Ultrasound characteristics and risk factors of female patients with pelvic varicose veins and concomitant chronic pelvic pain

Abstract

Objective: The study aims to elucidate clinical and ultrasonographic characteristics of female patients diagnosed with pelvic varicose veins (PVVs) and to assess potential risk factors associated with incidences of chronic pelvic pain (CPP) in this population.

Methods: Clinical and ultrasound data were retrospectively collected from female patients with PVVs at Beijing Shijitan Hospital between December 2017 and October 2022. Patient cohorts were divided into two groups based on whether they had been experiencing non-periodic pelvic pain over 6 months, consistent with the symptoms of CPP. Comparative analyses were conducted between the two groups, utilizing both univariate and multivariate logistic regression methodologies to identify risk factors for CPP.

Results: The study included a total of 236 patients: 89 patients in the CPP group and 147 patients in the non-CPP group. No statistically significant differences were found between the two groups with regard to demographic parameters including age, height, weight, age of menarche, and number of pregnancies and births. However, the CPP group showed a higher menstrual volume score and a greater incidence of varicose veins, coupled with a lower body mass index. Transabdominal ultrasonography revealed that patients with CPP had a significantly larger diameter in the left ovarian vein (LOV) (6.2 ± 1.9 mm vs 5.0 ±2.3 mm; P < .05), and a higher prevalence of left internal iliac vein incompetence (21.3% vs 8.8%). Moreover, positive rates for LOV incompetence were markedly higher (94.4% vs 23.1%; P < .05), even in the absence of left common iliac vein compression and nutcracker phenomenon. Multivariate logistic regression analysis discerned that the LOV reflux (odds ratio [OR], 9.102; 95% confidence interval [CI], 4.578-18.099; P < .05), lower body mass index (OR, 0.646; 95% CI, 0.502-0.83; P < .05), elevated menstrual bleeding (OR, 1.182; 95% CI, 1.131-1.234; P < .05), and concomitant varicose veins (OR, 3.140; 95% CI, 1.067-9.273; P < .05) are independent risk factors for the manifestations of CPP in our patient cohorts.

Conclusions: Ultrasonography serves as an efficacious modality for evaluating abdomino-pelvic vascular pathology in patients with PVVs. Notably, LOV and internal iliac vein incompetence emerge as independent risk factors for CPP, thus offering a pivotal point of reference for clinical diagnosis and therapeutic management of PVVs.

Keywords: Chronic pelvic pain; Pelvic venous reflux; Risk factor; Ultrasound.

Fig

Ultrasound images of the abdomino-pelvic vessels. A, Nutcracker phenomenon, in which the left renal vein (LRV) is compressed at the space between the superior mesenteric artery (SMA) and abdominal aorta. (Da1, narrowest point at where the LRV crosses the angle between the SMA and abdominal aorta (AAO). Db1, the point at which the LRV dilation is the most pronounced.). B, Left ovarian vein (LOV) reflux. Color Doppler imaging demonstrates reversed flow within the LRV and LOV. (Da2, maximum diameter of LOV/left gonadal vein [LGV]). C, Left common iliac vein (LCIV) compression. A longitudinal view of the LCIV imaged in B-mode and color Doppler imaging shows the compression of the LCIV by the right common iliac artery (CIA) on top and vertebrae underneath. (Da3, the luminal diameter of the LCIV at the point where the right CIA crosses the LCIV. Db3, the distal section of the LCIV). D, Internal iliac vein (IIV) reflux. Color Doppler imaging shows reversed flow within the left IIV. LEIV, Left external iliac vein; LIIV, left internal iliac vein; IVC, inferior vena cava; RCIA, right common iliac artery.