Duplex ultrasound findings of left ovarian vein reflux suggest an ascending pattern of progression in pelvic venous disorders (PeVD)

Abstract

Aim

To analyse the patterns of reflux in incompetent left ovarian veins (LOV) in women with associated symptoms and/or signs, to assess whether the progression of reflux is descending or ascending.

Methods

We retrospectively reviewed pelvic venous duplex ultrasound reports from women assessed for suspected pelvic venous reflux (PVR) and/or pelvic venous disorders (PeVD) (previously pelvic congestion syndrome) at our unit between January 2016 and July 2017. All examinations included transvaginal duplex ultrasonography (TVUS) and transabdominal duplex ultrasonography (TADUS), performed by vascular technologists using our published protocol. LOV reflux was categorised as: (i) total reflux, (ii) distal reflux with proximal competence, or (iii) proximal reflux with distal competence.

Results

In total, 317 women presenting with leg varicose veins with duplex evidence of reflux coming from the pelvis and/or symptoms of PeVD underwent TVUS and TADUS. Of these, 165 had reflux in the left ovarian vein (LOV); 108/165 (65%) demonstrated total LOV incompetence, 2/165 (1%) had proximal reflux without any distal reflux, and 55/165 (33%) showed distal-only LOV reflux. However, two of the distal-only LOV reflux had collaterals arising from the renal venous system. One of these has a true nutcracker syndrome. Of the two patients with proximal-only LOV reflux, one had symptomatic nutcracker syndrome, and the other had previously undergone left oophorectomy and was missing the distal LOV.

Conclusions

These results show that two reflux patterns predominated: total LOV reflux and distal-only LOV reflux. Isolated proximal reflux was rare. This distribution is consistent with a distal-to-proximal (ascending) pattern of reflux progression within the LOV. However, further prospective longitudinal studies are required to determine whether distal-only reflux represents an early stage in an ascending progression pathway.

Keywords

duplex ultrasound pelvic congestion syndrome PCS pelvic venous disorders PeVD venous reflux

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