Purpose To compare the imaging modalities of duplex ultrasound (DU) and magnetic resonance venography (MRV) in determining the presence of the anatomy associated with compression syndromes as well as the presence of pelvic varices in patients with suspected pelvic vein congestion syndrome (PCS). Methods A prospective study of 29 patients (27 females and 2 males) with signs and symptoms of PCS as well as MTS. Each patient underwent a DU and an MRV, for the purpose of diagnosing the presence of nutcracker anatomy (NA) and May–Thurner anatomy (MTA). The images were graded in an effort to determine if either DU or MRV was a better workup modality for the diagnosis of PCS and the compression syndromes that can be associated with it. A blinded independent reviewer did the grading. Results The left renal vein was well visualized to evaluate for the presence or absence of NA 89% of the time with DU and 81% of the time with MRV. The left common iliac vein was well visualized for the presence or absence of MTA 93% of the time with DU and 76% of the time with MRV. Pelvic varices were well visualized in 100% of the time for both DU and MRV. With an experienced technologist performing the DU, our study has demonstrated that DU can consistently provide the needed imaging in a noninvasive and less-expensive manner while continuing to allow the clinician and patient to make a well-informed decision about their diagnosis and treatment.

Superficial venous reflux is commonly the cause of symptomatic venous disease, but proximal venous obstruction may also play a role. A duplex ultrasound evaluating bilateral common femoral veins can detect differences in phasicity, which may be due to pelvic venous obstruction. We report a case of a patient with recurrent symptomatic varicose veins after treatment of superficial venous reflux. Based the duplex ultrasound results of damped respiratory phasicity, the patient was diagnosed with deep venous obstruction which was confirmed on MRV.

This Guideline was prepared by the Professional Guidelines Subcommittee of the Society for Vascular Ultrasound (SVU) as a template to aid the vascular technologist/sonographer and other interested parties. It implies a consensus of those substantially concerned with its scope and provisions. The guidelines contain recommendations only and should not be used as a sole basis to make medical practice decisions. This SVU Guideline may be revised or withdrawn at any time. The procedures of SVU require that action be taken to reaffirm, revise, or withdraw this Guideline no later than 3 years from the date of publication. Suggestions for improvement of this Guideline are welcome and should be sent to the Executive Director of the SVU. No part of this Guideline may be reproduced in any form, in an electronic retrieval system or otherwise, without the prior written permission of the publisher. Purpose Transabdominal pelvic venous duplex examinations are performed to assess abnormal blood flow in the abdominal and pelvic veins (excluding the portal venous system). The evaluation includes the assessment of abdominal and pelvic venous compressions, abdominal and pelvic venous insufficiency, and the presence or absence of pelvic varicosities. Note The transabdominal pelvic venous duplex examination is a separate and distinct guideline from a gynecological ultrasound examination, generally performed in a general ultrasound facility. Abdominal and pelvic venous disorders can be previously referred to as pelvic congestion syndrome or PCS; however, with the expansion of research into the abdominal and pelvic venous system, updated nomenclature is imperative to the proper diagnosis and treatment of these conditions.

Endovenous thermal ablation (EVTA) has become the mainstay of treatment for symptomatic varicose veins in the setting of saphenous vein insufficiency. We observed 5 iatrogenic arteriovenous fistulas (AVFs) following thermal ablation of the great saphenous vein (GSV). Postprocedure duplex ultrasound (DUS) results were analyzed for the presence of AVF in any location along or adjacent to the treated saphenous veins. Cases were prospectively followed. English literature was reviewed for any other published reports of AVF after EVTA. Data were compiled using our 5 cases, 2 cases were shared with us by colleagues and 20 cases were reported in the literature. Our center has performed more than 4000 (4155) cases of EVTA over the past 15 years. Five cases of AVFs were detected, 3 were found in asymptomatic patients during routine post-EVTA surveillance. The additional 2 cases presented with signs or symptoms which prompted a DUS after ablation. Including cases in the literature, we were able to identify 2 different types of AVFs. The first type of AVF was demonstrated in 13 cases where the AVF occurred along the treated vein. All of these cases involved ablation of the GSV and 90% of these showed signs of recanalization. The second type of AVF was seen in 14 additional cases where the AVF involved a vein segment adjacent to or remote from the ablated vein. The second type occurred in the GSV in 5 cases, external iliac vein (EIV) in 3 cases, and in the popliteal vein in 5 cases. There is 1 reported case of AVF involving the sural artery after perforator vein EVTA. Three of the type 1 cases were followed and spontaneously resolved; 3 of the type 1 cases were treated with surgical ligation with unreported outcomes. Seven cases did not report any follow-up information. Seven of the type 2 cases were treated, and had spontaneous resolution and 7 were not treated. The follow-up on these cases ranged from 1 month to 6 years. Thermal ablation can result in AVF either along the length of the treated vein or adjacent to the area of ablation. Further study would help elucidate the cause and treatment algorithms.