title: Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women.
abstract: OBJECTIVE
  To assess the suitability of transvaginal duplex ultrasonography to identify pathological reflux in the ovarian and internal iliac veins in women.
  
  
  METHODS
  A retrospective study of patients treated in 2011 and 2012 was performed in a specialised vein clinic. Diagnostic transvaginal duplex ultrasonography in women presenting with symptoms or signs of pelvic vein reflux were compared with the outcomes of treatment from pelvic vein embolisation. A repeat transvaginal duplex ultrasonography was performed 6 weeks later by a blinded observer and any residual reflux was identified.
  
  
  RESULTS
  Results from 100 sequential patients were analysed. Mean age 44.2 years (32-69) with mode average parity of 3 (0-5 deliveries). Pre-treatment, 289/400 veins were refluxing (ovarian - 29 right, 81 left; internal iliac - 93 right, 86 left). Coil embolisation was successful in 86/100 patients and failed partially in 14/100 - 5 due to failure to cannulate the target vein. One false-positive diagnosis was made.
  
  
  CONCLUSIONS
  Currently there is no accepted gold standard for pelvic vein incompetence. Comparing transvaginal duplex ultrasonography with the outcome from selectively treating the veins identified as having pathological reflux with coil embolisation, there were no false-negative diagnoses and only one false-positive. This study suggests that transvaginal duplex ultrasonography could be the gold standard in assessing pelvic vein reflux.
authors.affiliation: The Whiteley Clinic, Stirling House, Guildford, Surrey, UK Faculty of Health and Medical Sciences, University of Surrey, UK mark@thewhiteleyclinic.co.uk.
authors.forename: M S
authors.initials: MS
authors.lastname: Whiteley
authors.affiliation: The Whiteley Clinic, Stirling House, Guildford, Surrey, UK Faculty of Health and Medical Sciences, University of Surrey, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Dos Santos
authors.affiliation: The Whiteley Clinic, Stirling House, Guildford, Surrey, UK.
authors.forename: C C
authors.initials: CC
authors.lastname: Harrison
authors.affiliation: The Whiteley Clinic, Stirling House, Guildford, Surrey, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Holdstock
authors.affiliation: The Imaging Clinic, Mount Alvernia Hospital, London, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Lopez
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D010053:Ovary / Q000098:blood supply; D012189:Retrospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*; D014621:Vagina; D014680:Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy
keywords: Duplex ultrasound; internal iliac veins; ovarian veins; pelvic vein reflux; varicose veins