1
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Risner V, McColgan Y, Salazar G. Interventional Treatment of Labial Varices. Semin Intervent Radiol 2023; 40:384-388. [PMID: 37575344 PMCID: PMC10415056 DOI: 10.1055/s-0043-1771040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Labial varices are commonly seen in women with varicose veins of the pelvis. Initial management is conservative management since labial varies typically resolve, particularly in pregnant patients following delivery. Varices can be seen also in association with pelvic varices in the pelvic venous disease spectrum. Sclerotherapy is often the management. This article reviews the presentation and treatment of patients with labial varices, with a focus on interventional radiologic management.
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Affiliation(s)
- Victoria Risner
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | | | - Gloria Salazar
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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2
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Bressan M. Sclerotherapy of sciatic nerve varices. VEINS AND LYMPHATICS 2021. [DOI: 10.4081/vl.2021.10166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sciatic nerve varices (SNV) represent an infrequent presentation of varicose veins. They are usually not recognised and may present only with chronic sciatic pain with few varicosities. On clinical examination, sciatic pain can be reproduced by finger-pressing the superficial varicose veins at their point of connection with the SNV. These varices are then confirmed by duplex ultrasonography. We herein report a case of a 78-years-old woman affected by symptomatic SNV, treated by echo-guided Tessari foam sclerotherapy (EGFSCL) with immediate relief of the sciatic pain. Reflux through the sciatic veins, as the connected superficial varicose veins, disappeared completely and not any complications have emerged. EGFSCL seems to be both safe and effective, so representing a reliable and minimally invasive treatment for this disturb.
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3
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Kim H, Labropoulos N. Ultrasonographic Evaluation of Nerves and Their Association with Veins in the Lower Limbs. Phlebology 2021. [DOI: 10.37923/phle.2021.19.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hyangkyoung Kim
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Nicos Labropoulos
- Department of Surgery, Stony Brook University Medical Center, New York, USA
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4
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Meissner MH, Khilnani NM, Labropoulos N, Gasparis AP, Gibson K, Greiner M, Learman LA, Atashroo D, Lurie F, Passman MA, Basile A, Lazarshvilli Z, Lohr J, Kim MD, Nicolini PH, Pabon-Ramos WM, Rosenblatt M. The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. Phlebology 2021; 36:342-360. [PMID: 33849310 PMCID: PMC8371031 DOI: 10.1177/0268355521999559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This Practice Guidelines document has been co-published in
Phlebology [DOI: 10.1177/0268355521999559] and Journal of
Vascular Surgery: Venous and Lymphatic Disorders [DOI:
10.1016/j.jvsv.2020.12.084]. The publications are
identical except for minor stylistic and spelling differences in keeping
with each journal’s style. The contribution has been published under a
Attribution-Non Commercial 4.0 International (CC BY-NC 4.0), (https://creativecommons.org/licenses/by-nc/4.0/)
With the support of the American College of Obstetricians and
Gynecologists, the American Vein & Lymphatic Society, the American
Venous Forum, the Canadian Society of Phlebology, the Cardiovascular and
Interventional Radiology Society of Europe, the European Venous Forum, the
International Pelvic Pain Society, the International Union of Phlebology,
the Korean Society of Interventional Radiology, the Society of
Interventional Radiology, and the Society for Vascular Surgery
As the importance of pelvic venous disorders (PeVD) has been increasingly
recognized, progress in the field has been limited by the lack of a valid and
reliable classification instrument. Misleading historical nomenclature, such as
the May-Thurner, pelvic congestion, and nutcracker syndromes, often fails to
recognize the interrelationship of many pelvic symptoms and their underlying
pathophysiology. Based on a perceived need, the American Vein and Lymphatic
Society convened an international, multidisciplinary panel charged with the
development of a discriminative classification instrument for PeVD. This
instrument, the Symptoms-Varices-Pathophysiology (“SVP”) classification for
PeVD, includes three domains—Symptoms (S), Varices (V), and Pathophysiology (P),
with the pathophysiology domain encompassing the Anatomic (A), Hemodynamic (H),
and Etiologic (E) features of the patient’s disease. An individual patient’s
classification is designated as SVPA,H,E. For patients with pelvic
origin lower extremity signs or symptoms, the SVP instrument is complementary to
and should be used in conjunction with the
Clinical-Etiologic-Anatomic-Physiologic (CEAP) classification. The SVP
instrument accurately defines the diverse patient populations with PeVD, an
important step in improving clinical decision making, developing
disease-specific outcome measures and identifying homogenous patient populations
for clinical trials.
