Diagnosing of pelvic vein incompetence using minimally invasive ultrasound techniques.
Background Pelvic vein incompetence is a cause for pelvic pain and recurrent varicose veins in women. The gold standard diagnostic method is reflux venography involving radiation, nephrotoxic contrast and jugular puncture. Trans-vaginal ultrasound (TVU) is increasingly being used as a diagnostic tool for pelvic vein incompetence. Methods Fifty women with clinical suspicion of pelvic vein incompetence and aged between 18 and 55 years were recruited prospectively over two years at a large UK University Teaching Hospital. Trans-vaginal ultrasound was performed using a standardised protocol which included assessment of the ovarian and internal iliac veins bilaterally in the supine and semi-standing position with provocative manoeuvres. Diagnostic readability and inter-observer variability was determined. Results Mean (range) age of 43 (23-51). Visibility of all four pelvic veins was better in the supine position compared with semi-standing position (76% vs 64%). Pelvic vein incompetence was identified in 34 of 50 (68%) women in the supine position compared with 38 of 50 (76%) women in the semi-standing position. Pelvic vein incompetence was demonstrated in 35 of 50 (70%) women with Valsalva manoeuvre. Inter-observer variability was 0.84 (kappa, very good agreement, p = 0.001). Conclusion Trans-vaginal ultrasound is effective at demonstrating pelvic vein incompetence. All trans-vaginal ultrasound protocols should include assessment of pelvic veins in the supine and semi-standing position with Valsalva manoeuvre.
Institute of Cardiovascular Sciences, University of Manchester, Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK.
Vivak
V
Hansrani
Institute of Cardiovascular Sciences, University of Manchester, Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK.
Zainab
Z
Dhorat
Institute of Cardiovascular Sciences, University of Manchester, Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK.
Charles N
CN
McCollum
D000328:Adult; D004739:England; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging*; D008875:Middle Aged; D015588:Observer Variation; D010053:Ovary / Q000098:blood supply*; D056888:Patient Positioning; D010388:Pelvis / Q000098:blood supply*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D016683:Supine Position; D018608:Ultrasonography, Doppler / Q000379:methods*; D014636:Valsalva Maneuver; D014689:Venous Insufficiency / Q000000981:diagnostic imaging*; D055815:Young Adult
Doppler ultrasound; Pelvic vein incompetence; congestion syndrome; pelvic pain