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Arnoldussen CWKP. Imaging of Deep Venous Pathology. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03785-y. [PMID: 38951251 DOI: 10.1007/s00270-024-03785-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 06/04/2024] [Indexed: 07/03/2024]
Abstract
Imaging plays an important role in the identification and assessment of clinically suspected venous pathology. The purpose of this article is to review the spectrum of image-based diagnostic tools used in the investigation of suspected deep vein disease, both obstructive (deep vein thrombosis and post-thrombotic vein changes) as well as insufficiency (e.g., compression syndromes and pelvic venous insufficiency). Additionally, specific imaging modalities are used for the treatment and during clinical follow-up. The use of duplex ultrasound, magnetic resonance venography, computed tomography venography and intravascular ultrasound as well as conventional venography will be discussed in this pictorial review.
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Affiliation(s)
- Carsten W K P Arnoldussen
- Interventional and Cardiovascular Radiologist, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, Limburg, The Netherlands.
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Szkodziak F, Wozniak S, Szkodziak PR, Pyra K, Paszkowski T. Noninvasive diagnostic imaging of pelvic venous disorders. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024. [PMID: 38325406 DOI: 10.1055/a-2263-7193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
It is estimated that chronic pelvic pain (CPP) may affect up to 24% of women. Unfortunately, very often, despite extensive diagnostics, the cause of CPP remains unknown. The pathophysiology of CPP could be explained to a large extent by the occurrence of pelvic venous disorders (PVD). Although pelvic venography is still considered the gold standard for the diagnosis of PVD, noninvasive diagnostic imaging techniques seem to be instrumental in the initial identification of patients with PVD. This literature review aimed to analyze and evaluate the usefulness of noninvasive diagnostic imaging techniques like transvaginal ultrasonography, transabdominal ultrasonography, magnetic resonance, and computed tomography in the diagnosis and identification of patients with PVD. Forty-one articles published between 1984 and 2023 were included in this literature review. Based on this literature review, we conclude that the clinical application of noninvasive diagnostic techniques in the diagnosis of PVD seems to be very promising. Future studies investigating the role of noninvasive diagnostic imaging techniques in the diagnosis of PVD are required.
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Affiliation(s)
- Filip Szkodziak
- 3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | - Slawomir Wozniak
- 3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | | | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Paszkowski
- 3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
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Kavallieros K, Pope T, Mantonanakis K, Tan M, Gianesini S, Lazarashvili Z, Jaworucka-Kaczorowska A, Narayanan S, Gwozdz AM, Davies AH. A scoping review of scores or grading systems for pelvic venous disorders. J Vasc Surg Venous Lymphat Disord 2024:101901. [PMID: 38677550 DOI: 10.1016/j.jvsv.2024.101901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/28/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Pelvic venous disorders (PeVD) encompass a variety of conditions linked to chronic pelvic pain in women. However, PeVD remain underdiagnosed due to the absence of universally accepted diagnostic criteria. The complexity of PeVD classifications across specialties leads to delays in treatment. This scoping review aims to fill a gap in PeVD diagnosis and management by identifying all existing scoring or grading systems to lay the foundation for standardized clinical scoring tools for PeVD. METHODS This scoping review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews. Online databases were searched up to April 2023. Studies implementing a scoring or grading system for patients with confirmed or suspected PeVD were included. Scores or grading systems were classified into four main categories based on their use in the study: screening, diagnosis, measure of disease severity, and measure of response to treatment. RESULTS Of the 2976 unique records identified, 82 were reviewed in full, and 20 were included in this study. The publication dates ranged from 1984 to 2023 (median, 2018; interquartile range, 2003-2022). A total of 21 scores and/or grading systems were identified. Of these 21 scores, 10 (47.6%) were clinical scores, and 10 (47.6%) were scores based on radiological findings; one study included a score that used both clinical and radiological findings. The identified scores were used in various settings. Of the 21 scores, 2 (9.52%) were used for screening in a tertiary care setting; 3 (14.3%) were used to establish the PeVD diagnosis; 8 (38.1%) were used to assess disease severity; and 8 (38.1%) were used as measures of response to treatment. Of the eight scores assessing disease severity, four (50.0%) assessed the degree of dilatation of pelvic veins and four (50%) assessed the severity of reflux. Only three of the scores were validated. CONCLUSIONS This scoping review identified a range of scoring and grading systems for PeVD. We note a lack of a validated scoring system, both clinical and radiological, for screening and assessment of disease severity. This is an important first step in developing validated disease-specific scoring systems for patient screening, appropriate referral, assessment of symptom severity, and assessment of the response to treatment.
