{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T03:12:37Z","timestamp":1785381157595,"version":"3.55.0"},"reference-count":28,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T00:00:00Z","timestamp":1721347200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Objective: The purpose of this study was to evaluate the incidence of gonadal vein refluxes associated with lower-extremity varicose veins with Doppler ultrasonography (DUS). Method: A total of 6279 patients with venous disease-related symptoms of the lower extremity were evaluated with DUS in the vascular lab. Gonadal vein reflux using abdominal ultrasound was further evaluated in patients with unusual varices, defined as varices in the inguinal, inner or upper thigh and the vulvar area without refluxes in the saphenofemoral junction (SPJ). Those patients who showed gonadal vein reflux were diagnosed as having pelvic-origin varicosity. Results: Unusual varices were found in a total of 237 patients (3.8%), and of these patients, pelvic-origin varicosity was discovered with transabdominal ultrasound in 156 (65.8%). A total of 66.7% (n = 38\/57) of unusual varix patients with pelvic pain had gonadal vein reflux. The measurement of gonadal vein diameter was larger in ultrasonography than CT scans (8.835 vs. 8.81, p &lt; 0.001). Two patients with severe symptoms but no obstructive venous diseases were treated with gonadal vein embolization. Conclusion: The incidence of pelvic-origin varicosities was 2.5% (n = 156\/6279). However, more than half of the patients with unusual varices had gonadal vein reflux and 24.4% of these patients also presented with pelvic pain. The evaluation of pelvic-origin varicosities should be performed in patients who present with unusual forms of varices of the lower extremity.<\/jats:p>","DOI":"10.3390\/tomography10070088","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T14:16:38Z","timestamp":1721398598000},"page":"1159-1167","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Incidence and Characteristics of Pelvic-Origin Varicosities in Patients with Complex Varices Evaluated by Ultrasonography"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4763-7530","authenticated-orcid":false,"given":"Kwon Cheol","family":"Yoo","sequence":"first","affiliation":[{"name":"College of Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea"},{"name":"Department of Surgery, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyung Sub","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"},{"name":"Department of Surgery, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Sik","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Surgery, Uijeongbu Eulji Medical Center, Uijeongbu 11759, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taeseung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"},{"name":"Department of Surgery, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1067\/mva.2003.168","article-title":"Quality of life in patients with chronic venous disease: San Diego population study","volume":"37","author":"Kaplan","year":"2003","journal-title":"J. Vasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1067\/mva.2000.104103","article-title":"Measuring the quality of life in patients with venous ulcers","volume":"31","author":"Smith","year":"2000","journal-title":"J. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1016\/S0741-5214(99)70110-2","article-title":"Evaluating and improving health-related quality of life in patients with varicose veins","volume":"30","author":"Smith","year":"1999","journal-title":"J. Vasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1067\/mva.2002.121984","article-title":"Why insurers should reimburse for compression stockings in patients with chronic venous stasis","volume":"35","author":"Korn","year":"2002","journal-title":"J. Vasc. Surg."},{"key":"ref_5","first-page":"17","article-title":"Pelviperineal venous insufficiency and varicose veins of the lower limbs","volume":"15","author":"Balian","year":"2008","journal-title":"Phlebolymphology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1258\/026835507779700617","article-title":"Prevalence and management of gonadal venous insufficiency in the presence of leg venous insufficiency","volume":"22","author":"Sutaria","year":"2007","journal-title":"Phlebology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1111\/j.1368-5031.2005.00631.x","article-title":"Varicose veins arising from the pelvis due to gonadal vein incompetence","volume":"59","author":"Hobbs","year":"2005","journal-title":"Int. J. Clin. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/0002-9378(49)90422-6","article-title":"Vascular congestion and hyperemia: Their effect on structure and function in the female reproductive system","volume":"57","author":"Taylor","year":"1949","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_9","first-page":"123","article-title":"Pelvic congestion syndrome: Prevalence and quality of life","volume":"23","author":"Lazarashvili","year":"2016","journal-title":"Phlebolymphology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.ejvs.2021.12.024","article-title":"Editor\u2019s choice\u2013European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs","volume":"63","author":"Kakkos","year":"2022","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Rezaei-Kalantari, K., Fahrni, G., Rotzinger, D.C., and Qanadli, S.D. (2023). Insights into pelvic venous disorders. