PELVIC AND PERIPHERAL VENOUS INSUFFICIENCY: DIFFERRENT PRESENTATION AND COMMON PATHOPHYSIOLOGY

Aim: Varicose veins are related to other diseases including varicocele or utero-ovarian varices. On the base of close physiopathologic relationships between varicose veins and gonadal varicosity we decided to evaluate the features of pelvic venous insufficiency in patients affected by varicose veins. Patients and Methods: Seventy patients with different grades of chronic venous insufficiency (CVI) were included in the study. The patients were evaluated pre-operatively by color Doppler for grading of gonadal varicosity and assessment of valvular incompetence in the peripheral veins. Post-operatively, the number of valves in the stripped veins was correlated to the degree of gonadal varicosity. Results: Thirty patients were proved to have both peripheral and pelvic venous insufficiency. Higher grades of gonadal varices were associated with lesser number of saphenous valves. There was a significant relation between the Doppler grading of venous reflux in gonadal peripheral veins. Conclusions: The incidence of varicocele associated with CVI was higher than the incidence of isolated varicocele. The bilateral development of gonadal and peripheral varicosity in female patients refers to mechanical compression followed by axial reflux. The association of lesser number of valves in the saphenous veins with higher grades of varicocele raises the possibility of generalized valvular scarcity as a cause of venous insufficiency