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Affiliation(s)
- Konstantinos Kavallieros
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Tasneem Pope
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Matthew Tan
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sergio Gianesini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | | | - Sriram Narayanan
- The Venus Clinic, The Harley Street Heart and Vascular Centre, Singapore, Singapore
| | - Adam M Gwozdz
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
| | - Alun H Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Shahat M, Abdelbaqy OMA, AbdelHakam AM, Ali SH, Attalla K. Can cross-sectional imaging replace diagnostic venography in pelvic venous disorder (PeVD)? J Vasc Surg Venous Lymphat Disord 2024; 12:101724. [PMID: 38135217 DOI: 10.1016/j.jvsv.2023.101724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE The primary etiology of pelvic venous disorder is multifactorial and challengeable in vascular surgery as it mandates multidisciplinary team cooperation for its evaluation and management. METHODS All patients investigated for pelvic venous disorder in a high-volume, tertiary referral university hospital were identified and analyzed retrospectively during the period (March 2021 through September 2022). Demographic and medical data were scored. Agreement between the noninvasive modalities (computed tomographic venography [CTV] or magnetic resonance venography [MRV]) and diagnostic venography in detecting the refluxing pelvic veins was analyzed. Sensitivity, specificity, and diagnostic accuracy are also measured. No patients' treatments were reported in this study as the treatment is scheduled in other sessions in some cases and is out of the scope of this article. All patients had a diagnostic venogram regardless of the axial imaging modality. The main goal was to compare cross-sectional imaging with diagnostic venography. RESULTS The total number of patients was 120 with a mean age of 34.4 ± 7.1 years; 86.7% were multiparous. All patients presented chronic pelvic pain with vulvoperineal and/or atypical lower limb varicosities. Then patients were divided into two groups: those with CTV and those with MRV. Sensitivity, specificity, and diagnostic accuracy of CTV were 50%, 33%, and 47% for the detection of incompetent ovarian veins, 83%, 33%, and 53% for the detection of incompetent internal iliac veins, and 50%, 40%, and 47% for the detection of incompetent pelvic plexus veins, respectively, whereas time-resolved MRV achieved sensitivity, specificity, and diagnostic accuracy of 73%, 25%, and 60% for the detection of incompetent ovarian veins, 75%, 46%, and 53% for the detection of incompetent internal iliac veins, and 67%, 33% and 60% for detection of incompetent pelvic plexus veins, respectively. CONCLUSIONS The desire to avoid the drawbacks of diagnostic venography led to an increase in the use of noninvasive imaging modalities. Our results achieved acceptable sensitivity, specificity, and diagnostic accuracy outcomes for cross-sectional imaging with the superiority of MRV over CTV in diagnosing PCS.
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Affiliation(s)
- Mohammed Shahat
- Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt.
| | - Omar M A Abdelbaqy
- Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt
| | - Ahmed M AbdelHakam
- Department of Diagnostic and Interventional Radiology, Assiut University Hospitals, Assiut, Egypt
| | - Sahar H Ali
- Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt
| | - Khaled Attalla
- Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt
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O'Sullivan G, Smith S. Deep venous stenting in females. CVIR Endovasc 2023; 6:14. [PMID: 36920544 PMCID: PMC10017898 DOI: 10.1186/s42155-023-00354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/08/2023] [Indexed: 03/16/2023] Open
Abstract
Deep venous stenting has gained increasing prominence in recent years. This issue focuses on special considerations in female patients. The specific challenge relates to the fact that these patients are often much younger than those in whom arterial stents are placed. The stents have to perform adequately over potentially 60 years- and there is no data of that length available.
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Affiliation(s)
- Gerry O'Sullivan
- Interventional Radiology, Galway University Hospitals, Galway, Ireland.
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Zhao J, Chen W, Liu J. Lycopene ameliorates locomotor activity and urinary frequency induced by pelvic venous congestion in rats. Open Med (Wars) 2023; 18:20230638. [PMID: 36865495 PMCID: PMC9971737 DOI: 10.1515/med-2023-0638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/17/2022] [Accepted: 12/19/2022] [Indexed: 02/27/2023] Open
Abstract
Decreased locomotor activity and altered urinary frequency are induced by bilateral common iliac vein ligation in rats. As a carotenoid, lycopene has a strong anti-oxidative function. This research investigated the function of lycopene in the pelvic venous congestion (PC) rat model and the underlying molecular mechanism. Lycopene and olive oil were administered intragastrically on a daily basis for 4 weeks after successful modeling. Locomotor activity, voiding behavior, and continuous cystometry were analyzed. The levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG), nitrate and nitrite (NO x ), and creatinine in the urine were measured. Gene expression in the bladder wall was analyzed by quantitative reverse transcription polymerase chain reaction, enzyme-linked immunosorbent assay, and Western blot. Locomotor activity, single voided volume, the interval between the bladder contractions, and urinary NO x /cre ratio were all decreased in rats with PC, while the frequency of urination, urinary 8-OHdG/cre ratio, inflammatory responses, and nuclear factor-κB (NF-κB) signal activity were all increased. Lycopene treatment increased locomotor activity, decreased frequency of urination, elevated urinary NO x level, and decreased urinary 8-OHdG level in the PC rat model. Lycopene also inhibited PC-enhanced pro-inflammatory mediator expression and NF-κB signaling pathway activity. In conclusion, lycopene treatment ameliorates PC-induced phenotypes and shows an anti-inflammatory effect in the PC rat model.
