title: Role of descending venography and endovenous embolization in treatment of females with lower extremity varicose veins, vulvar and posterior thigh varices.
abstract: OBJECTIVE
  To evaluate the prevalence of refluxing pelvic veins among female patients with lower extremity varicose veins and the role of embolization treatment in these cases.
  
  
  METHODS
  Of 158 female patients suffering from primary varicose veins of the lower extremities presented to the Venous Disease Clinic at Dhahran Health Center between January 2002 and December 2004, 25 patients (15.8%) were noted to have vulvar or postero-medial thigh varices or both. Those were referred for trans-jugular descending pelvic venography with or without subsequent embolization of the contributing refluxing veins.
  
  
  RESULTS
  Venous reflux contributing to the vulvoperineal or posterior thigh varices was detected in 23 patients (92%) on catheter venography. Left ovarian venous reflux was responsible for 60% of all cases. Embolization, using multiple coils, was successful in 18 patients with positive reflux (78.3%). One patient had primary vulvar venous malformation that required additional percutaneous sclerotherapy using dehydrated ethanol. Four patients had femoro-saphenous reflux contributing to the varices and required subsequent surgical ligation excision. All treated cases showed significant improvement of their symptoms without any procedure related complications.
  
  
  CONCLUSIONS
  In patients with vulvar or postero-medial thigh varicose veins, radiological study of ovarian and hypogastric venous reflux should be considered. Trans-jugular descending venography and embolization is a feasible, effective and safe diagnostic and therapeutic modality.
authors.affiliation: Surgical Services Division and Radiology Services Division, Dhahran Health Center, Saudi Aramco Medical Services Organization, Dhahran, Kingdom of Saudi Arabia.
authors.forename: Majed A
authors.initials: MA
authors.lastname: Ashour
authors.forename: Hisham E T
authors.initials: HE
authors.lastname: Soliman
authors.forename: Ghaith A
authors.initials: GA
authors.lastname: Khougeer
mesh_terms: D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D035002:Lower Extremity / Q000098:blood supply*; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013848:Thigh / Q000098:blood supply; D016896:Treatment Outcome; D014648:Varicose Veins / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D014844:Vulva / Q000098:blood supply*