Varicosities of vulva (vulvar varices): a seldom seen entity in dermatologic practice

Direct Fluoroscopic-Guided Sclerotherapy for Vulvoperineal Varices: An Experience in 70 Patients

Purpose The aim of this study was to assess the safety and effectiveness of percutaneous vulvoperineal varices sclerotherapy using 2% polidocanol foam under fluoroscopic guidance.

Subjects and Methods This is a retrospective review of prospectively collected data of 70 patients treated between June 2020 and November 2021, with a mean age of 31 years (range: 24–42 years). All patients were not pregnant with residual vulvoperineal varices after embolization of their refluxing tributaries of the ovarian vein and/or internal iliac veins presenting with vulvoperineal heaviness/pain with or without lower limb varicosities. Technical and clinical successes together with procedural complications were assessed.

Results The technical success rate was 100%. No minor or major complications have been reported. Follow-up was at 1 week, 2 weeks, 6 months, and 12 months post sclerotherapy. Clinical success was observed in all patients with improvement in their symptoms.

Conclusion Direct fluoroscopic-guided sclerotherapy for vulvoperineal varices offers a safe and effective treatment option with the ability of visualization and embolization of the pelvic leak points to avoid recurrence.

Is the endovascular embolization of tributaries of the internal iliac veins essential in the treatment of isolated pelvic-perineal reflux?

Aim: The aim of study was to investigate the opportunities of local phlebectomy in the elimination of isolated pelvic-perineal reflux (PPR), as well as to determine the feasibility of endovascular embolization of the tributaries of internal iliac veins in PPR. Clinical trial no. NCT01598051.Materials and methods: The work is based on the results of examination and treatment of 43 female patients with varicose veins of the pelvis, perineum, and lower extremities. Patients had no signs of pelvic congestion syndrome (PCS). All patients underwent duplex ultrasound scanning (DUS) and ovariography with pelvic phlebography (OPP). For the elimination of PPR, local phlebectomy was performed in the major labia and perineal area, with maximal possible mobilization of the vessel within the operative wound (33 patients). In 10 patients with isolated varicose transformation of the superficial veins on the posterior thigh, mini-phlebectomy was performed using the Varady phlebectomy extractors.Results and discussion: The varicose syndrome of the external genitalia, perineum, and posterior thigh was successfully treated in 100% of patients. Findings suggest that thorough mobilization and excision of the veins of the pudendal labia, perineum, and subcutaneous veins of the thigh is a reliable method for eliminating the pathological reflux from the intrapelvic veins to the superficial veins of the perineum and lower extremities. No recurrences of vulvar, perineal varices or dilation of the veins of the lower extremities were observed in 100% of patients over the 3-year follow-up period.Conclusion: Local phlebectomy is an effective technique for eliminating the isolated PPR in patients with varicose transformation of intrapelvic, vulvar, or perineal veins. Endovascular embolization of the tributaries of the internal iliac veins is not an essential component in the treatment of PPR. The present study has a limitation due to the absence of patients with PCS. The effectiveness of phlebectomy in the treatment of isolated PPR was studied.

Vulvar Varicosities: A Review

BACKGROUND

Vulvar varicosities (VV) are dilated and tortuous veins occurring within the external female genitalia. Patients may seek treatment of these varices for both medical and cosmetic purposes. In some patients, VV may be associated with a chronic pelvic pain syndrome called pelvic congestion syndrome (PCS).

OBJECTIVE

To review the English language literature on VV in both pregnant and nonpregnant women.

MATERIALS AND METHODS

A literature search pertaining to vulvar varicosities and PCS was performed using PubMed and Google Scholar databases.

RESULTS

There is an overall paucity of literature discussing VV, particularly in nonpregnant women without PCS. Management options for VV include compression, sclerotherapy, embolization, and surgical ligation. Treatment can be dependent on the coexistence of pelvic or leg varicosities and may require referral to a vein specialist for advanced imaging techniques and procedures. Direct sclerotherapy to VV may not provide adequate treatment if pelvic or leg varices are also present.

CONCLUSION

In women with persistent VV, imaging studies should be obtained before treatment to evaluate the surrounding venous anatomy of the pelvis and leg, as the results often affect the treatment approach. Patients presenting with VV and chronic pelvic pain should be evaluated for PCS.

A Vulvovaginal Mass in a 16-Year-Old Adolescent: A Case Report

BACKGROUND

Vulvar varicosities might be misdiagnosed as vulvar venous malformations in the prepubertal or pubertal age. If seen isolated, they can mimic other masses that are usually seen in this anatomic area like a hernia or a cyst. Depending on the associated symptoms and clinical findings, imaging modalities investigate the nature of such a mass and might provide a therapeutic alternative besides surgery.

CASE

We report a case of an isolated asymptomatic vulvar varicosity in a 16-year-old adolescent. A pelvic ultrasound followed by a Doppler and a magnetic resonance imaging scan confirmed the diagnosis. We used guided direct sclerotherapy for successful treatment.

SUMMARY AND CONCLUSION

Optimal management and outcome are assured using a multidisciplinary approach. Guided sclerotherapy provides a safe, effective, and minimally invasive procedure to treat vulvar varicosities.