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Affiliation(s)
- Jinchai Zhao
- Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, 050000, China
| | - Wei Chen
- Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, 050000, China
| | - Jian Liu
- Department of Pharmacy, The Second Hospital of Hebei Medical University, 215 West Heping Road, Xinhua District,, Shijiazhuang City, Hebei Province, 050000, China
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Noncontrast MRI in assessing venous reflux of legs using QFlow analysis and radial basis function neural network technique. Sci Rep 2023; 13:3263. [PMID: 36828951 PMCID: PMC9958037 DOI: 10.1038/s41598-023-30437-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/23/2023] [Indexed: 02/26/2023] Open
Abstract
Since venous reflux is difficult to quantify, triggered angiography non-contrast-enhanced (TRANCE)-magnetic resonance imaging (MRI) is a novel tool for objectively evaluating venous diseases in the lower extremities without using contrast media. This study included 26 pre-intervention patients with superficial venous reflux in the lower extremities and 15 healthy volunteers. The quantitative flow (QFlow) analyzed the phase shift information from the pixels within the region of interest from MRI. The fast and simple radial basis function neural network (RBFNN) learning model is constructed by determining the parameters of the radial basis function and the weights of the neural network. The input parameters were the variables generated through QFlow, while the output variables were morbid limbs with venous reflux and normal limb classification. The stroke volume, forward flow volume, absolute stroke volume, mean flux, stroke distance, and mean velocity of greater saphenous veins from QFlow analysis could be used to discriminate the morbid limbs of pre-intervention patients and normal limbs of healthy controls. The neural network successfully classified the morbid and normal limbs with an accuracy of 90.24% in the training stage. The classification of venous reflux using the RBFNN model may assist physicians in clinical settings.
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Jambon E, Le Bras Y, Cazalas G, Grenier N, Marcelin C. Pelvic Venous Insufficiency: Input of Short Tau Inversion Recovery Sequence. J Pers Med 2022; 12:jpm12122055. [PMID: 36556277 PMCID: PMC9781825 DOI: 10.3390/jpm12122055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives: To evaluate indirect criteria of pelvic venous insufficiency (PVI) of a short tau inversion recovery (STIR) sequence retrospectively compared with phlebographic findings. Methods: Between 2008 and 2018, 164 women who had received MRI and phlebography for pelvic congestion syndrome (60), varicose veins in the lower limbs (45), both (43), or other symptoms (16) were included. The presence of periuterine varicosities and perivaginal varicosities were compared to the findings of phlebography: grading of left ovarian vein reflux and presence of internal pudendal or obturator leak. Results: There was a correlation between the grading of LOV reflux on phlebography and the diameter of periuterine varicosities on STIR sequence (p = 0.008, rho = 0.206, CIrho [0.0549 to 0.349]). Periuterine varicosities had a positive predictive value of 93% for left ovarian reflux (95% CI [88.84% to 95.50%]). Obturator or internal pudendal leaks were found for 118 women (72%) and iliac insufficiency for 120 women (73%). Conclusions: Non-injected MRI offers a satisfactory exploration of PVI with STIR sequence. STIR sequences alone enabled the detection of left ovarian and iliac insufficiency.
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Attia NM, Sayed MA, Galal Mohamed HE, AbdelAleem MA. The role of MR venography with time-resolved imaging in diagnosis of pelvic congestion syndrome. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-021-00687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pelvic congestion syndrome (PCS) represents a diagnostic challenge due to its variable clinical presentation, complex anatomy, and pathophysiology. Accurate delineation of the venous anatomy, detection of venous reflux or obstruction, its extent will enable interventional radiologists to successfully treat such patients and to avoid recurrence. Magnetic resonance imaging (MRI) allows a noninvasive examination of the anatomy and flow inside the pelvic veins in addition to its excellent soft-tissue contrast allowing evaluation of the pelvic organs. Our study is aiming to investigate the role and accuracy of MR venography with time-resolved imaging (TR-MRV) as a diagnostic tool for pretreatment planning of PCS.
