. JAMA2021; 325: 2381–2391. DOI: 10.1001/jama.2021.2631.
20.
GloviczkiPLawrencePFWasanSM, et al.The 2023 society for vascular surgery, American venous forum, and American vein and lymphatic society clinical practice guidelines for the management of varicose veins of the lower extremities. Part II: endorsed by the society of interventional radiology and the society for vascular medicine. J Vasc Surg Venous Lymphat Disord2024; 12: 101670. DOI: 10.1016/j.jvsv.2023.08.011.
21.
Elsevier. Gray’s anatomy: the anatomical basis of clinical practice, 41st ed., Amsterdam: Elsevier; 2015.
22.
KimSHChoSWKimHD, et al.Nutcracker syndrome: diagnosis with Doppler US. Radiology1996; 198: 93–97. DOI: 10.1148/radiology.198.1.8539413.
23.
LabropoulosNBorgeMPierceK, et al.Criteria for defining significant central vein stenosis with duplex ultrasound. J Vasc Surg2007; 46: 101–107. DOI: 10.1016/j.jvs.2007.02.062.
24.
FarinaRFotiPVContiA, et al.The role of ultrasound imaging in vascular compression syndromes. Ultrasound J2021; 13: 4. DOI: 10.1186/s13089-020-00202-6.
25.
WhiteleyAMTaylorDCDos SantosSJ, et al.Pelvic venous reflux is a major contributory cause of recurrent varicose veins in more than a quarter of women. J Vasc Surg Venous Lymphat Disord2014t; 2: 411–415. DOI: 10.1016/j.jvsv.2014.05.005.
26.
LishovDEBoykoLVZolotukhinIA, et al.Duplex ultrasound of lower limbs venous system. Russian phlebology association expert panel report. Flebol2021; 15: 318–340. (In Russ.) DOI: 10.17116/flebo202115041318.
27.
KachlikDPechacekVMusilV, et al.The venous system of the pelvis: new nomenclature. Phlebology2010; 25: 162–173. DOI: 10.1258/phleb.2010.010006.
28.
Dos SantosSJHoldstockJMHarrisonCC, et al.Ovarian vein diameter cannot be used as an indicator of ovarian venous reflux. Eur J Vasc Endovasc Surg2015; 49: 90–94. DOI: 10.1016/j.ejvs.2014.10.013.
29.
GavrilovSKaralkinAMishakinaN, et al.Relationships of pelvic vein diameter and reflux with clinical manifestations of pelvic venous disorder. Diagnostics2022; 12: 145. DOI: 10.3390/diagnostics12010145.
30.
GrishenkovaASKaralkinAVMishakinaNY, et al.The role of pelvic venous reflux and vasoactive neuropeptides in the development of chronic pelvic pain in patients with pelvic venous disease. Angiol Vasc Surg2023; 29: 134–142. (In Russ) DOI: 10.33029/1027-6661-2023-29-2-134-142.
31.
GrishenkovaASMoskalenkoEPMishakinaNY, et al.Relationship between pelvic pain and pelvic venous incompetence with reflux in patients with pelvic venous congestion syndrome. Flebol2021; 15: 251–258. (In Russ.) DOI: 10.17116/flebo202115041251.
32.
GavrilovSGMishakinaNYEfremovaOI, et al.Complications and adverse events of gonadal vein embolization with coils. J Personalized Med2022; 12: 1933. DOI: 10.3390/jpm12111933.
33.
GavrilovSGMishakinaNYGrishenkovaAS. Venous thromboembolism after interventions on the ovarian veins in patients with pelvic venous disorder. Ann Vasc Surg2023; 91: 191–200. DOI: 10.1016/j.avsg.2022.11.016.
34.
GavrilovSGMishakinaNYVasilyievAV, et al.Retrospective analysis of complications after gonadal vein interventions for pelvic venous disorder. J Surg Res2023; 283: 249–258. DOI: 10.1016/j.jss.2022.10.062.
35.
GavrilovSGSazhinAVAkhmetzianovR, et al.Surgical and endovascular treatment of pelvic venous disorder: results of a multicentre retrospective cohort study. J Vasc Surg Venous Lymphat Disord2023; 11: 1045–1054. DOI: 10.1016/j.jvsv.2023.04.009.
36.
GavrilovSGNyuMKirsanovKV, et al.Complications of gonadal vein embolization with coils: causes and consequences. Journal of Venous Disorders2022; 16: 185–194. (In Russ.) DOI: 10.17116/flebo202216031185.
37.
MishakinaNYMoskalenkoEPVasilievAV, et al.Duplex ultrasound in assessing the results of treatment of pelvic venous disorders. Flebol2023; 17: 79–91. (In Russ.) DOI: 10.17116/flebo20231702179.
38.
MetzgerPBRossiFHKambaraAM, et al.Criteria for detecting significant chronic iliac venous obstructions with duplex ultrasound. J Vasc Surg Venous Lymphat Disord2016; 4: 18–27. DOI: 10.1016/j.jvsv.2015.07.002.
39.
RadaidehQPatelNMShammasNW. Iliac vein compression: epidemiology, diagnosis and treatment. Vasc Health Risk Manag2019; 15: 115–122. DOI: 10.2147/vhrm.s203349.
40.
RajuSWalkerWNoelC, et al.Dimensional disparity between duplex and intravascular ultrasound in the assessment of iliac vein stenosis. Vasc Med2021; 26: 549–555. DOI: 10.1177/1358863x211003663.
41.
AnanthanKOnidaSDaviesAH. Nutcracker syndrome: an update on current diagnostic criteria and management guidelines. Eur J Vasc Endovasc Surg2017; 53: 886–894. DOI: 10.1016/j.ejvs.2017.02.015.
42.
NastasiDRFraserARWilliamsAB, et al.A systematic review on nutcracker syndrome and proposed diagnostic algorithm. J Vasc Surg Venous Lymphat Disord2022; 10: 1410–1416. DOI: 10.1016/j.jvsv.2022.08.003.
43.
ChaitJSenIKalraM. Nutcracker syndrome: how to diagnose it and when/how should it be treated in the pelvic venous disease population. Tech Vasc Intervent Radiol2021; 24: 100734. DOI: 10.1016/j.tvir.2021.100734.
44.
GavrilovSGKaralkinAVMishakinaNY, et al.Effect of left renal vein compression stenosis on functional status of left kidney in patients with pelvic venous disorders. J Vasc Surg Venous Lymphat Disord2024; 12: 101668. DOI: 10.1016/j.jvsv.2023.08.009.
45.
BeckettDHoldstockJWhiteA, et al.Does left ovarian vein reflux cause a pseudo-nutcracker effect creating meso-aortic narrowing of the left renal vein?The Arab Journal of Interventional Radiology2019; 3: S1–S2.