Oshaani Abeyakoon MBBS, BSc, Presenter: Nothing to Disclose

Meghna Bansal MD, FRCR, Abstract Co-Author: Nothing to Disclose

Abdulrahman J. Alvi MBBS, MRCS, Abstract Co-Author: Nothing to Disclose

John Bottomley, Abstract Co-Author: Nothing to Disclose

To assess potential pelvic sources of lower limb venous incompetence using time resolved MRA and high resolution ‘steady state’ imaging using gadofosveset.

We retrospectively reviewed the MRA findings of 36 consecutive female patients referred between 09-2007 and 03-2010 with perineal or lower limb varices. Some patients had additional symptoms suggestive of pelvic congestion syndrome. All patients had a preceding duplex ultrasound examination of their lower limb veins where a possible pelvic source for perineal/lower limb varicosities was considered. The MR imaging protocol included a coronal lower abdominal and pelvic time resolved MRA extending into the venous phase. A high resolution gradient echo or ‘steady state’ sequence was performed in three stations; abdomen/pelvis, upper and lower legs. All imaging was reviewed on a 3D workstation using multiplanar reformats and thin MIP’s by an experienced consultant vascular radiologist. Positive findings consistent with a possible pelvic source of perineal/lower limb varices included dynamic ovarian vein reflux, dilated ovarian veins >6 mm, extensive and dilated para-uterine, para-vaginal and perivesical varices, varices of the round ligament, superficial pubic and vulval varices, great saphenous vein and accessory saphenous vein varices, left renal vein compression, left common iliac vein compression.  

20 of 36(56%) patients referred for MRA had dynamic left ovarian vein reflux demonstrated on time resolved MRA with a mean left ovarian vein diameter of 8 mm. Of these 20 patients 14(70%) had gone on to left ovarian vein embolisation. 5 patients had evidence of external venous compression with either co-existing suspected nut-cracker syndrome or May-Thurner syndrome. We describe the different patterns of communication between the intra pelvic varices and the perineal and or lower limb varicosities

Time resolved MRAusing a blood pool contrast agent identifies a large proportion (56%) of patients with dynamic left ovarian vein reflux in patients presenting with perineal and or upper leg varices. The addition of high resolution ‘steady state’ imaging aids in determining the likely patterns of venous communication between the intrapelvic and superficial venous systems as well as identifying potential levels of external venous compression.

Assist diagnosis and treatment of perineal/lower limb varicosities.

Abeyakoon, O, Bansal, M, Alvi, A, Bottomley, J, Ovarian Vein Reflux and Pelvic Venous Congestion Causing Perineal and Lower Limb Varices: The Utility of Time-resolved MRA and a Blood Pool Contrast Agent.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9006730.html