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1102063"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1111\/j.1445-2197.1992.tb07554.x","article-title":"An evaluation of Doppler ultrasound and photoplethysmography in the investigation of venous insufficiency","volume":"62","author":"McMullin","year":"1992","journal-title":"Aust. N. Z. J. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1016\/S0741-5214(99)70206-5","article-title":"A national survey of practice patterns in the noninvasive diagnosis of deep venous thrombosis","volume":"29","author":"Blebea","year":"1999","journal-title":"J. Vasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1001\/archsurg.1994.01420310033005","article-title":"A comparison of the cuff deflation method with Valsalva\u2019s maneuver and limb compression in detecting venous valvular reflux","volume":"129","author":"Markel","year":"1994","journal-title":"Arch. Surg."},{"key":"ref_15","unstructured":"Nicolaides, A.N. (1997). Cardiovascular Disease Educational and Research Trust; European Society of Vascular Surgery."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1053\/ejvs.1999.0812","article-title":"New insights into perforator vein incompetence","volume":"18","author":"Labropoulos","year":"1999","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_17","unstructured":"Abai, B., and Labropoulos, N. (2008). Duplex ultrasound scanning for chronic venous obstruction and valvular incompetence. Handbook of Venous Disorders: Guidelines of the American Venous Forum, CRC Press. [3rd ed.]."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1016\/j.jvs.2014.04.049","article-title":"Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery\u00ae and the American Venous Forum","volume":"60","author":"Passman","year":"2014","journal-title":"J. Vasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1161\/CIRCULATIONAHA.113.006898","article-title":"Chronic Venous Insufficiency","volume":"130","author":"Eberhardt","year":"2014","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s12928-018-0532-y","article-title":"Stent implantation for May\u2013Thurner syndrome with acute deep venous thrombosis: Acute and long-term results from the ATOMIC (AcTive stenting for May\u2013Thurner Iliac Compression syndrome) registry","volume":"34","author":"Funatsu","year":"2019","journal-title":"Cardiovasc. Interv. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1177\/1531003511400426","article-title":"Syndromes associated with the deep veins: Phlegmasia cerulea dolens, May-Thurner syndrome, and nutcracker syndrome","volume":"22","author":"Suwanabol","year":"2010","journal-title":"Perspect. Vasc. Surg. Endovasc. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.jvsv.2014.05.007","article-title":"Diagnosis and treatment of the pelvic congestion syndrome","volume":"3","author":"Gillespie","year":"2015","journal-title":"J. Vasc. Surg. Venous Lymphat. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Zamboni, P., Mendoza, E., and Gianesini, S. (2018). General Considerations to the Treatment of Pelvic Leak Points, Ch. 8. Saphenous Vein-Sparing Strategies in Chronic Venous Disease, Springer International Publishing.","DOI":"10.1007\/978-3-319-70638-2"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1007\/s10016-004-0180-9","article-title":"Treatment of lower extremity venous insufficiency due to pelvic leak points in women","volume":"19","author":"Francheschi","year":"2005","journal-title":"Ann. Vasc. Surg."},{"key":"ref_25","first-page":"42","article-title":"Anatomie fonctionnelle et diagnostic des points de fuite bulboclitoridiens chez la femme (point C)","volume":"33","author":"Franceschi","year":"2008","journal-title":"J. Mal. Vasc."},{"key":"ref_26","first-page":"142","article-title":"Pelvic congestion syndrome: Does one name fit all?","volume":"23","author":"Gianesini","year":"2016","journal-title":"Phlebolymphology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.jvsv.2014.05.005","article-title":"Pelvic venous reflux is a major contributory cause of recurrent varicose veins in more than a quarter of women","volume":"2","author":"Whiteley","year":"2014","journal-title":"J. Vasc. Surg. Venous Lymphat. Disord."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ricci, S., and Oswald, M.A. (2018). Proposal for a protocol for sex hormones level sampling in patients with varices to evidence pelvic reflux. JTAVR, 3.","DOI":"10.24019\/jtavr.93"}],"container-title":["Tomography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2379-139X\/10\/7\/88\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:19:27Z","timestamp":1760109567000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2379-139X\/10\/7\/88"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,19]]},"references-count":28,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["tomography10070088"],"URL":"https:\/\/doi.org\/10.3390\/tomography10070088","relation":{},"ISSN":["2379-139X"],"issn-type":[{"value":"2379-139X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,19]]}}}