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International Angiology 2020 Jun 25

DOI: 10.23736/S0392-9590.20.04402-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Diagnostic value of pelvic venography in female patients with pelvic varicose veins and vulvar varicosities

Sergey G. GAVRILOV 1 , Alexey VASILIEV 2, Yekaterina MOSKALENKO 3, Nadezhda MISHAKINA 3

1 Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia; 2 Department of Endovascular Methods of Diagnosis and Treatment, Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia; 3 Department of Ultrasound Diagnostics, Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia


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BACKGROUND: Instrumental diagnosis of pelvic-perineal reflux is based on the use of ultrasound and radiological methods; however, the volume of their use represents a stumbling block for various researchers. The study was aimed at determining the diagnostic value and reasonability of ovarian and pelvic venography in female patients with pelvic varicose veins (PVV) and vulvar varicosities (VV).
METHODS: A total of 62 women with PVV were examined and allocated into two groups with or without the pelvic congestion syndrome (PCS) symptoms. Patients of group 1 with the PCS symptoms (n=30) had concomitant VV (13.3%) and valvular incompetence of the left (83.3%) or right (16.7%) gonadal veins, parametrial (100%) and uterine (70%) veins, according to the duplex ultrasound scanning (DUS). Patients of group 2 without the PCS symptoms (n=32) had valvular incompetence of the left gonadal vein (9.4%), parametrial (100%), uterine (3.1%) and vulvar veins (100%), according to the DUS. All patients underwent ovarian and pelvic venography (OPV) for imaging of the pelvic-perineal reflux.
RESULTS: Group 1. Dilation and valvular incompetence of the gonadal and parametrial veins were confirmed by the OPV in 100% of patients. The imaging of the obturator vein (OV) was obtained in 6.6% patients and internal pudendal vein (IPV) in 6.6% patients; no reflux of the contrast agent in the vulvar veins was observed. Group 2. The OPV confirmed the valvular incompetence of the left gonadal vein in 9.4% patients and parametrial vein in 100% patients. The contrast agent in the OV was found in 9.4%, and in the IPV in 6.3% patients, while no reflux of the contrast agent in the dilated vulvar veins was observed.
CONCLUSIONS: Pelvic venography is a not mandatory component of the examination of women with pelvic and vulvar varicose veins without varicose veins of the lower extremities, who do not have symptoms of the PCS and valvular incompetence of the gonadal veins according to the DUS.


KEY WORDS: Pelvic varicose veins; Pelvic-perineal reflux; Vulvar varicosities; Pelvic congestion syndrome; Pelvic venography

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