Incidence and management of symptomatic pelvic venous disorders in patients with lower extremity varicose veins

Abstract

Background

Pelvic venous disorders (PeVD) are a recognized cause of venous origin chronic pelvic pain (VO-CPP) in women. However, the prevalence and management of PeVD in patients with lower extremity varicose veins remain understudied. This study assesses the incidence of PeVD among women with superficial venous insufficiency (SVI) and evaluates the role of transvaginal ultrasound (TVUS) as a screening tool.

Methods

A retrospective analysis was conducted on 350 female patients with SVI (CEAP C2-C6) from January 2021 to December 2023. SVI was confirmed by duplex ultrasound (DUS). All patients were evaluated for CPP at the initial visit. In those with CPP, pelvic symptom management preceded any lower limb intervention. Symptomatic patients were assessed using the Pelvic Venous Congestion Symptom Scale (PVCSS), Visual Analog Scale (VAS), and TVUS for features suggestive of PeVD. In confirmed cases, diagnostic venography and ovarian vein embolization were performed, followed by saphenous vein ablation.

Results

PeVD was identified in 11% (37/350) of patients. TVUS revealed pelvic varicosities, ovarian veins dilation >6 mm, and reflux, confirmed by venography. Of the 37 patients, 41% (15/37) underwent embolization, while 59% opted for conservative management. Post-treatment, median PVCSS scores improved from 20 to 2 (p < 0.001), and VAS scores from 8 to 0 (p < 0.001), indicating significant symptom relief. Mean follow-up was 17 months, with assessments at 1, 6, and 12 months. Reintervention-free survival was 86.7%.

Conclusion

Approximately one in 10 women with SVI have symptomatic PeVD, highlighting the importance of targeted screening. TVUS serves as a useful non-invasive diagnostic tool. Further studies are needed to clarify optimal treatment strategies and long-term outcomes in this population.

Keywords

Symptomatic pelvic venous disorders superficial venous insufficiency chronic pelvic pain ovarian vein embolization varicose veins

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