Results
Our study included 25 female patients with mean age 48 ± 12.34, who were referred to the radiology department in the period from April/2019 to April/2020 with clinical and ultrasound features suggesting PCS. TR-MRV was performed and interpreted in a blind fashion evaluating the vascular anatomy, venous dilatation, and reflux. The results were compared to conventional venography as a reference. The sensitivity, specificity, and accuracy of TR-MRV in the detection of ovarian vein reflux were 87%, 80%, and 84%, respectively, versus 75%, 53%, and 72% in internal iliac vein reflux and 92%, 69%, and 64% for pelvic venous plexus reflux. Demonstration of the venous anatomy was excellent in 68% of the patients and was sufficient in 32%. Ovarian vein dilatation was detected in 16 patients by venography and in 10 patients by TR-MRV. The weighted k-values (Cohen's Kappa coefficient statistics) indicated excellent agreement between the two observers for identifying all the refluxing veins by TRI in each patient (k = 0.78).
Conclusion
MRI with TR imaging has shown high diagnostic accuracy when compared to conventional venography in evaluating pelvic congestion syndrome before endovascular treatment and thus facilitating treatment planning.
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Ford RW, Winokur RS. Pelvic Venous Disorders (PeVD). Semin Intervent Radiol 2022; 39:483-489. [PMID: 36561941 PMCID: PMC9767768 DOI: 10.1055/s-0042-1757938] [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: 12/24/2022]
Abstract
Pelvic venous disorders (PeVDs) have replaced the concept of pelvic congestion syndrome encompassing venous origin chronic pelvic pain (VO-CPP) in women. The evaluation of women with VO-CPP includes the assessment for other causes of pelvic pain as well as imaging evaluation for pelvic varicosities measuring greater than 5 mm diameter, ovarian vein diameter, and flow direction, as well as iliac vein diameter and signs of compression. Proper identification of these patients can lead to high degrees of success eliminating chronic pelvic pain following ovarian vein embolization and/or iliac vein stenting. Strong encouragement is provided to use the symptoms, varices, pathophysiology classification for these patients and upcoming research studies on the specific symptoms of patients with VO-CPP will help elucidate patient selection for intervention. Additional future randomized controlled trials are also upcoming to evaluate for outcomes of ovarian vein embolization and iliac vein.
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Affiliation(s)
- Robert W. Ford
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ronald S. Winokur
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Marcelin C, Le Bras Y, Molina Andreo I, Jambon E, Grenier N. Diagnosis and Management of Pelvic Venous Disorders in Females. Diagnostics (Basel) 2022; 12:2337. [PMID: 36292025 PMCID: PMC9600975 DOI: 10.3390/diagnostics12102337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/29/2022] [Accepted: 09/21/2022] [Indexed: 08/13/2023] Open
Abstract
Pelvic venous pathologies in females are responsible for chronic symptoms grouped under the term pelvic congestion syndrome, which includes chronic pelvic pain, perineal heaviness, urgency, and postcoital pain, along with vulvar, perineal, and lower limb varicose veins. These conditions are also associated with ovarian and pelvic venous reflux and venous obstruction. This review aimed to explore the clinical and imaging modalities for diagnosing pelvic congestion syndrome, pelvic venous pathologies, their therapeutic management, and their outcomes.
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Affiliation(s)
- Clément Marcelin
- Department of Radiology, Centre Hospitalier Universitaire (CHU) Pellegrin de Bordeaux, 33000 Bordeaux, France
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Reinboldt-Jockenhöfer F, Traber J, Holzer LI, von Weymarn A, Dissemond J, Duewell S. Impact of ovarian vein embolization in recurrent varicose veins of the lower extremity. VASA 2022; 51:212-221. [DOI: 10.1024/0301-1526/a001008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Background: The treatment success of catheter-based ovarian vein embolization due to peripheral varicose veins and ovarian vein reflux (OVR) should be investigated in this clinical investagtion. Patients and methods: For this study, 95 female patients were identified over a 5-year period (beginning of 2006 to end of 2011) after catheter-based coil (+/- chemical) embolization of the ovarian vein due to peripheral primary or recurrent varicose veins and proven reflux in the ovarian vein. Treatment success was retrospectively assessed in 2014 by means of a structured telephone interview (n=60), clinical examination (n=56), duplex ultrasound (n=56) and magnetic resonance imaging (n=51) in patients who were willing to participate in the study. Results: After an average of 51.9 months, 95.2% of the 60 included patients were diagnosed with recurrent varicose veins by duplex sonography and 88.1% by clinical examination. In 15.2%, a new intervention was required due to clinical symptoms. The median recurrence-free time was 47.0±5.5 months. A significant improvement by therapy was reported for all subjective symptoms in both pelvis and legs. No significant correlation between radiological findings and complaints or between radiological findings and clinical recurrence was found. Conclusions: The medical history of female patients with peripheral varicose veins should obligatorily include the question of symptoms in the pelvis. An appropriate diagnostic should follow in order to prevent a possible overlook of a pelvic leak point. Only then an individually adapted therapy for symptom relief is possible. Catheter-based ovarian vein embolization is one optional safe procedure that leads to significant improvement of subjective symptoms but does not necessarily prevent recurrent varicose veins.
