Doppler ultrasound of the pelvic and abdominal veins - what is the test?

Doppler ultrasound is a key test for the detection of venous insufficiency in both men and women. Nowadays, it is regarded as the examination of choice in the initial diagnosis, mainly because of its great availability, its lack of harm to the patient's body, as well as the increasingly perfect and accurate imaging modalities.

Identifying the contemporary Doppler ultrasound examinations exclusively with flow assessment, is now history. Current ultrasound systems use a variety of techniques to superimpose 2D as well as 3D images on the movement of body fluids within the venous and arterial vessels. The excellent capabilities of assessing organ structures, as well as the walls and interior of the vessels, make this imaging technique an essential tool in the daily work of the physician FLEBOLOGA. Ultrasound examinations are nowadays used both at the initial diagnostic stage (e.g. during the phlebology consultation), intra-operatively as well as post-operatively, in order to evaluate the effects of the venous procedures carried out.

Doppler studies (with assessment of venous and arterial flows) performed at the Phlebology Clinic are carried out by qualified radiology and diagnostic imaging specialists and phlebologists trained at the Phlebology Clinic.

It is worth noting that in the Phlebology Clinic it is possible to have a consultation with an experienced vascular surgeon with a simultaneous examination of the Doppler ultrasound of the veins or arteries.

We offer a full panel of Doppler studiesincluding highly specialised Doppler ultrasound examination of the veins in the abdominal cavity, small pelvis with assessment of the perineal area in women or scrotal sac in men. Current costs for all Doppler examinations can be found in the PRICE LIST on the homepage of the Clinic of Phlebology.

Why is assessment of the small pelvic and abdominal veins so important in phlebology practice?

The experience of the last few years gained by doctors of the Department of Phlebology "shows" that disorders of the pelvic and abdominal venous system play the most significant role in the development of venous insufficiency.

In recent years, we have performed more than several thousand imaging examinations on our patients, both ultrasound and venography in computed tomography and magnetic resonance imaging. This knowledge, in correlation with the clinical assessment of patients, has allowed us to create a new, holistic, system for the diagnosis and complex treatment of patients presenting to our institution with varicose veins, spider veins, post-thrombotic syndromes or varicose veins in the pelvis. - explains Dr Cezary Szary, phlebologist at the Department of Phlebology.

The flow of the main venous vessels located above the pelvic floor and the downstream veins of the lower limbs can be likened to an extensive river system. Adverse phenomena that cause overloading of such a system, such as flooding or river dams, always disrupt its functioning. The ones that are the highest in the hierarchy are the most affected. The same is true of the venous system, which is a rather complex hydraulic system.

In the human body, the very structure and distribution of the vessels, or so-called anatomy, plays a key role. It turns out that how the vessels are built and how they are arranged in relation to each other determines their function as a whole. People whose vessels are compressed from birth (as in the case of the venous compression syndromes) or not fully formed properly, the first venous problems are seen as early as 10-15 years of age - comments Dr Tomasz Grzela from the Department of Phlebology.

Hence, it is important to fully assess the venous system and not to stop at assessing the leg veins. An undoubted obstacle in this respect is the ability to assess. This is one of the drawbacks of ultrasonography. The conclusions drawn from the examinations performed depend primarily on the skills of the specialist performing the examination, as well as on the equipment used for diagnosis.

At the Phlebology Clinic, we always use a holistic assessment, i.e. we do not focus only on assessing the lesions visible on the legs. As our many years of practice have shown, such an approach is incorrect and leads to many misdiagnoses and numerous unnecessary treatments. It is important to remember that a venous vessel overloaded with blood will sooner or later stretch. This stretching always results from something. Rarely is the initial problem a malfunction of the valves in the veins - explains Dr Justyna Wilczko, phlebologist at the Department of Phlebology.

In women, by far the most common overload of the venous system occurs during pregnancy. During pregnancy, the volume of circulating blood increases (a bit like a 'flood') and there is an increase in the number of dams on the river. This is all due to the enormous pressure generated by the enlarged uterus. Patients we examine in the third trimester, during the second or third pregnancy, can have veins as much as 5-8 times dilated compared to normal - adds Dr Justyna Wilczko.

This is where the study also comes to the rescue Doppler ultrasound with evaluation of the veins of the abdomen, small pelvis and perineum. It is similar in men. It is difficult to diagnose well a patient in whom the presence of venous vessels in the abdomen is ignored. It is important to remember that the chine starts its course in the legs, then has to pass through the iliac, spinal and testicular veins in men to finally reach the heart. Any obstruction to the outflow and excessive physical exertion or excessive standing and sitting lead to hydraulically unfavourable outflow conditions and vein problems in the legs. In men, the most common manifestation of venous problems are varicose veins of the genital tract located inside the scrotal sac. It is important to remember that varicocele is only a sign of diseaseand not a disease in itself!

All of these phenomena are the responsibility of the so-called pelvic venous insufficiency, i.e. the abnormal circulation of venous blood within the abdominal and pelvic venous system. This results in overloading of the venae cavae, i.e. the venous plexuses located in women peripherally (e.g. in the parametria), in the wall of the organs (e.g. in the vagina) and in the pelvic floor and in the subcutaneous tissue (the so-called 'vas deferens'). cork varicose veins and vulva). In men, the venous problem is most often transmitted to the venous plexuses inside the scrotal sac. Ultimately, the problem ends up in the veins of the legs. The superficial system is overloaded first, then the deep system.

As can be seen, the role of a comprehensive Doppler assessment of the venous system is invaluable and essential in making a first and correct diagnosis.

In the Department of Phlebology, after each Doppler examination, the patient is informed whether further (in-depth) imaging diagnosis of the venous system and surrounding structures is required. This is because often a percutaneous ultrasound examination alone (performed through the sheaths) is not sufficient, and the decision on treatment involves performing additional examinations to assess the venous vessels in some detail, which include:

- Transvaginal ultrasound (TV ultrasound);
– Intravascular ultrasound (IVUS);
– magnetic resonance venography;
– venography in computed tomography;
- whether digital phlebography.

Remember that every patient has a different history, different concomitant diseases and different anatomy. Each case must be approached on an individual basis, bearing in mind that the venous system functions as a whole and not as separate components scattered throughout the legs or abdomen. For this reason, it should also be assessed as a whole, and treatment should always be as causal as possible and based on a reliable ultrasound and imaging diagnosis," he concludes Dr Cezary Szary.

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