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SIR: Pelvic Congestion May Be Linked to Ovarian and Leg Varicose Veins By Paula Moyer NEW ORLEANS, LA -- April 11, 2005 -- The underlying pathogenesis for pelvic congestion may be both ovarian and leg varicose veins, according to investigators who presented their findings here April 4th at the 30th annual meeting of the Society of Interventional Radiology. "Often what you see in lower extremity vein disease is only the tip of the iceberg," said principal investigator Carl M. Black, MD, interventional radiologist and partner of Intermountain Vein Center in Provo, Utah, United States. To see the full picture, a venous duplex ultrasound of the full leg, "all the way up to the vulva," often is necessary, he said. Complex patterns of superficial venous insufficiency that involve saphenous and non-saphenous veins are often associated with pelvic venous congestion syndrome (PVCS), Dr. Black said. Because of the challenges in addressing these patients' discomfort or pain, treating physicians need to use a comprehensive approach so that they identify all treatable sources of reflux and therefore provide the greatest opportunity for symptomatic relief, he said. Dr. Black and his colleagues have treated 160 women, who initially underwent evaluation for superficial venous reflux disease of the legs. The treating physicians took a detailed medical history and examined the patients with a thorough lower extremity venous duplex ultrasound. Among these women, 26 had symptoms of pelvic venous congestion syndrome (PVCS) and refluxing varicosities that involved the vulva. In addition to the lower extremity evaluation, those women also underwent gonadal venography, which showed that 38% had non-saphenous patterns only, while the remaining 62% had mixed patterns of varicosities involving both the saphenous and non-saphenous veins. Of the 26 women with PVCS, 24 underwent ovarian venography, and 92% of these underwent transcatheter embolization for ovarian venous insufficiency. Among these women, 14 had left-sided varices, one had right-sided varices, and seven had bilateral varices. The physicians treated saphenous and nonsaphenous patterns of superficial venous reflux with a combination of endovenous laser and radiofrequency ablation, as well as sclerotherapy, ambulatory phlebectomy, superficial vein excision or a combination of these modalities, as indicated. They then followed patients with clinic visits at 1 week, 1 month and 3 to 6 months after treatment was completed. Among the patients who were treated with ovarian vein embolization, 63% said they experienced either relief or significant reduction of both pelvic and leg discomfort after embolization alone. After they received comprehensive treatment of their remaining identifiable sources of leg superficial venous reflux, 91% of those treated for PVCS said that they were satisfied with their final outcome. [Presentation title: Pelvic Venous Congestion Syndrome and Lower Extremity Superficial Reflux Disease. Abstract 123] E-mail this page to a friend or colleague! To print, use this version