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Affiliation(s)
- Finja Reinboldt-Jockenhöfer
- Department of Dermatology, Venereology and Allergology, University Hospital of Essen, Germany
- Both authors contributed equally as first authors to this work
| | - Jürg Traber
- Department of Dermatology, Venereology and Allergology, University Hospital of Essen, Germany
- Vein Clinic Bellevue, Kreuzlingen, Switzerland
- Both authors contributed equally as first authors to this work
| | | | | | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital of Essen, Germany
| | - Stefan Duewell
- Institute for Radiology, Kantonsspital Frauenfeld, Switzerland
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Symptomatic pelvic venous insufficiency: a review of the current controversies in pathophysiology, diagnosis, and management. Clin Radiol 2022; 77:409-417. [DOI: 10.1016/j.crad.2022.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/25/2022] [Indexed: 11/19/2022]
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Abstract
Chronic venous disease is a worldwide problem associated with significant morbidity and is expected to increase in prevalence as the current population ages. This is a comprehensive review of the anatomy, pathophysiology, genomics, clinical classification, and treatment modalities of chronic venous disease.
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Affiliation(s)
- Tom Alsaigh
- Division of Vascular Surgery, Vascular Medicine Section, Stanford University, 780 Welch Road, Suite CJ 350, Palo Alto, CA 94304, USA
| | - Eri Fukaya
- Division of Vascular Surgery, Vascular Medicine Section, Stanford University, 780 Welch Road, Suite CJ 350, Palo Alto, CA 94304, USA.
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Chen CW, Tseng YH, Wong MY, Lin YH, Yang TY, Hsu YC, Lin BS, Huang YK. Using Non-Contrast MRA to Discriminate between Obstructive and Nonobstructive Venous Diseases of the Legs. Diagnostics (Basel) 2021; 11:1392. [PMID: 34441326 PMCID: PMC8394703 DOI: 10.3390/diagnostics11081392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/25/2021] [Accepted: 07/29/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Venous interventions of the legs are less predictable owing to a lock of objective tools. METHODS One hundred and twenty patients with lower extremity venous disease were evaluated anatomically using TRANCE MRI. Then, a QFlow analysis was performed in 53 patients with only one leg affected for hemodynamic evaluation. Those patients with complete QFlow were classified into obstructive and nonobstructive. RESULTS The QFlow-namely, stroke volume, forward flow volume, mean flux, stroke distance (SD), and mean velocity (MV) in the external iliac vein (EIV), femoral vein (FV), popliteal vein (PV), and great saphenous vein (GSV). The obstructed group had a shorter SD and lower MV in the EIV, EIV/FV, and GSV/PV (SD: p-values of 0.025, 0.05, and 0.043, respectively; MV: p-values of 0.02, 0.05, and 0.048, respectively). A good performance in discriminating obstructive venous disease was reported for SD in the EIV (area under the curve (AUC) = 67.9%, 95% confidence interval (CI) = 53.2-82.7%), EIV/FV (AUC = 72.4%, 95% CI = 58.2-86.5%), and GSV/PV (AUC = 67.9%, 95% CI = 51.7-84.1%). The SD in the EIV, EIV/FV, and GSV/PV had the ability to discriminate between obstructive and nonobstructive diseases (p-values of 0.025, 0.005, and 0.043). The MV in the EIV, EIV/FV, and GSV/PV had ability to discriminate between obstructive and nonobstructive venous diseases (p-values of 0.02, 0.005, and 0.048). CONCLUSIONS The SD and MV were lower for obstructive than nonobstructive disease in the EIV.
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Affiliation(s)
- Chien-Wei Chen
- Department of Diagnostic Radiology, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Chiayi 61363, Taiwan; (C.-W.C.); (Y.-C.H.)
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Yu-Hui Lin
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Teng-Yao Yang
- Department of Cardiology, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan;
| | - Yin-Chen Hsu
- Department of Diagnostic Radiology, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Chiayi 61363, Taiwan; (C.-W.C.); (Y.-C.H.)
