The Role of Ct Phlebography in the Diagnosis of Pelvic Varicose Disease in Women

Abstract

Diagnosis of pelvic varicose disease remains one of the most difficult tasks in the examination of women with chronic pelvic pain, in pelvic varicose disease they occur in 30% of women. The first diagnostic method is ultrasound examination, which gives the opportunity to determine preliminarily the cause of the disease. The next method is multispiral computed tomography with intravenous contrast, which, if methodologically correct, gives an accurate assessment of the anatomical and topographic features of the pelvic veins. But the lack of standardized examination protocols and methodologies changes the attitude and approach to administering this method, making it insufficiently informative. The purpose of the study was to improve the CT phlebography protocol in the diagnosis of pelvic varicose disease in women. Materials and methods. The study included 54 women who were examined at the Republican Clinical Hospital of Kazan in 2022–2024, the average age was 35±15 years. All of them underwent ultrasound and multispiral computed tomography with intravenous contrast of the pelvic veins in certain anatomical zones. The anatomical integrity of the veins making part of the inferior vena cava system, diameters, and levels of venous confluence were evaluated, and arteriovenous conflicts were confirmed or excluded. Study results. Taking into account the anatomical zones of the revealed pathologies, the patients were divided into four groups: group 1 (n = 26) patients with valvular insufficiency; group 2 (n = 15) – with aorto-mesenteric compression of the left renal vein, group 3 (n = 7) – with compression of the left common iliac vein between the spine and the right common iliac artery, group 4 (n = 6) – with aplasia of the inferior vena cava, compression of the left renal vein by an aortic aneurysm, compression of the right ovarian vein by the pancreatic head. The patients of the 1st, 2nd and 3rd groups differed in indices of the left renal vein, aorto-mesenteric angle, and the left common iliac vein. In women of the 4th group, disruption of anatomical integrity of the veins was revealed, i.e. obstructive causes of pelvic varicose disease, which led to an increase in ovarian veins, venous plexuses of the veins in the pelvic organs. The informative value of the CT phlebography method for valvular insufficiency was: sensitivity was 97.55%, specificity was 92.5%; in aorto-mesenteric compression, sensitivity was 91.2%, specificity was 86.9%; in obstructive forms, including against the background of rare causes, sensitivity was 91.7%, specificity was 84.3%. Conclusions. Multispiral computed tomography with intravenous contrast enables to carry out accurate visual examination of all pelvic veins involved in the main pathohemodynamic links in the development of pelvic venous diseases. To provide complete information, the protocol should contain a description of the anatomical and topographic features of the veins from the inferior vena cava to atypical veins.