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Affiliation(s)
- Mark H Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Neil M Khilnani
- Department of Radiology (Interventional Radiology) Weill Cornell Medicine-New York Presbyterian Hospital, New York, USA
| | - Nicos Labropoulos
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA
| | - Antonios P Gasparis
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA
| | | | - Milka Greiner
- Interventional Radiology, Hopital Americain de Paris, Paris, France
| | - Lee A Learman
- Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Diana Atashroo
- Department of Obstetrics and Gynecology, Stanford Medicine, Palo Alto, USA
| | - Fedor Lurie
- Department of Surgery, Jobst Vascular Institute, Promedica, Toledo, USA
| | - Marc A Passman
- Department of Surgery, University of Alabama School of Medicine, Birmingham, USA
| | - Antonio Basile
- Department of Interventional Radiology, University of Catania, Catania, Italy
| | | | - Joann Lohr
- Department of Surgery, University of South Carolina School of Medicine, Columbia, USA
| | - Man-Deuk Kim
- Department of Radiology, Yonsei University School of Medicine, Seoul, South Korea
| | | | - Waleska M Pabon-Ramos
- Department of Radiology (Interventional Radiology), Duke University School of Medicine, Durham, USA
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5
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Abstract
ZusammenfassungDie Perforansvenen (PV) der unteren Extremitäten sind nicht nur gerade und direkte Verbindungen zwischen den tiefen und oberflächlichen Venennetzen, sondern bilden gemeinsam ein weit verzweigtes Netz. Trotz ihrer starken anatomischen Variabilität ist ihre Position bemerkenswert konstant und prognostizierbar. Dies ist durch ihre enge Beziehung zu den Muskelvenen bedingt und durch die hämodynamischen Ebenen entlang der Extremität zu erklären. Sie sind bei der Beurteilung durch Ultraschalluntersucher in der täglichen Praxis eine Hilfe.Der anatomische Inhalt dieses Artikels stammt aus folgenden Quellen: Anatomische Präparationen von C. Gillot nach Latex-Injektion und anschließender farblicher Unterteilung von über 400 Extremitäten. Dreidimensionale Rekonstruktionen von CT-Venografien von 1200 Extremitäten und präoperativen Hautvenenvermessungen von 25 000 Extremitäten.Es wird Folgendes beschrieben: Referenzpunkte der Extremität, Perforansvenen des Fußes, Beins und Sprunggelenks, der Wade, Anastomosen zwischen den Perforansvenen, Begleitarterien der Bein-PVs und Oberschenkel-PVs.
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6
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Meissner MH, Khilnani NM, Labropoulos N, Gasparis AP, Gibson K, Greiner M, Learman LA, Atashroo D, Lurie F, Passman MA, Basile A, Lazarshvilli Z, Lohr J, Kim MD, Nicolini PH, Pabon-Ramos WM, Rosenblatt M. The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. J Vasc Surg Venous Lymphat Disord 2021; 9:568-584. [PMID: 33529720 DOI: 10.1016/j.jvsv.2020.12.084] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/05/2020] [Indexed: 12/26/2022]
Abstract
As the importance of pelvic venous disorders (PeVD) has been increasingly recognized, progress in the field has been limited by the lack of a valid and reliable classification instrument. Misleading historical nomenclature, such as the May-Thurner, pelvic congestion, and nutcracker syndromes, often fails to recognize the interrelationship of many pelvic symptoms and their underlying pathophysiology. Based on a perceived need, the American Vein and Lymphatic Society convened an international, multidisciplinary panel charged with the development of a discriminative classification instrument for PeVD. This instrument, the Symptoms-Varices-Pathophysiology ("SVP") classification for PeVD, includes three domains-Symptoms (S), Varices (V), and Pathophysiology (P), with the pathophysiology domain encompassing the Anatomic (A), Hemodynamic (H), and Etiologic (E) features of the patient's disease. An individual patient's classification is designated as SVPA,H,E. For patients with pelvic origin lower extremity signs or symptoms, the SVP instrument is complementary to and should be used in conjunction with the Clinical-Etiologic-Anatomic-Physiologic (CEAP) classification. The SVP instrument accurately defines the diverse patient populations with PeVD, an important step in improving clinical decision making, developing disease-specific outcome measures and identifying homogenous patient populations for clinical trials.
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Affiliation(s)
- Mark H Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, Wash.
| | - Neil M Khilnani
- Department of Radiology (Interventional Radiology) Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY
| | - Nicos Labropoulos
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | - Antonios P Gasparis
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | | | - Milka Greiner
- Interventional Radiology, Hopital Americain de Paris, Paris, France
| | - Lee A Learman
- Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, Va
| | - Diana Atashroo
- Department of Obstetrics and Gynecology, Stanford Medicine, Palo Alto, Calif
| | - Fedor Lurie
- Department of Surgery, Jobst Vascular Institute, Promedica, Toledo, Ohio
| | - Marc A Passman
- Department of Surgery, University of Alabama School of Medicine, Birmingham, Ala
| | - Antonio Basile
- Department of Interventional Radiology, University of Catania, Catania, Italy
| | | | - Joann Lohr
- Department of Surgery, University of South Carolina School of Medicine, Columbia, Ohio
| | - Man-Deuk Kim
- Department of Radiology, Yonsei University School of Medicine, Seoul, South Korea
| | | | - Waleska M Pabon-Ramos
- Department of Radiology (Interventional Radiology), Duke University School of Medicine, Durham, NC
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7
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Aberrant Vein Within Common Connective Tissue Sheath of the Sciatic Nerve at the Popliteal Fossa. Reg Anesth Pain Med 2014; 39:82-3. [DOI: 10.1097/aap.0000000000000021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Van Gompel JJ, Griessenauer CJ, Scheithauer BW, Amrami KK, Spinner RJ. Vascular Malformations, Rare Causes of Sciatic Neuropathy: A Case Series. Neurosurgery 2010; 67:1133-42; discussion 1142. [DOI: 10.1227/neu.0b013e3181ecc84e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Sciatica is typically a clear-cut symptom complex commonly related to an impingement at the spinal nerve level. Etiologies of sciatic neuropathy outside the neural foramina are uncommon.
