Non-saphenous Varicose Veins in a Patient with Pelvic Pain

A 36-year-old female with an 8-year history of symptomatic right lower limb varicose veins that presents with pain, heaviness and fatigue of the right leg with prolonged standing. The patient notes that she has also experienced symptoms of pelvic pain and fullness associated with dyspareunia and increased urinary frequency that is worsened at the end of the day and during menstruation. Past medical history includes hypothyroidism, uterine ablation and is G4, P3. There is a family history of varicose veins. On examination, both lower limbs are warm and well perfused with distal pulses palpable (2+ bilaterally). There is no swelling, skin changes or ulcerations. Prominent varicosities (CEAP C2) are located in the right posterior thigh and proximal posterior calf. Venous duplex of the lower limbs demonstrated right great saphenous vein measuring 6 mm with 0.4 sec reflux and extensive posterior thigh varicose veins with >5 sec reflux which originate from gluteal area. Pelvic venous duplex demonstrated left ovarian vein reflux 8 mm with extensive periuterine veins.

What is the best course of management for this patient?

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