Recently, I treated Emma from Bristol who developed very large, uncomfortable varicose veins around her vulva and upper thigh during pregnancy. After she had her baby, the veins around her vulva disappeared but the veins in her thigh persisted and gradually got worse. Her duplex ultrasound scan showed that the veins in her thigh were filling from her ovaries.
She had a condition called “Ovarian Vein Reflux”. The treatment for this is controversial, but my approach is to treat these veins with ultrasound guided foam sclerotherapy unless there are symptoms of pelvic pain, bladder irritation or pain during intercourse. So far, the results of foam sclerotherapy for this condition have been very good.
Here we can see Emma’s clinical photographs taken before and after treatment. After ultrasound guided foam sclerotherapy, all the discomfort and pain in her leg have gone and her leg looks much improved.
As this is a controversial topic, I have invited are my colleague and good friend Philip Coleridge Smith to review the medical literature and share his own personal experience. Philip has a large venous practice in London and the south-east.
Philip Coleridge Smith
Consultant Vascular Surgeon and Reader in Surgery, UCL Medical School
Medical Director, British Vein Institute
President, British Society of Sclerotherapists
” I have treated many patients with varicose veins over the years but only occasionally have I needed to treat the ovarian veins. These pass up the back of the abdomen and drain into the renal vein on the left and the inferior vena cava on the right.
Following pregnancy the valves in these veins may become incompetent allowing reverse flow towards the ovaries. Mark Whiteley of the Whiteley Clinic has investigated women attending his clinic for varicose veins in the leg and found that about 1 in 6 patients have varicose veins in the pelvis.
But is this a problem? Mr Whiteley’s paper on the subject does not address this issue. In fact, I have seen thousands of patients with varicose veins but in only a handful did symptoms appear to arise from ovarian vein incompetence. The classical syndrome is referred to a ‘pelvic congestion syndrome’ in which a heavy dull pain arises in the pelvis and is worse on standing. Urgency of micturition can be a problem as can post-coital pain. In this group of patients, ligation or embolisation of the ovarian veins results in considerable improvement in symptoms.
A further group of patients have varicose veins in the leg descending over the inside of the thigh in the pudendal region. The origin of these veins is the pelvic varices filled from ovarian veins. All of the patients that I have seen so far have been free of pelvic symptoms but are troubled by the leg veins, which can caused marked aching.
Recently I have seen a number of patients with pudendal varices who have undergone ovarian vein embolisation. This resulted in no improvement in the appearance of the varicose veins in the legs or in the symptoms arising from the veins. My usual treatment in this group of patients is to use ultrasound guided foam sclerotherapy to treat all the veins in the legs. I don’t do any treatment for the ovarian veins unless pelvic congestion syndrome is present. I have found that this strategy leads to long lasting relief from the pudendal varices and any symptoms arising from them. I have provided this treatment in patients who have undergone ovarian vein embolisation as well as many who have not. Both groups of patients were very grateful for the freedom from leg symptoms.
From my personal observations I have concluded that ovarian vein embolisation procedures are not appropriate and that they are potentially hazardous in patients with pudendal varices. This treatment is only necessary to treat pelvic congestion syndrome. ”
Thank you Philip for sharing your expertise.
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