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University and Department of Medical Research, Chi-Mei Medical Center, Tainan 71004, Taiwan;
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
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Chen CW, Tseng YH, Fang YF, Wong MY, Lin YH, Huang YK. Superficial Venous Reflux Intervention Guided by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging: Different QFlow Pattern from Health Controls. J Pers Med 2021; 11:jpm11080751. [PMID: 34442395 PMCID: PMC8398290 DOI: 10.3390/jpm11080751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: To assess the effectiveness of triggered angiography non-contrast-enhanced (TRANCE)-magnetic resonance imaging (MRI) in superficial venous reflux and its difference from health controls. (2) Methods: Thirty patients underwent TRANCE MRI before surgical intervention of their superficial venous reflux of the legs. Ten healthy volunteers were included as a control. (3) Results: TRANCE MRI involves the major tributaries, thus enhances the additional ablations in 20% of patients. QFlow pattern of superficial venous reflux (QFlow GSV/PV MF ratio > 1) was compared with the duplex scan (SFJ reflux) using Cohen’s kappa coefficient at 0.967. The 30 morbid legs undergoing TRANCE MRI-guide interventions and the healthy volunteers’ legs on the same side were compared. The stroke volumes (SV) are higher in EIV (p = 0.021) in the left-leg-intervention group. The mean flux (MF) is higher in the EIV (p = 0.012) and trend of increasing in GSV segment (p = 0.087) in the left-leg-intervention group. The QFlow of 10 patients with right leg intervention are higher in GSV in the right-leg-intervention group (SV p = 0.002; FFV p = 0.001; MF p = 0.001). QFlow data is shown for all legs for superficial venous intervention with GSV/PV (MF) ratio > 1. (4) Conclusions: Typical figures in QFlow (GSV/PV MF ratio > 1) could be observed in the morbid limbs but not in the controls.
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Affiliation(s)
- Chien-Wei Chen
- Department of Diagnostic Radiology, Chia-Yi Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan;
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chia-Yi Chan Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Yueh-Fu Fang
- Department of Thoracic Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan;
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chia-Yi Chan Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Yu-Hui Lin
- Division of Thoracic and Cardiovascular Surgery, Chia-Yi Chan Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chia-Yi Chan Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
- Correspondence:
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Maratto S, Khilnani NM, Winokur RS. Clinical Presentation, Patient Assessment, Anatomy, Pathophysiology, and Imaging of Pelvic Venous Disease. Semin Intervent Radiol 2021; 38:233-238. [PMID: 34108811 PMCID: PMC8175105 DOI: 10.1055/s-0041-1729745] [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: 10/21/2022]
Abstract
Pelvic venous disorders (PeVDs) can result in several different clinical presentations, but can be challenging to distinguish from other etiologies of chronic pelvic pain (CPP). Clinical evaluation of CPP patients optimally should be performed in a multidisciplinary fashion and patients who may have PeVD should be referred for consultation with a vascular interventionalist whose evaluation would utilize an imaging workup to search for pelvic varices. Additionally, it is critical to quantify the quality-of-life effects of all CPP to determine the impact on the patient's overall health. Diagnostic imaging, including transabdominal and transvaginal ultrasound, computed tomography, magnetic resonance imaging, and venography, can be utilized to identify pelvic varices, as well as venous reflux and obstruction leading to CPP. The use of the SVP tool is important to classify PeVD patients based on their clinical symptoms, varicose veins, and pathophysiology for precise clinical communication and for reporting clinical research. The goal of this publication is to delineate the clinical presentation, anatomy, pathophysiology, and imaging evaluation of patients with CPP suspected of having PeVD.
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Affiliation(s)
- Sean Maratto
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Neil M. Khilnani
- Division of Interventional Radiology, Weill Cornell Vein Treatment Practice, New York – Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Ronald S. Winokur
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Topper SR, Winokur RS. Imaging of Pelvic Venous Disorders (PeVD); Should Every Patient Get an MRI? Tech Vasc Interv Radiol 2021; 24:100731. [PMID: 34147189 DOI: 10.1016/j.tvir.2021.100731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pelvic venous disease (PeVD) is part of the broad differential diagnosis of chronic pelvic pain with a challenging diagnosis and clinical workup to identify those patients that are most likely to benefit from intervention. Ultrasound, MRI, CT, venography, and intravascular ultrasound can all provide information to aid in the diagnostic algorithm. The purpose of this article is to review imaging as a component of the outpatient workup of patients with chronic pelvic pain to guide appropriate understanding and use of imaging modalities to accurately identify patients suffering from PeVD. A favored approach is to begin with transabdominal sonography with selective use of MRI/MRV in specific patient populations.
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Affiliation(s)
- Stephen R Topper
- Department of Radiology, Division of Interventional Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ronald S Winokur
- Department of Radiology, Division of Interventional Radiology, Thomas Jefferson University Hospital, Philadelphia, PA.
