Cardiovascular and interventional radiology · 2026
Compression and Superficial Varicosities Outperform Gonadal Vein Diameter in Differentiating Symptomatic from Asymptomatic Pelvic Venous Disorders: A Case-Control Study.
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Gonzales Estefania, Nguyen Victoria, Risner Victoria, du Pisanie Lourens, Keefe Nicole, Mody Priya, Kohi Marueen P, Salazar Gloria
Аннотация
PURPOSE: To assess whether gonadal vein (GV) diameter associates with pelvic venous disorder (PeVD)-consistent symptoms in women with pelvic varices, compared with proximal venous outflow obstruction (VOO; iliac/left renal vein stenosis/obstruction) and superficial varicosities.
MATERIALS AND METHODS: This retrospective, case-control study identified patients with abdominopelvic imaging (2013-2024) showing parauterine/pelvic varices > 5 mm and documentation within ± 12 months for symptom adjudication. GV diameter was measured on venous-phase computed tomography/magnetic resonance imaging by two readers, or from ultrasound when unavailable. Proximal VOO was ascertained by highest-confidence available testing and evaluated with logistic regression.
RESULTS: Of 200 patients (mean age, 52.4 ± 17.0 years), 84 (42.0%) were symptomatic and 116 (58.0%) asymptomatic. Mean GV diameter did not differ by symptom status (8.89 ± 2.29 vs 9.43 ± 2.50 mm; P = 0.121) and was not associated with symptoms in crude (odds ratio [OR], 0.91 per mm; 95% confidence interval [CI], 0.80-1.03) or adjusted analysis (adjusted OR [aOR], 0.97 per-mm; 95% CI, 0.81-1.14). Proximal VOO was assessable in 189 patients and more common in symptomatic vs asymptomatic patients (32.9% vs 2.6%; P < 0.001), as were lower-extremity (LE) varices (44.0% vs 12.9%; P < 0.001) and superficial pelvic varicosities (28.6% vs 1.7%; all P < 0.001). In the adjusted model, younger age (aOR, 0.50 per 10 years; 95% CI, 0.39-0.65), LE varices (aOR, 9.80; 95% CI, 3.76-25.50), and any proximal VOO (aOR, 10.89; 95% CI, 2.66-44.55) were independently associated with symptomatic status. Discrimination was acceptable (c-statistic, 0.82; 95% CI, 0.76-0.89) and unchanged by GV diameter.
CONCLUSION: Among women with pelvic varices, GV diameter was not associated with PeVD-consistent symptoms and added no incremental predictive value beyond age, LE varices, and VOO. Comorbid venous disease and outflow obstruction may better distinguish clinically significant PeVD than diameter thresholds alone.
MATERIALS AND METHODS: This retrospective, case-control study identified patients with abdominopelvic imaging (2013-2024) showing parauterine/pelvic varices > 5 mm and documentation within ± 12 months for symptom adjudication. GV diameter was measured on venous-phase computed tomography/magnetic resonance imaging by two readers, or from ultrasound when unavailable. Proximal VOO was ascertained by highest-confidence available testing and evaluated with logistic regression.
RESULTS: Of 200 patients (mean age, 52.4 ± 17.0 years), 84 (42.0%) were symptomatic and 116 (58.0%) asymptomatic. Mean GV diameter did not differ by symptom status (8.89 ± 2.29 vs 9.43 ± 2.50 mm; P = 0.121) and was not associated with symptoms in crude (odds ratio [OR], 0.91 per mm; 95% confidence interval [CI], 0.80-1.03) or adjusted analysis (adjusted OR [aOR], 0.97 per-mm; 95% CI, 0.81-1.14). Proximal VOO was assessable in 189 patients and more common in symptomatic vs asymptomatic patients (32.9% vs 2.6%; P < 0.001), as were lower-extremity (LE) varices (44.0% vs 12.9%; P < 0.001) and superficial pelvic varicosities (28.6% vs 1.7%; all P < 0.001). In the adjusted model, younger age (aOR, 0.50 per 10 years; 95% CI, 0.39-0.65), LE varices (aOR, 9.80; 95% CI, 3.76-25.50), and any proximal VOO (aOR, 10.89; 95% CI, 2.66-44.55) were independently associated with symptomatic status. Discrimination was acceptable (c-statistic, 0.82; 95% CI, 0.76-0.89) and unchanged by GV diameter.
CONCLUSION: Among women with pelvic varices, GV diameter was not associated with PeVD-consistent symptoms and added no incremental predictive value beyond age, LE varices, and VOO. Comorbid venous disease and outflow obstruction may better distinguish clinically significant PeVD than diameter thresholds alone.