Complex pathologies in a patient referred for varicose veins

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Phlebology

Background:

• Varicose veins often stem from saphenous vein reflux but can involve intricate venous pathologies.
• Pelvic pain and leg varicosities can coexist, suggesting complex underlying venous issues.

Observation:

• A 45-year-old woman presented with painful leg varicosities and significant pelvic pain.
• Duplex ultrasound revealed bilateral superficial venous reflux.
• Cross-sectional imaging identified enlarged ovarian veins and non-thrombotic iliac vein compression.

Findings:

• The patient underwent a multi-stage treatment: ovarian vein embolization, iliac vein stenting, and bilateral lower extremity venous ablations with sclerotherapy.
• Following treatment, the patient reported resolution of pelvic symptoms and minimal residual leg symptoms at a 5-year follow-up.

Implications:

• This case underscores the importance of investigating complex venous pathologies beyond superficial reflux in patients with combined leg and pelvic symptoms.
• Successful management involves a tailored, multi-modal approach addressing both pelvic and lower extremity venous abnormalities.
• Integrated treatment strategies can lead to long-term symptom relief and improved quality of life for patients with complex venous disease.