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Tseng YH, Chen CW, Wong MY, Yang TY, Lin BS, Ting H, Huang YK. Discriminating Reflux from Non-Reflux Diseases of Superficial Veins in Legs by Novel Non-Contrast MR with QFlow Technique. J Pers Med 2021; 11:jpm11040242. [PMID: 33810500 PMCID: PMC8066982 DOI: 10.3390/jpm11040242] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To find an objective diagnostic tool for the superficial veins in legs. Methods: This study included 137 patients who underwent TRANCE-MRI from 2017 to 2020 (IRB: 202001570B0). Among them, 53 with unilateral leg venous diseases underwent a QFlow scan and were classified into the reflux and non-reflux groups according to the status of the great saphenous veins. Results: The QFlow, namely stroke volume (SV), forward flow volume (FFV), mean flux (MF), stroke distance (SD), and mean velocity (MV) measured in the external iliac, femoral, popliteal, and great saphenous vein (GSV). The SV, FFV, SD, MF, SD, and MV in the GSV (morbid/non-morbid limbs) demonstrated a favorable ability to discriminate reflux from non-reflux in the ROC curve. The SD in the GSV and GSV/PV ratio (p = 0.049 and 0.047/cutoff = 86 and 117.1) and the MV in the EIV/FV ratio, GSV, and GSV/PV ratio (p = 0.035, 0.034, and 0.025/cutoff = 100.9, 86.1, and 122.9) exhibited the ability to discriminate between reflux and non-reflux group. The SD, MV, and FFV have better ability to discriminate a reflux from non-reflux group than the SV and MF. Conclusions: QFlow may be used to verify the reflux of superficial veins in the legs. An increasing GSV/PV ratio is a hallmark of reflux of superficial veins in the legs.
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Affiliation(s)
- Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.T.); (M.Y.W.)
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 408, Taiwan;
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.T.); (M.Y.W.)
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 300, Taiwan;
| | - Teng-Yao Yang
- Department of Cardiology, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan;
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 300, Taiwan;
| | - Hua Ting
- Institute of Medicine, Chung Shan Medical University, Taichung 408, Taiwan;
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.T.); (M.Y.W.)
- Correspondence:
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20
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Osman AM, Mordi A, Khattab R. Female pelvic congestion syndrome: how can CT and MRI help in the management decision? Br J Radiol 2021; 94:20200881. [PMID: 33252986 DOI: 10.1259/bjr.20200881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Diagnosis of female pelvic congestion syndrome (PCS) is challenging. Although invasive venography is the gold-standard for diagnosis, however, CT and MRI are important in the assessment. In this study, we tried to highlight the role of CT and MRI as non-invasive tools in the diagnosis and management of PCS. METHODS AND MATERIAL This was a retrospective study of 50 patients confirmed clinically to have PCS. These patients had already done CT and MRI before venography or surgery. RESULTS The mean age of the patients was 48 years ± 12 years SD. Vaginal discharge and pelvic heaviness were the commonest symptoms (46 and 42% respectively). The commonest risk factor was multiparity (56%) followed by the RVF uterus (26%). No significant difference was found between CT, MRI, and venography as regarding the diameter of the ovarian vein, diameter, and the number of the varicose veins. The sensitivity of CT and MRI was 94.8 and 96%. CT and MRI discovered five cases with local pelvic obstructing cause,14 cases with evidence of vascular compression syndrome, and the rest 31 cases diagnosed to have primary non-obstructing PCS which was effective in decision-making with the surgery indicated in the first group while stenting of the vascular obstruction followed by bilateral ovarian veins coiling was the better option for the second group and only bilateral coiling was needed for the last group. CONCLUSION CT and MRI play important roles in the diagnosis and even management decision in cases of PCS. ADVANCES IN KNOWLEDGE: Identification of the importance of diagnostic radiology before management decisions of cases with PCS.
