engleski

Importance of recognising pelvic venous reflux in the treatment of leg varicose veins

Leg varicose veins are associated with pelvic venous reflux (PVR) in 15-20% of patients and are 4 times more frequent in multiparous women. PVR is usually associated with pelvic congestion syndrome (PCS) but can also exist as separate condition. Clinical presentation varies according to the site of reflux but atypical distribution of varicose veins in upper inner or posterior aspects of thighs and presence of vulvar veins raises the suspicion of pelvic source of varicosities. Understanding pelvic venous anatomy and anatomical sites of pelvic reflux points is a major precondition for successful treatment of varicose veins and foundation of durable results. There are 6 recognised anatomical points through which a pelvic venous reflux can be transmitted to the lower limbs and be responsible for varicose veins on ipsilateral or contralateral side. These are I(inguinal), P(perineal), CP(clitoris point), superior and inferior gluteal point (SGP, IGP) and obturator point (O). Pelvic venous system is a complex system of interconnecting venous drainage paths including visceral organs, front and back parietal structures and lower limbs. It is also important to highlight that valves in pelvic veins have variable and inconstant presentation ranging from complete avalvular truncal veins and venous plexuses, valvular collecting parietal veins and inconstantly valvulated visceral veins. Diagnosis is made by clinical examination, detailed Colour Doppler (CD) exam in standing position of patient performing Valsalva manouver and finally CT or MR phlebography when therapeutic embolisation of insufficient ovarian or other pelvic veins is planned. Treatment of pelvic venous reflux consists of combination of various techniques and procedures depending on patients clinical presentation, aetiology (primary or recurrent veins) and presence of reflux in truncal leg veins. It usually includes embolisation of refluxing ovarian veins, ultrasound guided foam sclerotherapy (UGFS) of veins at escape points and thermal or non-thermal closure of truncal leg veins. Recognising pelvic venous reflux during initial investigation in patient with lower limb varicose veins results in more effective treatment and significantly reduces the rate of recurrent varicose veins.

embolisation, escape points, pelvic veins, recurrence, reflux

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