OBJECTIVE:
To describe 4 patients presenting with radiating leg pain due to sciatic nerve involvement, all with a vascular etiology.
METHODS:
Four patients presenting with neuropathic pain were retrospectively reviewed. Preoperative 3 Tesla magnetic resonance imaging was used to identify these lesions, which most commonly showed diffuse T2 changes with nerve enhancement upon administration of contrast.
RESULTS:
Exploration revealed vascular lesions. All patients went on to external and limited internal neurolysis of the involved sciatic nerve segment. Intraoperative histological study confirmed the presence of a venous angioma, an arteriovenous malformation, a venous malformation associated with Klippel-Trenaunay syndrome, and a capillary hemangioma. Follow-up demonstrated stable neurological examinations with reduction in pain at 1 year or greater.
CONCLUSION:
In patients with sciatic distribution symptoms and signs, after initial negative spine imaging, high-resolution imaging of the sciatic nerve itself should be undertaken to address rarer causes such as vascular abnormalities. In these cases, exploration and fascicular biopsy provided a diagnosis; external and limited internal neurolysis improved pain.
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9
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Abstract
Objectives To investigate and review collected and reported transcutaneous ultrasound, transthoracic echocardiography (TTE) and transcranial Doppler (TCD) data obtained during ultrasound-guided foam sclerotherapy (USGFS) of incompetent saphenous, tributary and perforating veins of the lower extremities. Methods TTE and/or middle cerebral artery TCD were performed during USGFS. Ultrasound (US) findings and adverse events were recorded. Existing literature was reviewed. Results Ultrasound detected emboli circulating in superficial, perforating, communicating and deep veins and into the central circulation. TTE detected bright echoes in the right heart after every injection and in the left heart in up to 65% of selected patients. TCD high-intensity transient signals (HITS) were detected in 14–42% of the patients. Incidence of HITS was higher than patient reports of adverse events. Incidence of HITS was independent of foam volumes injected. Conclusion Echogenic signals were detected in non-treated veins, in heart chambers and in the cerebral circulation by transcutaneous US, TTE and TCD. Pathological consequences of such findings remain to be investigated.
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Affiliation(s)
- N Morrison
- Morrison Vein Institute, 8575 E. Princess Dr, Suite 223, Scottsdale, AZ 85255, USA
| | - D L Neuhardt
- CompuDiagnostics, Inc, Clinical Ultrasound Specialists, Scottsdale, AZ, USA
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10
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Labropoulos N, Tassiopoulos AK, Gasparis AP, Phillips B, Pappas PJ. Veins along the course of the sciatic nerve. J Vasc Surg 2009; 49:690-6. [DOI: 10.1016/j.jvs.2008.09.061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 09/29/2008] [Accepted: 09/30/2008] [Indexed: 10/21/2022]
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11
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Gianesini S, Menegatti E, Tacconi G, Scognamillo F, Liboni A, Zamboni P. Echo-guided foam sclerotherapy treatment of venous malformation involving the sciatic nerve. Phlebology 2009; 24:46-7. [DOI: 10.1258/phleb.2008.008058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Primary sciatic nerve varices (SNV) lie within the sciatic nerve possibly causing chronic venous disease and sciatic pain as well. We report a series of 12 consecutive patients affected by symptomatic SNV. All of them were treated by echo-guided Tessari foam sclerotherapy (EGFSCL). Mean follow up lasted two years. Reflux through the sciatic veins, as the connected superficial varicose veins, disappeared in the entire cohort and only minor complications have emerged. EGFSCL seems to be both safe and effective, so representing a reliable and minimally invasive treatment.
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Affiliation(s)
- S Gianesini
- Department of Surgery, Vascular Diseases Centre, University of Ferrara
| | - E Menegatti
- Department of Surgery, Vascular Diseases Centre, University of Ferrara
| | - G Tacconi
- Department of Surgery, Vascular Diseases Centre, University of Ferrara
| | - F Scognamillo
- Institute of Surgical Pathology, University of Sassari, Italy
| | - A Liboni
- Department of Surgery, Vascular Diseases Centre, University of Ferrara
| | - P Zamboni
- Department of Surgery, Vascular Diseases Centre, University of Ferrara
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12
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Thrombosis in unusual sites of the lower extremity veins. J Vasc Surg 2008; 47:1022-7. [DOI: 10.1016/j.jvs.2007.12.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 12/10/2007] [Accepted: 12/16/2007] [Indexed: 11/17/2022]
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