Improving Deep Vein Thrombosis (DVT) services

North West multi-centre collaboration

Current DVT services are highly variable in terms of provider, site, staffing and support services.

IVS is currently leading a project to link DVT services across the North West region in order to look at variations in DVT pathways, develop a forum for exchange of ideas, improve efficiency of services and develop the highest quality services in the UK.

A medical research student will lead an independent investigation of a number of services across the region and feedback to all sites hopefully helping them to improve existing services.

It is hoped the resultant network will deliver services to over 10,000 patients per year providing an ideal population for further research and development allowing the North West Region to become a national leader in DVT service delivery.


Pelvic vein incompetence, pelvic varices and vulvar varices

Terms:

Chronic pelvic pain in otherwise healthy multiparous females can be caused by dilation of pelvic veins leading to congestion of the ovarian plexuses and broad ligaments. Over the years some studies have demonstrated that otherwise unexplained pelvic pain can be caused by dilation of major pelvic veins in more than 80% of cases.

New or recurrent varicosities in the vagina or vulvar area spreading into the inner upper thigh or back of the thigh can often develop as a consequence of multiple pregnancies. It is estimated that this condition may affect as many as 15% of women.

Unfortunately to patients this condition is not well known. Most surgeons would simply treat the visible varicosities in the legs leaving the potential pelvic source of these veins untreated.

The Team IVS has developed a one-stop service to provide fast and effective diagnosis of pelvic and vulvar varicosities using the latest non-invasive techniques. If a possible pelvic vein reflux (internal iliac vein or ovarian vein) is suspected during initial clinical assessment or during a routine Duplex scan of the leg veins, we can perform a simple transvaginal (internal) pelvic ultrasound to assess these veins. In order to perform this scan it is necessary to gently insert the tip of an ultrasound probe into the vagina. It will be covered with a protective sheath and lubricating gel. This is a simple and usually painless procedure and usually takes no longer than 20 minutes. The probe is a little bigger than the size of a finger or a tampon. The examination should not be painful or distressing.

With IVS all internal scans are performed by an accredited female Senior Clinical Vascular Scientist. A report will be forwarded to your surgeon who will provide a full treatment plan.

 

Fig 1 – Perivulval varices may extend over the buttock and particularly across the back of the thigh, and after several pregnancies, they persist and may communicate with the greater saphenous vein, which is then involved even when the sapheno-femoral junction is competent or has been previously ligated. Occasionally, even the short saphenous vein is involved via the Giacomini vein on the back of the thigh.

Fig 2 – Vulvar varicose veins extending over the buttocks. These are often referred as “atypical” varicose veins.

 

IVS Diagnostic

Can save 17% to 34% of the cost of setting up and running a vascular laboratory

Reduces capital expenditure

Lowers staff and administration costs

95% of inpatients investigated the same day

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