Varicose veins are the pelvis - the least studied and most difficult question of modern phlebology.
The hardest thing for varicose pelvic veins is the lack of clinical manifestations. It is also difficult to diagnose and carries a wrong choice of treatment.
It is a mistake can be done, and unwarranted hysterectomy (removal of uterus), entailing the loss of menstrual and reproductive functions.
In the present distinguish primary varicose veins of the pelvis - a congenital or acquired valvular insufficiency ovarian veins. Secondary manifestation due to the presence of gynecological pathology (tumors of the pelvic organs, endometriosis, etc.).
The main symptoms of varicose pelvic veins:
chronic pain in lower abdomen associated with long-term static and dynamic loads
increasing pain during the second phase of the menstrual cycle
painful crises (in the psycho-emotional stress, physical exhaustion, cooling)
dyspareunia (discomfort, pain in the vulva and vagina during intercourse and / or after)
patients are often concerned about the pronounced premenstrual syndrome, dysmenorrhea, and sometimes Impairment of Fertility.
On examination, 50% of nabdyudaetsya combination of varicose pelvic veins with similar changes in the superficial veins in the area of the perineum, the buttocks and thigh posteroexternal. When conducting a survey of manual can be identified venous nodules, tenderness to palpation of internal walls of the pelvis, cyanosis of the vaginal walls.
The most efficient diagnosticmethod is ultrasound, with the help of defined varicose veins as overly convoluted anehogennyh structures. Doppler can detect reduced peak systolic velocity in the ovarian, uterine and internal iliac veins. With uninformative echographic methods for assessing the functional capacity of the valve apparatus, the state of the venous system of the uterus and appendages do chrezmatochnuyu phlebography, which, among other things, the presence of complications makes it possible to determine the location of blood clots.
In some cases, necessary to perform diagnostic laparoscopy, which allows in cases of dispute, not only to confirm existing pelvic varicose veins, but also to exclude intercurrent disease. Of noninvasive methods for identifying comorbidities used a computer or magnetic resonance imaging.
Treatment of pelvic varicose veins can be both conservative and consist, primarily, in the performance of medical gymnastics and taking fleboprotektorov with antiplatelet properties, and surgery - in the presence of persistent pain (embolization of ovarian veins under angiographic control, at least - clipping or open resection of the gonadal veins).
