Jornal Vascular Brasileiro
https://app.periodikos.com.br/journal/jvb/article/doi/10.1590/S1677-54492010000200002
Jornal Vascular Brasileiro
Original Article

Evaluation of pelvic varicose veins using color Doppler ultrasound: comparison of results obtained with ultrasound of the lower limbs, transvaginal ultrasound, and phlebography

Avaliação de varizes pélvicas por Doppler colorido: comparação dos resultados obtidos com ultrassom dos membros inferiores, ultrassom transvaginal e flebografia

Fanilda Souto Barros; José Maria Gomez Perez; Eliana Zandonade; Sérgio X. Salles-Cunha; Javier Leal Monedero; Ariadne Basseti Soares Hilel; Antônio Augusto Barbosa de Menezes; Daniela Souto Barros

http://dx.doi.org/10.1590/S1677-54492010000200002 J Vasc Bras, vol.9, n2, p.15-23, 2010
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Abstract

Introduction: Pelvic varicose veins, one of the main causes of chronic pelvic pain and dyspareunia, are an important source of reflux for lower limb varicose veins, especially in recurrent cases. Color Doppler ultrasound of the lower limbs and transvaginal ultrasound are the noninvasive diagnostic methods most commonly used to assess pelvic venous insufficiency, whereas phlebography is still considered as the gold standard. Objectives: To determine the prevalence of lower limb varicose veins originating from the pelvis in a group of female patients and to determine the agreement between results obtained via color Doppler ultrasound of the lower limbs, transvaginal ultrasound, and phlebography. Methods: The sample comprised female patients referred to a vascular laboratory for lower limb screening. Patients diagnosed with deep venous thrombosis were excluded. Data analysis included kappa coefficient of agreement, McNemar's test, sensitivity and specificity values. Results: Of a total of 1,020 patients, 124 (12.2%) had findings compatible with reflux of pelvic origin. Among these patients, 51 (41.2%) were recurrent cases. A total of 249 were submitted to transvaginal ultrasound. There was significant agreement between lower limb ultrasonographic findings and transvaginal findings. Phlebography was performed in 54 patients. The comparison between transvaginal ultrasound and phlebography was associated with a 96.2% sensitivity and 100% specificity. Conclusions: The authors draw attention to the relatively high prevalence of lower limb varicose veins originating from the pelvis, suggesting an important but underdiagnosed cause of recurrent varicose veins.

Keywords

Color Doppler ultrasound, pelvic varicose veins, transvaginal Doppler ultrasound, phlebography

Resumo

Introdução: AS VARIZES Pélvicas, uma das principais causas de dor pélvica crônica e dispareunia, são uma importante fonte de refluxo para as varizes dos membros inferiores, especialmente em casos recorrentes. O Doppler colorido dos membros inferiores e o ultrassom transvaginal são os métodos diagnósticos não-invasivos mais comumente usados para avaliar a insuficiência venosa pélvica, enquanto a flebografia ainda é considerada como o padrão-ouro. Objetivos: Determinar a prevalência de varizes dos membros inferiores originadas na pélvis em um grupo de pacientes do sexo feminino e determinar a concordância entre os resultados obtidos por Doppler colorido dos membros inferiores, ultrassom transvaginal e flebografia. Métodos: A AMOstra incluiu pacientes do sexo feminino encaminhadas para o laboratório vascular para triagem dos membros inferiores. As pacientes diagnosticadas com trombose venosa profunda foram excluídas. A análise dos dados incluiu o coeficiente de concordância kappa, o teste de McNemar e os valores de sensibilidade e especificidade. Resultados: De um total de 1.020 pacientes, 124 (12.2%) tiveram achados compatíveis com refluxo de origem pélvica. Entre essas pacientes, 51 (41.2%) eram casos recorrentes. Um total de 249 foram submetidas a ultrassom transvaginal. Houve concordância significativa entre os achados ultrassonográficos dos membros inferiores e os achados transvaginais. A flebografia foi realizada em 54 pacientes. A comparação entre o ultrassom transvaginal e a flebografia foi associada a 96.2% de sensibilidade e 100% de especificidade. Conclusões: OS AUTores chamam a atenção para a prevalência relativamente alta de varizes dos membros inferiores originadas na pélvis, sugerindo uma importante, embora subdiagnosticada, causa de varizes recorrentes.

Palavras-chave

Doppler colorido, varizes pélvicas, ultrassonografia Doppler transvaginal, flebografia

References

Labropoulos N, Tiongson J, Pryor L. Nonsaphenous superficial vein reflux. J Vasc Surg. 2001;34:872-7.

Francheschi C, Bahnini A. Treatment of lower extremity venous insufficiency due to pelvic leak points in women. Ann Vasc Surg. 2005;19:284-8.

