Lake Washington Vascular Surgeons, Bellevue, Wash.
Lake Washington Vascular Surgeons, Bellevue, Wash.
J Vasc Surg Venous Lymphat Disord. 2017 Jul;5(4):493-499. doi: 10.1016/j.jvsv.2017.03.012. Epub 2017 May 12.
Pelvic venous incompetence can cause symptomatic varicose veins in the perineum, buttock, and thigh. Presentation, symptom severity, and response to treatment of pelvic source varicose veins are not well defined. Currently available tools to measure the severity of lower extremity venous disease and its effects on quality of life may be inadequate to assess disease severity in these patients. The purpose of this study was to evaluate the histories, demographics, and clinical presentations of women with pelvic source varicose veins and to compare these data to a population of women with nonpelvic source varicose veins.
A total of 72 female patients with symptomatic pelvic source varicose veins were prospectively followed up. Age, weight, height, parity, and birth weights of offspring were recorded. Both pelvic source varicose veins and saphenous incompetence were identified by duplex ultrasound. Patients were queried as to their primary symptoms, activities that made their symptoms worse, and time when their symptoms were most prominent. Severity of disease was objectively evaluated using the revised Venous Clinical Severity Score (rVCSS) and 10-point numeric pain rating scale (NPRS).
Compared with women without a pelvic source of varicose veins (N = 1163), patients with pelvic source varicose veins were younger (mean, 44.6 ± 8.6 vs 52.6 ± 12.9 years; P < .001), had lower body mass index (mean, 21.9 ± 2.8 vs 25.8 ± 6.2; P < .001), and had larger babies than the U.S. population mean (mean, 3656 ± 450 g vs 3389 ± 466 g; P < .001). The most common symptoms were aching (68%), throbbing (47%), and heaviness (35%). In premenopausal patients, 70% noted that symptoms were worst during menses. NPRS score varied from 0 to 8 (mean, 4.9). The correlation between rVCSS (mean 5.6 ± 1.9) and NPRS was small (r = 0.26; P = .03). There was a modest correlation between older age and lower NPRS scores (r = -0.39; P < .001).
Women with pelvic source varicose veins are a unique subset of patients. They are younger and thinner than those with nonpelvic source varicose veins, have larger infants than the general U.S. population, and have an inverse correlation between age and pain. As the majority of premenopausal patients have increased symptoms during menses, this may be due to hormonal influence. As it is poorly associated with patient-reported discomfort, the rVCSS is a poor tool for evaluating pelvic source varicose veins. A disease-specific tool for the evaluation of pelvic source varicose veins is critically needed, and this study is a first step in that endeavor.
盆腔静脉功能不全可导致会阴、臀部和大腿出现症状性静脉曲张。盆腔源静脉曲张的表现、症状严重程度和治疗反应尚未得到明确界定。目前用于评估下肢静脉疾病严重程度及其对生活质量影响的工具可能不足以评估这些患者的疾病严重程度。本研究旨在评估盆腔源静脉曲张女性的病史、人口统计学和临床表现，并将这些数据与非盆腔源静脉曲张女性进行比较。
前瞻性随访 72 例有症状的盆腔源静脉曲张女性。记录年龄、体重、身高、产次和子女出生体重。盆腔源静脉曲张和隐静脉功能不全均通过双功能超声确定。询问患者主要症状、使症状加重的活动以及症状最明显的时间。使用修订后的静脉临床严重程度评分（rVCSS）和 10 分数字疼痛评分量表（NPRS）客观评估疾病严重程度。
与无盆腔源静脉曲张的女性（N=1163）相比，盆腔源静脉曲张患者更年轻（平均 44.6±8.6 岁 vs. 52.6±12.9 岁；P<0.001），体重指数更低（平均 21.9±2.8 岁 vs. 25.8±6.2；P<0.001），婴儿体重也大于美国人群平均值（平均 3656±450 g vs. 3389±466 g；P<0.001）。最常见的症状是酸痛（68%）、悸动（47%）和沉重感（35%）。在绝经前患者中，70%的患者表示症状在月经期间最严重。NPRS 评分范围为 0 至 8（平均 4.9）。rVCSS（平均 5.6±1.9）与 NPRS 之间的相关性较小（r=0.26；P=0.03）。年龄较大与 NPRS 评分较低呈中度相关（r=-0.39；P<0.001）。
盆腔源静脉曲张女性是一个独特的亚组。与非盆腔源静脉曲张患者相比，她们更年轻、更瘦，婴儿体重大于美国一般人群，年龄与疼痛呈负相关。由于大多数绝经前患者在月经期间症状加重，这可能是由于激素的影响。由于 rVCSS 与患者报告的不适程度相关性较差，因此它不是评估盆腔源静脉曲张的有效工具。迫切需要一种用于评估盆腔源静脉曲张的专用工具，本研究是这方面的第一步。
