Abdominal and pubic collateral veins as indicators of deep venous obstruction

Objective: Chronic deep venous obstruction can cause a significant loss of quality of life, although it can be treated successfully by stenting. A clear referral pattern for additional imaging is warranted in patients with lower limb complaints. The aim of this study was to determine the value of clinically visible abdominal wall collateral veins in the diagnosis of a potentially treatable deep venous obstruction. Methods: A total of 295 patients referred for evaluation at a tertiary venous clinic with a collateral vein on the abdominal wall or pubic bone, visible on physical examination, were retrospectively analyzed and compared with a randomly selected control group of 365 patients without such a collateral vein. Duplex ultrasound, magnetic resonance venography, computed tomography venography, and conventional venography were used to determine the presence or absence of deep venous obstruction. Results: Mean age of the group with a positive collateral was 43.5 +/- 13.7 (6-76) years compared with 44.7 +/- 14.2 (16-89) years in the control group. In the collateral group, 66.1% were female compared with 63.3% in the control group. Sensitivity of the abdominal wall collateral vein for any obstruction at the level of the groin or more proximal was 53% (95% confidence interval [CI], 48-57); specificity, 86% (95% CI, 79-91); positive predictive value, 93% (95% CI, 90-96); and negative predictive value, 32% (95% CI, 28-37). Sensitivity was 68% (95% CI, 62-73) for higher degrees of post-thrombotic obstruction and 27% (95% CI, 19-36) in iliac vein compression. Conclusions: A collateral vein on the abdominal wall or across the pubic bone in patients with complaints of the lower limb has an excellent positive predictive value for deep venous obstructive disease at the level of the groin or higher. Such collateral veins should therefore not be removed, and symptomatic patients could be offered further diagnostics and treatment.