Pelvic Venous Congestion: Ultrasound Criteria for Gonadal Vein Reflux
Place of Pelvic Reflux in Source Classification
According to the guidelines by B.V. Blagodir, reflux is classified along several axes: etiology (primary/secondary/congenital), anatomical extent (segmental — multisegmental — axial), system (superficial/deep/perforating/combined), and source localization (junctional/trunk/perforating/tributary/non-saphenous-pelvic). Gonadal (pelvic) reflux falls under the category of non-saphenous-pelvic source.
Strategy for Finding the Source
The source ('leakage point') is strictly sought from top to bottom: junctions — trunk — re-entry into tributary — perforators — pelvis. The source is treated, tributaries secondarily. Varicose veins are almost always tributaries; trunk varicosities are rare since the trunk is in the saphenous compartment, fixed, and the wall is more resilient.
Ultrasound Criteria for Reflux (Thresholds)
| Segment | Pathological Reflux Threshold |
|---|---|
| Superficial, perforating, tibial, deep femoral vein | >0.5 s |
| Femoral and popliteal veins | >1.0 s |
| Pathological perforator | diameter ≥3.5 mm, outward reflux >0.5 s under ulcer C5–C6 |
Thresholds are provided according to the international consensus (SVS/AVF). Specific values for gonadal veins are not specified in the fragments — [clarify].
Report Formatting
The report should indicate the duration of reflux with segmental testing, diameters, source, perforators. A vein map is mandatory: blue for competent veins, red for incompetent/tortuous tributaries/varicose veins with leakage and re-entry points — as a plan for the phlebologist. Description is conducted according to the CEAP 2020 classification (Clinical—Etiology—Anatomy—Pathophysiology).
Differential Diagnosis
When assessing pelvic veins, a differential range is considered, including deep pelvic vein thrombosis and venous compression syndromes (Nutcracker). For detailed assessment of pelvic venous structures, intravascular ultrasound (IVUS) is used in some cases.
Frequently asked questions
What is the pathological reflux duration threshold?
According to the SVS/AVF consensus: >0.5 s for superficial, perforating, tibial, and deep femoral veins; >1.0 s for femoral and popliteal veins.
To which category does gonadal reflux belong?
To the non-saphenous-pelvic source in the classification by source localization (junctional/trunk/perforating/tributary/non-saphenous-pelvic).
In what order should the reflux source be sought?
From top to bottom: junctions — trunk — re-entry into tributary — perforators — pelvis. The source is treated, tributaries secondarily.
What must be included in the protocol?
Duration of reflux with segmental testing, diameters, source, perforators, CEAP formula, and a vein map with leakage and re-entry points.
Are there separate thresholds for gonadal veins?
Specific thresholds for gonadal veins are not specified in the provided fragments — [clarify].