Diagnosis of arteriovenous compression in small pelvic varicose veins

Faibushevich A.G.¹, Akulova A.A.¹, Shugushev Z.Kh.², Lobastov K.V.³, Taranenko O.V.⁴, Chaban A.S.⁵, Maksimkin D.A.^1,2, Baranovich V.Yu.¹

¹ Department of Hospital Surgery with a Course of Paediatric Surgery,
² Department of Cardiovascular Surgery of the Faculty of Continuing Medical Education, Peoples’ Friendship University of Russia,
³ Department of General Surgery and Radiodiagnosis, N.I. Pirogov Russian National Research Medical University of the RF Ministry of Public Health,
⁴ Therapeutic Department, Scientific Centre of Obstetrics, Gynaecology and Perinatology named after Academician V.I. Kulakov,
⁵ Joint-Stock Company “Family Physician”, Moscow, Russia

Objective. The study was aimed at assessing the incidence of arteriovenous compression in women with chronic venous insufficiency of the inferior vena cava and at developing an optimal diagnostic algorithm.

Materials and methods. During the period 2019-2020, we performed a cross-sectional study including a total of sixty-six 18-to-55-year-old (mean 33.5±5.0) women with clinical manifestations of chronic venous insufficiency of the basin of the inferior vena cava. A diagnostic algorithm included questionnaire, transvaginal ultrasound examination, multislice computed tomography, direct phlebography in combination with phlebotonometry.

Results. Chronic venous insufficiency of lower limbs was diagnosed in 66 (100%) cases and was presented by the following clinical classes according to the CEAP classification: C0 – 4.5%, C1 – 60.6%, C2 – 27.2%, C3 – 3%. Symptoms of pelvic venous plethora were revealed in 36 (55.5%) examined patients. Arteriovenous compression syndrome according to the findings of multislice computed tomography was verified in 16 (24%) women, including May-Turner syndrome in 5 (7.6%), aortomesenteric compression syndrome in 8 (12%) women, with a combination of both syndromes observed in 3 cases; the frequency of their detection did not differ statistically in subgroups of women with and without clinical signs pelvic varicose veins. Direct phlebography in combination with phlebotonometry was performed in 9 women, the diagnosis of arteriovenous compression (May–Thurner syndrome) was confirmed in 1 case only.

Conclusions. In women with signs of chronic venous insufficiency in the system of the inferior vena cava the frequency of detecting arteriovenous compression on multislice computed tomography may reach 24% and does not depend on the presence of symptoms of pelvic venous plethora. The proportion of arteriovenous compression according to the findings of direct phlebography and phlebotonometry in the structure of causes of the development of pelvic varicose veins did not exceed 11%. An algorithm for diagnosing arteriovenous compression syndromes should obligatorily include multislice computed tomography, direct phlebography and phlebotonometry.

KEY WORDS: pelvic varicose veins, May-Thurner syndrome, aortomesenteric compression syndrome, pelvic venous plethora, chronic pelvic pain.

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