Ovarian Vein Insufficiency Ultrasound

There are two main reasons that you may be asked to have an ovarian vein ultrasound scan. The first could be because of the site of the varicose veins in your legs, particularly if the veins occur in your thighs and groin. The second is because you may have symptoms that can indicate pelvic congestion syndrome, such as dull aching and dragging pains in the pelvis.

Just like the veins in your legs, it’s possible for the valves in the ovarian vein to stop working adequately and as a result the flow of blood drains into the pelvic region and then into the leg.

As well as evaluating the flow in the ovarian veins, the sonographer will examine other deep veins in your abdomen. This is to assess for blood clot in the vein, any blood flow in the wrong direction as a result of the valves no longer functioning or to see if there is any compression of any of the veins.

The primary purpose of this ultrasound scan is to check to see which way the blood is moving in the ovarian veins. Typically, patients will have two ovaries, one on the right and one on the left. Each of them will have at least one vein taking flow away from the ovary back towards the heart. The sonographer will check to see if the flow is travelling in the correct direction or if it is flowing back into your ovary.

Other causes of pelvic symptoms can be related to the anatomy, and variations in your anatomy can result in some of the veins being compressed which in turn can affect the flow of blood.

There are two main types of compression that the sonographer will look for:

• May-Thurner syndrome
  
• Nutcracker syndrome

May-Thurner syndrome is where the left common iliac vein becomes compressed between the spine and the large artery which takes blood toward the right leg, called the right common iliac artery. It happens because the vein, which is taking flow from your left leg back towards the heart, gets squashed underneath the artery. The artery is strong and tough as is the bone in the spine, unfortunately for the vein it is soft and is easily compressed. Over time this can cause the delicate inner layer of the vein to become damaged and thickened which makes it difficult for flow to pass through. The flow will instead drain backwards into to the pelvis and this can contribute to pelvic congestion symptoms.

Nutcracker syndrome describes a problem where the vein taking flow away from your left kidney (left renal vein) can become squashed between two arteries, as the name suggests this acts a bit like a nutcracker. The main artery in the abdomen called the aorta. The aorta has a branch just below you ribs that takes flow to your intestines and is called the superior mesenteric artery. The angle that this artery comes out of the aorta can impact the left renal vein because it has to pass between them. If the angle is too acute between the aorta and superior mesenteric artery then the vein is squashed. This results in flow being forced back the wrong way in to the ovarian vein and back into the pelvis.