2. Pelvic and vulvar varicose veins
Debate: Pelvic vein reflux must be treated before addressing leg veins
For the motion.
J. Brookes
In males, varicocele of the gonadal veins is a relatively common occurrence that is easily recognized by clinical examination. The same occurs in the gonadal veins of women, but the deep ovaries hide the presence of varicosities to external examination. The deep iliac veins have three fields of drainage and may be incompetent alone or in combination with gonadal veins. They may drain to the leg directly or via pudendal tributaries.
Diagnosis of pelvic venous insufficiency is clinical and is confirmed with imaging. Dynamic contrast venography should be done to obtain a complete examination of the deep venous pathways and to allow for the appropriate and selective treatment by transcatheter embolization at the same time.
Against the motion.
J. Earnshaw
Only 2% of lower limb varices in women are due to isolated incompetent pelvic veins. Pelvic venous incompetence may be diagnosed using ultrasound imaging, transvaginal ultrasonography, venography, and magnetic resonance imaging (MRI). Ovarian vein embolization was first described in 1993, but most reported series in the literature are small with numerous biases.
Treating pelvic vein incompetence first before varicose veins of the lower limbs in a two-stage session has not shown any evidence for improving the symptoms of pelvic reflux or preventing varicose vein recurrence. In addition, some complications such as coil migration have been reported. Concomitant foam sclerotherapy could be an alternative solution to this infrequent problem, but controlled studies are required.
How to treat vulvar veins after pelvic embolization.
B. Price
Vulval varices are common and do not disappear after delivery. These kinds of varices should not be considered as a separate entity and they should be treated in the context of a complete plan with other sources of reflux. Surgical avulsion is a good technique, but it could be difficult to perform in certain locations. Foam sclerotherapy combined with compression seems to be the treatment of choice, but few data are available.
Pelvic venous congestion causes hemorrhoids.
J. Holdstock
No high-quality studies are available on this topic.
