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Purpose To demonstrate lower extremity varicose veins distributions in patients with Pelvic Congestion Syndrome. Material and Methods During a period of January 2015 to December 2018, 913 consecutive patients (1552 limbs) referred to Interventional Radiology Department due to lower extremity varicosities were retrospectively evaluated. Clinical evaluation was made in concordance with CEAP (clinical, etiological, anatomical and pathological elements) classification and included pain scores according to Visual Analogue Scale and Pelvic Venous Insufficiency questionnaire. Duplex ultrasound examinations were performed in patients’ standing position. Computed Tomography Angiography was performed all suspected patients and obtained images were evaluated on workstation. Results Totally of 93 patients (all females) were adopted as PCS according to clinical, duplex ultrasound and CTA findings. The mean age was 44 (range 24-72 years). Median PVI VAS score was 39 (range 20-82). All patients were multiparous (median delivery number 3.7, range 2-7). Of 93 patients with PCS, purely non-saphenous varicosities (vulvar, groin or buttock) were demonstrated in 32 (34.4%) patients in 55 limbs and the combination of non-saphenous and saphenous varicosities were demonstrated in 55 (59.1%) patients. On the other hand, only six (6.5%) patients were involved in saphenous venous insufficiency alone. Saphenous-femoral (SF) and saphenouspopliteal (SP) junctions were competent in the majority of the saphenous insufficiencies (51 of 61, 83.6%). Distribution of saphenous vein insufficiency was as follows: great saphenous vein (70.5%), small saphenous vein (22.9%) and combination of great and small saphenous vein (6.6%). Total number of patients with non-saphenous varicosities was 87. We detected the combination of genital, thigh and calf regions varicosities in 52 (59.8%) patients. Thirty (34.5%) of them had genital and thigh varicosities and the remaining five (5.7%) patients were involved with genital region alone. Conclusion Varicose veins of the lower limbs with atypical distributions should prompt consideration of PCS especially in multiparous fertile women. A knowledge about variant distributions of lower extremity varicose veins could save patients suffering from recurrent interventions owing to the lower limb varicosities.



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