In a study of 56 women with pelvic varicose veins, 44 patients demonstrated varying degrees of venous insufficiency. This information suggests a connection between pelvic varicose veins and venous insufficiency. Duplex US of the lower extremities may then be a very reasonable evaluation in patients with known pelvic varicose veins [51]. In addition, Khilnani et al [52] notes that duplex US in patients with varicose veins in the posterior thigh, vulva, and inguinal regions (nonsaphenous pelvic origin varicose veins) can help identify venous escape points from reflux in the internal iliac venous system. US Duplex Doppler Pelvis It is widely agreed upon that duplex US should be the first assessment of the lower extremity venous system [1,9,14]. Duplex US is currently the most common imaging technique because it is noninvasive. Evaluation should include direction of blood flow, assessment for venous reflux, and venous obstruction [20]. If there are vulvar varicose veins, operators are rarely able to trace these vessels to a pelvic origin. These examinations require a very experienced sonographer to acquire relevant information. Most often, it is necessary to characterize with advanced imaging [1]. US Duplex Doppler IVC and Iliac Veins There is no relevant literature regarding the use of US for evaluation of the IVC and iliac veins in the treatment of pelvic-origin lower extremity varicose veins. As in arterial vasculature, critical stenosis is defined by a sharp reduction in forward flow; in venous vasculature, critical stenosis is related to venous hypertension. In fact, the beneficial effects of venous stenting are related to peripheral venous decompression [44]. This is an important distinction to make because Doppler US can be used to evaluate for this metric via peak systolic velocities.
Lower Extremity Chronic Venous Disease. In a study of 56 women with pelvic varicose veins, 44 patients demonstrated varying degrees of venous insufficiency. This information suggests a connection between pelvic varicose veins and venous insufficiency. Duplex US of the lower extremities may then be a very reasonable evaluation in patients with known pelvic varicose veins [51]. In addition, Khilnani et al [52] notes that duplex US in patients with varicose veins in the posterior thigh, vulva, and inguinal regions (nonsaphenous pelvic origin varicose veins) can help identify venous escape points from reflux in the internal iliac venous system. US Duplex Doppler Pelvis It is widely agreed upon that duplex US should be the first assessment of the lower extremity venous system [1,9,14]. Duplex US is currently the most common imaging technique because it is noninvasive. Evaluation should include direction of blood flow, assessment for venous reflux, and venous obstruction [20]. If there are vulvar varicose veins, operators are rarely able to trace these vessels to a pelvic origin. These examinations require a very experienced sonographer to acquire relevant information. Most often, it is necessary to characterize with advanced imaging [1]. US Duplex Doppler IVC and Iliac Veins There is no relevant literature regarding the use of US for evaluation of the IVC and iliac veins in the treatment of pelvic-origin lower extremity varicose veins. As in arterial vasculature, critical stenosis is defined by a sharp reduction in forward flow; in venous vasculature, critical stenosis is related to venous hypertension. In fact, the beneficial effects of venous stenting are related to peripheral venous decompression [44]. This is an important distinction to make because Doppler US can be used to evaluate for this metric via peak systolic velocities.