Ultrasound Scan:
Ovarian/Gonadal Vein Duplex

Pelvic congestion syndrome (PCS) is a condition that occurs in women and is characterised by chronic pain in the pelvic area. It is caused by the presence of varicose veins in the pelvis, specifically in the ovarian veins and/or other veins in the pelvic region. In a healthy pelvis, blood flows through the veins and returns to the heart. However, in pelvic congestion syndrome, the valves in the veins that help maintain proper blood flow become weakened or damaged. This leads to blood pooling and increased pressure in the veins, causing them to enlarge and become varicose. The exact cause of pelvic congestion syndrome is not fully understood, but it is believed to be related to hormonal factors and increased blood flow to the pelvic area, such as during pregnancy. Other potential risk factors for developing PCS include multiple pregnancies, hormonal imbalances, and a history of blood clots. The primary symptom of pelvic congestion syndrome is chronic pelvic pain that is typically dull, aching, and can be described as a heaviness or pressure in the lower abdomen. The pain may worsen after prolonged standing, during or after sexual intercourse, or during menstruation. Other possible symptoms may include lower back pain, leg pain or swelling, and an increase in symptoms before or during the menstrual cycle.

We request a 4 hr fast for this study.

Eating creates a gas that ultrasound is unable to scan through and may obstruct structures we need to see.

​

This scan usually takes between 20- 30 minutes.

​

The purpose of an Iliocaval ultrasound is to assess the ovarian/gonadal veins for incompetence. This ultrasound requires direct contact with your skin. We often don't require you to remove any clothing but will ask if your trousers can be shuffled down to the hips and your shirt and jumper lifted up nice and high. We will ask for you to lie down on the examination bed. During the scan we will apply ultrasound gel to your abdomen and use the ultrasound machine to look at the vessels.

In situations of pelvic congestive syndrome or recurrent varicose veins the congestion of blood within the ovarian/gonadal vein are frequently the source of the issue. Using ultrasound we can determine whether these veins are incompetent and how dilated they are. An ovarian vein incompetence ultrasound, also known as ovarian vein Doppler ultrasound, may be performed for various reasons related to suspected issues with the ovarian veins or pelvic blood flow. Here are some common indications for an ovarian vein incompetence ultrasound:

Evaluation of pelvic pain

Ovarian vein incompetence ultrasound can be used to assess the pelvis and help identify potential causes of pelvic pain. It allows visualization of the pelvic organs, including the ovaries and surrounding structures, as well as the ovarian veins. This can help detect abnormalities such as dilated or refluxing veins.

Diagnosis of pelvic congestion syndrome (PCS)

Pelvic congestion syndrome is characterised by chronic pelvic pain due to the presence of varicose veins in the pelvis, including the ovarian veins. An ovarian vein incompetence ultrasound can help visualise the ovarian veins, assess blood flow patterns, and aid in the diagnosis of PCS.

Evaluation of venous insufficiency

Ovarian vein incompetence ultrasound can be used to assess blood flow in the ovarian veins and evaluate the competence of the venous valves. It helps identify any reflux (backward flow) or abnormalities in the blood flow, which may contribute to venous insufficiency or varicose veins.

​

Preoperative planning

Ovarian vein incompetence ultrasound may be performed as part of preoperative planning for certain gynecological or vascular procedures. It provides valuable information about the anatomy, size, and location of the ovarian veins, aiding the surgical team in planning the procedure.

Monitoring treatment response

After initiating treatment for ovarian vein incompetence, such as embolisation or sclerotherapy, follow-up ultrasound examinations can be performed to assess the effectiveness of the treatment and monitor any changes in the ovarian veins and blood flow patterns.

Ovarian vein incompetence refers to the inability of the ovarian veins to adequately transport blood from the ovaries back to the heart, resulting in blood pooling and potential vein dilation. While the exact cause of ovarian vein incompetence is not fully understood, there are several potential risk factors associated with its development. These include:

​

Pregnancy

Ovarian vein incompetence is most commonly observed during and after pregnancy. The increased blood volume, hormonal changes, and pressure on the pelvic veins during pregnancy can contribute to the development of vein dilation and incompetence.

Multiple pregnancies

Women who have had multiple pregnancies, especially those that are closely spaced, may have an increased risk of developing ovarian vein incompetence.

Hormonal factors

Fluctuations in hormone levels, particularly estrogen, can impact the elasticity and tone of blood vessels. This hormonal influence may contribute to the development of vein incompetence.

Family history

There may be a genetic component to ovarian vein incompetence, as it has been observed to occur more frequently in certain families. Having a family history of varicose veins or venous insufficiency may increase the risk.

Previous pelvic vein surgery or interventions

Previous surgical procedures or interventions involving the pelvic veins may disrupt the normal venous flow and increase the risk of ovarian vein incompetence.

Pelvic congestion syndrome (PCS)

Ovarian vein incompetence is often associated with pelvic congestion syndrome, a condition characterized by chronic pelvic pain due to the presence of varicose veins in the pelvis. Women with PCS may have a higher risk of ovarian vein incompetence.

Chronic pelvic pain due to the presence of varicose veins in the pelvis, including the ovarian veins. The symptoms of pelvic congestion syndrome can vary among individuals, but common symptoms may include:

Chronic pelvic pain

Persistent, dull, or aching pain in the lower abdomen or pelvic region is a hallmark symptom of PCS. The pain may be intermittent or constant, and it may worsen with prolonged standing or sitting, during or after sexual intercourse, or during menstruation.

Painful menstruation (dysmenorrhea)

Women with PCS may experience increased pain and discomfort during their menstrual periods.

Pain during or after sexual intercourse (dyspareunia)

Intercourse may be accompanied by pelvic pain or discomfort in individuals with pelvic congestion syndrome.

Varicose veins

Visible veins that appear enlarged, twisted, or bulging may be present in the pelvic area, buttocks, or upper thighs.

​

Abdominal bloating or heavines≥s

Some individuals with PCS may experience a sense of abdominal bloating or heaviness due to the increased pelvic venous pressure.

Urinary symptoms

PCS can occasionally be associated with urinary symptoms such as frequency, urgency, or a sensation of incomplete bladder emptying.

Backache or leg pain

In some cases, PCS may cause lower back pain or a dull, aching pain in the legs, which can be associated with the varicose veins; this is especially so during menstruation.

The treatment for ovarian vein incompetence aims to alleviate symptoms, improve blood flow, and manage complications associated with the condition. The specific treatment approach may vary depending on the severity of symptoms, individual circumstances, and patient preferences. Some common treatment options for ovarian vein incompetence are:

• Lifestyle modifications: Measures such as regular exercise, elevation of the legs, avoiding prolonged standing or sitting, and wearing compression stockings can help improve blood circulation and reduce symptoms.

• Ovarian vein embolisation: This procedure involves the insertion of a catheter into the affected ovarian vein, where small coils or embolic agents are used to block the blood flow, redirecting it to healthier veins. Ovarian vein immobilisation can help relieve symptoms and improve blood flow.