Venous insufficiency and varicose veins are due to a faulty connection between the deep and superficial vein systems such that deep vein blood (under pressure) flows backwards (refluxes) down the superficial veins, stretching them, and causing bulging. Usually the faulty connection is at the groin or behind the knee. Treatment involves closing off the faulty connection and attending to the damaged veins below (see Varicose Veins page)

Sometimes, often following pregnancy, the faulty connection is higher up, in the pelvis and cannot be closed directly from the leg. This leakage causes varicose veins in the legs but also can cause varicose veins around the vagina (vulval varicose veins). Often these veins will resolve in the first 6 months after birth but if not, then the leaking pelvic vein must be found and closed off before any veins in the leg or around the vulva can be dealt with effectively.

 

(N.B Any treatment that does not attend to the source of the leak in the pelvis will result in disappointment and recurrence as the leaking vein in the pelvis will find new venous drainage pathways into the leg.  Secondary, recurrent venous drainage pathways are much harder to treat and cause disappointing cosmetic results).

 

Pelvic venous incompetence is diagnosed at consultation with a history of;

 

  • vulval (vaginal) varices during pregnancy and/or

  • leg varicose veins that are worse/more painful during menstrual periods

  • heavy bleeding and pre-menstrual bloating

  • haemorrhoids in pregnancy

  • aching after sex ("dyspareunia")

 

This is then confirmed with Duplex scan/MR venography and pelvic dynamic venography arranged (see below). Once the primary leak in the pelvis has been located and blocked off (pelvic vein embolisation, see below for procedural details) the incompetent venous pathways in the leg can be attended to appropriately by a combination of laser ablation, avulsion of varices and sclerotherapy.  Microsclerotherapy to surface spider veins and flares is not usually undertaken at the time of the primary procedure and, depending on the extent of the veins, may involve two or three subsequent clinic visits.  

 

 

Pelvic vein embolisation procedure (ovarian and iliac vein embolisation) 

If the primary source of venous leak and reflux is in the pelvis then identification and closure (embolisation) of this leak must be carried out before attending to the secondary incompetent venous drainage pathways into the legs, buttocks or vulval region.  This is achieved by a short angiographic procedure involving catheterization via needle access of the pelvic veins under x-ray guidance, which is carried out as an out-patient procedure with light sedation and local anaesthetic.  This is an entirely separate procedure to treatment of leg varicose veins and the separate equipment requirements dictate that it is carried out in a separate procedural room.  It can however be carried out on the same day as any leg procedure, if that is desirable for patient convenience.  There is no specific recovery associated with pelvic venous embolisation procedure. 

 

For means of reference the pelvic venous embolisation procedure is the same procedure as carried out for pelvic vein congestion syndrome, vulval varices and/or female varicocele (it is similar but not identical to the procedure for fibroid embolisation).

 

(See the Xray pictures of the Pelvic vein embolisation procedure, to the right)   

 

These procedures, as recommended, are covered by Health Insurance providers but this should always be confirmed by pre-authorisation before undertaking any treatment. 

 

 

 

SUMMARY

Pelvic Vein Incompetence, Vulval Varices and Haemorrhoids

Image from pelvic venous embolisation
Haemorrhoids are varicose veins of the rectum
Haemorrhoids treated by coil embolisation during pelvic venography