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Introduction: Pelvic varicose veins, one of the main causes of chronic pelvic pain and dyspareunia, are an important source of reflux for lower limb varicose veins, especially in recurrent cases. Color Doppler ultrasound of the lower limbs and transvaginal ultrasound are the noninvasive diagnostic methods most commonly used to assess pelvic venous insufficiency, whereas phlebography is still considered as the gold standard. Objectives: To determine the prevalence of lower limb varicose veins originating from the pelvis in a group of female patients and to determine the agreement between results obtained via color Doppler ultrasound of the lower limbs, transvaginal ultrasound, and phlebography. Methods: The sample comprised female patients referred to a vascular laboratory for lower limb screening. Patients diagnosed with deep venous thrombosis were excluded. Data analysis included kappa coefficient of agreement, McNemar' s test, sensitivity and specificity values. Results: Of a total of 1,020 patients, 124 (12.2%) had findings compatible with reflux of pelvic origin. Among these patients, 51 (41.2%) were recurrent cases. A total of 249 were submitted to transvaginal ultrasound. There was significant agreement between lower limb ultrasonographic findings and transvaginal findings. Phlebography was performed in 54 patients. The comparison between transvaginal ultrasound and phlebography was associated with a 96.2% sensitivity and 100% specificity. Conclusions: The authors draw attention to the relatively high prevalence of lower limb varicose veins originating from the pelvis, suggesting an important but underdiagnosed cause of recurrent varicose veins.

Objective: To present our experience with embolization of pelvic reflux routes in patients with recurrent varices after surgery (REVAS). Method: Single patient group study of patients with previous surgical treatment for varicose veins, with REVAS in Unidad de Angiología y Cirugía Vascular, Hospital Ruber Internacional, Madrid, España. Patients presenting with REVAS with pelvic venous insufficiency (PVI) documented per transvaginal colour duplex, undergoing selective pelvic venography, were treated with embolization of insufficient gonadal and hypogastric mainstem and collateral veins. Results: In all, 215 patients (89.9%) reported relief of pelvic pain and symptoms of lower extremity venous stasis six months postembolization; total relief in 120 (50.2%) and partial relief in 95 (39.7%). Conclusions: There is high incidence of PVI in patients with REVAS. Embolization of insufficient gonadal and hypogastric mainstem and collateral vessels is associated with significant relief of clinical signs and symptoms of pelvic and lower extremity venous stasis in patients with REVAS and PVI.

Pelvic congestion syndrome (PCS) is frequent and underestimated as both symptoms and signs are not specific. Furthermore, patients consult general practitioners as well as specialist gynaecologists, urologists, vascular surgeons and phlebologists who are frequently unaware of this condition. Investigation protocol must first eliminate other diseases with similar clinical disorders and then identify which veins are responsible for PCS related to compression or reflux. Selective venography is the more informative investigation but transvaginal ultrasound examination is a valuable screening test. Outcome analyses after endovenous treatment have been reported in several articles, but no randomized controlled trial is available for comparing various operative treatments knowing that most of them were undertaken after failure of medical treatment. In our experience, about two-thirds of patients were symptom-free after vein compression, stenting, or embolization at middle-term assessment.