Labropoulos et al [45] and Metzger et al [46] agree that a peak systolic velocity ratio >2.5 across the stenosis (poststenotic velocity to prestenotic velocity) as an accurate criterion to use for the presence of a pressure gradient of 3 mm Hg. Doppler US can thus be used to determine candidacy for intervention and monitor success of treatment on follow-up. Variant 6: Pelvic-origin lower extremity varicose veins in females. Treatment. Saphenous Vein Ablation Patients commonly present with lower extremity symptoms related to pelvic venous insufficiency. Typically after embolization and sclerotherapy of gonadal veins and pelvic varices, respectively, they may then have endovenous venous ablation of their saphenous veins for definitive treatment [56]. Compression Sclerotherapy Foam sclerotherapy is an option to treat chronic pelvic pain and pelvic-origin lower extremity varicose veins in women caused by a pelvic venous disorder, often in conjunction with embolization. Most of the current literature involves therapy of pelvic venous disease. Lower Extremity Chronic Venous Disease The commonly used substances reported in the literature for sclerotherapy are sodium tetradecyl sulfate and polidocanol. In high-flow pelvic varicoceles, there is a small risk of systemic dispersion of the sclerosant. In order to optimize the quantity and efficacy of the sclerosant, stop-flow foam sclerotherapy techniques have been described. This technique involves the use of balloon occlusion of high-outflow collaterals to achieve the complete filling of pelvic varices and exclusion of collaterals, thereby embolizing the entire length of incompetent vessels, including tributaries [57]. In a retrospective study of 26 patients involving the use of 3% sodium tetradecyl sulfate foam, significant improvement in symptoms was observed at 1, 3, 6, and 12 months. Of note, all patients had colic-like pain that spontaneously resolved after 5 minutes [58].
Lower Extremity Chronic Venous Disease. Labropoulos et al [45] and Metzger et al [46] agree that a peak systolic velocity ratio >2.5 across the stenosis (poststenotic velocity to prestenotic velocity) as an accurate criterion to use for the presence of a pressure gradient of 3 mm Hg. Doppler US can thus be used to determine candidacy for intervention and monitor success of treatment on follow-up. Variant 6: Pelvic-origin lower extremity varicose veins in females. Treatment. Saphenous Vein Ablation Patients commonly present with lower extremity symptoms related to pelvic venous insufficiency. Typically after embolization and sclerotherapy of gonadal veins and pelvic varices, respectively, they may then have endovenous venous ablation of their saphenous veins for definitive treatment [56]. Compression Sclerotherapy Foam sclerotherapy is an option to treat chronic pelvic pain and pelvic-origin lower extremity varicose veins in women caused by a pelvic venous disorder, often in conjunction with embolization. Most of the current literature involves therapy of pelvic venous disease. Lower Extremity Chronic Venous Disease The commonly used substances reported in the literature for sclerotherapy are sodium tetradecyl sulfate and polidocanol. In high-flow pelvic varicoceles, there is a small risk of systemic dispersion of the sclerosant. In order to optimize the quantity and efficacy of the sclerosant, stop-flow foam sclerotherapy techniques have been described. This technique involves the use of balloon occlusion of high-outflow collaterals to achieve the complete filling of pelvic varices and exclusion of collaterals, thereby embolizing the entire length of incompetent vessels, including tributaries [57]. In a retrospective study of 26 patients involving the use of 3% sodium tetradecyl sulfate foam, significant improvement in symptoms was observed at 1, 3, 6, and 12 months. Of note, all patients had colic-like pain that spontaneously resolved after 5 minutes [58].