The source of varicose veins in the legs is usually found on the same legs, commonly a faulty main vein or local perforators. Regardless, in a number of cases, veins coming from the abdomen, pudendal veins, contribute or are the sole source of the leg veins.
Pudendal veins are veins in the upper inner aspect of the thigh running from the genital-vulvar area and abdomen and down the leg. They typically appear after pregnancies due to the changes that occur in the pelvic veins from a pregnant uterus and an increase in female hormone levels. Occasionally, pudendal veins are due to obstruction of major veins in the pelvis.
Diagnosis of the pudendal veins is done easily in the office by history, physical examination, and ultrasound. But if missed, treatment of the leg veins without treating them, will eventually lead to recurrence.
In rare occasions, these pudendal veins are associated with extensive veins in the vulvar, gluteal region, perineum, and hemorrhoids or with abdominal symptoms (pelvic congestion syndrome), or with a history of thrombosis, trauma, or pelvic surgery. In these special situations, further diagnostic testing with magnetic resonance of the veins (MRV) is indicated.
The symptoms of pelvic congestion syndrome include: 1) Abdominal fullness, post coital pain, 2) bladder irritation, 3) and painful menstrual cycle
Treatment of the pudendal veins is very simple since these veins respond extremely well to sclerotherapy. Once the pudendal veins have been closed, varicose vein originating from them are also treated with sclerotherapy as well. If pudendal veins coexist with other source of reflux, such as failure of the main vein, they should be treated first before other procedures (such as EVLT) are performed to eliminate the main vein.
In case of severe of abdominal complaints (pelvic congestion syndrome), after diagnostic testing (MRV), the abdominal component is treated after the treatment of the pudendal leg veins.