Case study: Varicose veins near the pelvic region a warning sign of a vascular condition?
In this article, we will look at varicose veins forming near the pelvic region. The Center for Vascular Medicine doesn’t recommend a venogram procedure for most cases. We recommend a procedure for a patient who feels that the pelvic pain is unbearable or debilitating. We recommend those with mild symptoms continue monitoring and see if the symptoms progress. If symptoms progress then further action can be taken with the recommendation of your physician.
Case Study: Women with varicose veins near the pelvic region
This is a case of a 46 old female college professor who complained of lower abdominal and pelvic pressure, generalized over three years.
She notes pain is worsening with her menstrual period. Her left leg was swelling over the past year. There is clear evidence of varicose veins noted near the upper inner thighs. No significant past medical and surgical history. She had 3 vaginal deliveries.
She visited multiple gynecologists and they all showed everything is normal. The patient began to think that her groin pain was on in her head. She decided to visit a vascular doctor to make sure it is not a problem with her pelvic veins.
Diagnosis with Center for Vascular Medicine
A skilled ultrasound technician revealed minimal superficial axial vein reflux. This requires a highly training vascular sonographer to detect venous reflex using non-invasive ultrasound. This is intravascular ultrasound similar to sonography completed during pregnancy.
Detailed history needs to be obtained:
- Primary Medical History including risk factors such as high blood pressure
- Previous surgical history
- Social History including the use of tobacco products/nicotine-containing products
- Details about symptoms the patient is experiencing
Careful physical examination is mandatory
- Pulses in the affected extremity
- Temperature and color of the extremity
- Presence of slow healing or non-healing wounds/ulcerations
- Various examinations to rule out any other possible vascular conditions.
Initial Diagnostic Testing
Duplex (Ultrasound) Study of the Extremity. This is a non-invasive sonography scan similar to a pregnancy scan to look for venous reflux. The ultrasound revealed significant diameter reduction and increased reflux times within the left common iliac vein. It also revealed a collection of veins within the left adnexal space.
Patient Procedure
The patient was recommended to undergo a procedure. The patient accepted to go with the minimally-invasive procedure. No hospital stays are required and the patient can go back to work the next day.
Venogram - A venogram is a procedure to make the veins visible for the doctor to see blood flow. The physician was looking for iliac vein compression. The venogram showed May-Thurner Syndrome.
Intravascular Ultrasound (IVUS) – shows significant narrowing greater than 70% for this patient so a stent was placed.
Venous stent – FDA-approved stents are alloy mesh tubes that are deployed into the veins to provide structural support. They come in a variety of designs and sizes. Stents are usually delivered to their target area using a vascular catheter and in a compressed state. Some are self-expanding while others require the assistance of an inflated balloon. The venous stent was placed on the left-common iliac vein. This narrowing was reopened using the FDA-approved stent.
Most stents remain permanently in place once deployed and are very difficult to remove if the need arises. Additionally, some stents can be coated or designed to deliver medications slowly over time.
Results of Procedure
On 1-week follow-up, the patient-reported dull abdominal discomfort over 2 days post-procedure, which was relieved with NSAIDs.
At the 6-week follow-up, no further abdominal heaviness and pelvic pressure were experienced.
At the 3-month follow-up, the varicosities of the inner thigh and vulva were no longer bulging.
At 6-months, left leg swelling has completely resolved varicosities.
She was relieved that the symptoms were indeed “real” and not just “in her head.”
This was life-changing for the patient to no longer had to suffer from the pain in her groin or pelvic region. She didn’t have to worry about her leg swelling or varicose veins in her thigh region.