Lasry JL, Coppé G, Balian E, Borie H. Pelvi-perineal venous insufficiency and varicose veins of the lower limbs: duplex Doppler diagnosis and endoluminal treatment in thirty females. J Mal Vasc. 2007;32:23-31.

Ashour MA, Soliman H, Khougeer GA. Role of discending venography and endovenous embolization in treatment of females with lower extremity varicose veins, vulvar and posterior thigh varices. Saudi Med J.. 2007;28:206-12.

Greiner M, Gilling-Smith GL. Leg varices originating from the pelvis: diagnosis and treatment. Vascular. 2007;15:70-8.

Creton D, Hennequin L, Kohler F, Allaert FA. Embolisation of symptomatic pelvic veins in women presenting with non-saphenous varicose veins of pelvic origin: three-year follow-up. Eur J Vasc Endovasc Surg. 2007;34:112-7.

Uflaker R. Atlas de anatomia vascular. 2003:635-729.

Engelhorn CA, Engelhorn AL, Cassou MF, Casagrande C, Gosalan CJ, Ribas E. Classificação anatomofuncional da insuficiência das veias safenas baseada no eco-Doppler colorido dirigida para o planejamento cirúrgico das varizes. J Vasc Bras. 2004;3:13-9.

Nicolaides AN, Allegra C, Bergan J. Management of chronic venous disorders of the lower limbs: guidelines according to scientific evidence. Int Angiol. 2008;27:1-59.

Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs: UIP consensus document. Part I: basic principles. Eur J Vasc Endovasc Surg. 2006;31:83-92.

Labropoulos N, Tiongson J, Pryor L. Definition of venous reflux in lower-extremity veins. J Vasc Surg. 2003;38:793-8.

Barros FS. Varizes pélvicas. Guia prático de ultra-sonografia vascular. 2006:191-195.

Leal Monedero J, Ezpeleta SZ, Castro FC, Senosiain LDC. Recidiva varicosa de etiologia pélvica. Tratado de flebologia e linfologia. 2006:301-22.

Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES Jr. Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. Am J Roentgenol. 2001;176:119-22.

Liddle AD, Davies AH. Pelvic congestion syndrome: chronic pelvic pain caused by ovarian and internal iliac varices. Phlebolgy. 2007;22:100-4.

Perrin M, Gillet JL. Management of recurrent varices at the popliteal fossa after surgical treatment. Phlebology. 2008;23:64-8.

Van Rij AM, Jiang P, Solomon C, Christie RA, Hill GB. Recurrence after varicose vein surgery (a prospective long-term clinical study with duplex ultrasound scanning and air plethysmography). J Vasc Surg. 2003;38:935-43.

Perrin MR, Labropoulos N, Leon LR Jr. Presentation of the patient with recurrent varices after surgery (REVAS). J Vasc Surg. 2006;43:327-34.

Geier B, Barbera L, Mumme A. Reflux patterns in the ovarian and hypogastric veins in patients with varicose veins and signs of pelvic venous incompetence. Chir Ital. 2007;59:481-8.

Jacques NMP, Pinto MG. Vasos do tronco: Anatomia e aplicações médico-cirúrgicas. Doenças Vasculares Periféricas. 2008:17-69.

Scultetus AH, Villavicencio JL, Gillespie DL, Kao TC, Rich NM. The pelvic venous syndromes: analysis of our experience with 57 patients. J Vasc Surg. 2002;36:881-8.

Kim HS, Malhotra AD, Rowe PC, Lee JM, Venbrux AC. Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol. 2006;17:289-97.

Ratnam LA, Marsh P, Holdstock JM. Pelvic vein embolisation in the management of varicose veins. Cardiovasc Intervent Radiol. 2008;31:1159-64.

Jaeschke R, Guyatt G, Sackett DL. Users' guides to the medical literature: III. How to use an article about a diagnostic test. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 1994;271:389-91.

Jaeschke R, Guyatt GH, Sackett DL. Users' guides to the medical literature: III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA. 1994;271:703-7.

Barros FS, Perez JMG, Zandonade E. Evaluation of pelvic varicose veins using color Doppler ultrasound: comparison of results obtained with ultrasound of the lower limbs, transvaginal ultrasound, and phlebography. J Vasc Bras.. 2010:9:xx-xx.

Oxman AD, Sackett DL, Guyatt GH. Users' guides to the medical literature: I. How to get started. The Evidence-Based Medicine Working Group. JAMA. 1993;270:2093-5.

Castro AA. Avaliação da qualidade da informação. Fiat lux. 2005:1-14.

Fletcher RH, Fletcher SW. Epidemiologia clínica: elementos essenciais. 2006.

Labropoulos N, Tiongson J, Pryor L. Nonsaphenous superficial vein reflux. J Vasc Surg.. 2001;34:872-7.

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