JK Navel Stab Bleed :35

Detection and assessment of pelvic veins is impossible without the use of ultrasound and radiological techniques. This is determined by the deep location of pelvic veins, the nonspecific clinical picture, and the need to obtain accurate information about the diameters of the pelvic, iliac, and renal veins and to establish the presence and duration of pelvic venous reflux in numerous pelvic veins. This is especially true for patients with a combination of MTS and PCS because the disorders of pelvic vein hemodynamics are the most complex in this category of patients.

JK navel stab bleed :35

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Duplex ultrasound scanning (DUS)Duplex ultrasound scanning (DUS) of the pelvic veins is considered the gold standard method for the diagnosis of pelvic varicose veins.37,38 With DUS it is possible to measure diameters of pelvic (parametrial, uterine, gonadal) veins, establish the presence of reflux and its duration, as well as objectively assess the state of the left renal vein (nutcracker syndrome) and the patency and diameters of the iliac veins.39 Other advantages of DUS include its noninvasiveness, the reproducibility of results, and the absence of radiation exposure. Disadvantages include operator dependence and the need for bowel preparation and following of a diet before the examination for better imaging of the pelvic veins. Whiteley et al report a high informative value of DUS in detecting pelvic-perineal reflux (PPR) and valvular incompetence of the internal pudendal, obturator, and inferior gluteal veins.37 Our experience with DUS in patients with MTS and PCS suggests the opposite: the reliable imaging of the IIV tributaries with DUS is unlikely and, most importantly, is completely unnecessary.40 If the treatment of vulvar varicose veins consists of sclerotherapy or excision of the vulvar veins, the presence of reflux in the IIV tributaries makes no difference. But if the task is localization diagnosis of PPR and embolization of IIV tributaries, pelvic venography is essential. Therefore, there is no point in wasting time and effort to identify reflux in the IIV tributaries using DUS. The main purpose of performing DUS in PeVD is to detect pelvic varicose veins and pelvic venous reflux and to assess the left renal vein (Figure 3).Figure 3. Duplex ultrasound scanning. (A) Arrows indicate dilated parametric veins. (B) Arrows indicate a dilated left gonadal vein. 2ff7e9595c