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Affiliation(s)
- Ahmed M Osman
- Radiology, Faculty of Medicine - Ain shams University, Cairo, Egypt
| | - Ahmed Mordi
- EBIR Interventional Radiology, Faculty of Medicine- Ain shams University, Cairo, Egypt
| | - Rasha Khattab
- Radiology, Faculty of Medicine - Ain shams University, Cairo, Egypt
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21
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Ohe H, Kim JY, Lee H, Park G, Park J, Hwang H, Park I, Yun S, Hong KP, Park JK, Jang JH, Yun SS. Draft Revision of Clinical Practice Guidelines for Varicose Veins -Diagnosis-. Phlebology 2020. [DOI: 10.37923/phle.2020.18.2.23] [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)
- Haengjin Ohe
- Division of Vascular and Transplant, Department of Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Jang Yong Kim
- Division of Vascular and Transplant Surgery, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Hogyun Lee
- Division of Vascular and Transplant Surgery, Department of Surgery, Chonnam National University Hospital, Kwangju, Korea
| | - Geunmyeong Park
- Division of Vascular and Transplant Surgery, Department of Surgery, Inha University Hospital, Inchon, Korea
| | - Junho Park
- Happy Varicose Vein Clinic, Seoul, Korea
| | - Hongpil Hwang
- Division of Vascular and Transplant Surgery, Department of Surgery, Jeonbuk National University Hospital, Jeonju, Korea
| | | | - Sangchul Yun
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Ki-Pyo Hong
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jong Kwon Park
- Division of Vascular and Transplant, Department of Surgery, Inje University Haeundae Paik Hospital, Pusan, Korea
| | | | - Sang Seob Yun
- Division of Vascular and Transplant Surgery, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
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22
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Hasjim BJ, Fujitani RM, Kuo IJ, Donayre CE, Maithel S, Sheehan B, Kabutey NK. Unique Case of Recurrent Pelvic Congestion Syndrome Treated with Median Sacral Vein Embolization. Ann Vasc Surg 2020; 68:569.e1-569.e7. [PMID: 32283303 DOI: 10.1016/j.avsg.2020.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/28/2020] [Accepted: 04/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pelvic congestion syndrome (PCS) is defined as noncyclical pelvic pain or discomfort caused by dilated parauterine, paraovarian, and vaginal veins. PCS is typically characterized by ovarian venous incompetence that may be due to pelvic venous valvular insufficiency, hormonal factors, or mechanical venous obstruction. METHODS We describe a case of a 38-year-old multiparous female with a history of pelvic pressure, vulvar varices, and dyspareunia. She underwent left gonadal vein coil embolization in 2014 for PCS that lead to symptomatic relief of her pain. Four years later, the patient returned for recurrent symptoms. Magnetic resonance venogram demonstrated dilated pelvic varices. The previously embolized left gonadal vein remained thrombosed, and there was no evidence of right gonadal vein insufficiency. However, catheter-based venography revealed a large, dilated, and incompetent median sacral vein. RESULTS Pelvic venography demonstrated left gonadal vein embolization without any evidence of reflux. The right gonadal vein was also nondilated without reflux. Internal iliac venography showed large cross-pelvic collaterals and retrograde flow via a large, dilated median sacral vein. Coil embolization of the median sacral vein resulted in a dramatic reduction of pelvic venous reflux and resolution of symptoms. CONCLUSIONS Recurrence of PCS can occur after ovarian vein embolization through other tributaries in the venous network. The median sacral vein is a rare cause of PCS. We present an interesting case of a successfully treated recurrent PCS with coil embolization of an incompetent median sacral vein.
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Affiliation(s)
- Bima J Hasjim
- Division of Vascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA
| | - Roy M Fujitani
- Division of Vascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA
| | - Isabella J Kuo
- Division of Vascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA
| | - Carlos E Donayre
- Division of Vascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA
| | - Shelley Maithel
- Division of Vascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA
| | - Brian Sheehan
- Division of Vascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA
| | - Nii-Kabu Kabutey
- Division of Vascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA.
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Toh MR, Tang TY, Lim HHMN, Venkatanarasimha N, Damodharan K. Review of imaging and endovascular intervention of iliocaval venous compression syndrome. World J Radiol 2020; 12:18-28. [PMID: 32226586 PMCID: PMC7061234 DOI: 10.4329/wjr.v12.i3.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 02/06/2023] Open
Abstract
Iliocaval venous compression syndrome (ICS) is the extrinsic compression of the common iliac vein by the overlying iliac artery against the vertebra. Chronic compression can lead to venous stenosis and stasis, which manifests as chronic venous disease and treatment resistance. Therefore, early recognition of ICS and prompt treatment are essential. Clinical presentations of ICS can be ambiguous and diagnosis requires a high index of suspicion with the relevant imaging studies. The initial imaging test is typically a Duplex ultrasound for vessel assessment and pelvic ultrasound to exclude a compressive mass, which is followed by computed tomography (CT) or magnetic resonance (MR) venography. CT and MRI can identify the anatomical causes for venous compression. In patients with high clinical suspicion for ICS, negative findings on CT and MR venography would still warrant further investigations. Definitive diagnosis can be established using catheter-based venography complemented with intravascular ultrasonography but the nature of their invasiveness limits its utility as a routine imaging modality. In this review paper, we will discuss the evidence, utility and limitations of the existing imaging modalities and endovascular intervention used in the management of ICS.
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Affiliation(s)
- Ming Ren Toh
- Duke-NUS Medical School, Singapore 544886, Singapore
| | - Tjun Yip Tang
- Department of Vascular surgery, Singapore General Hospital, Singapore 169608, Singapore
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Tonolini M, Foti PV, Costanzo V, Mammino L, Palmucci S, Cianci A, Ettorre GC, Basile A. Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis-part I: corpus luteum and haemorrhagic ovarian cysts, genital causes of haemoperitoneum and adnexal torsion. Insights Imaging 2019; 10:119. [PMID: 31853900 PMCID: PMC6920287 DOI: 10.1186/s13244-019-0808-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/18/2019] [Indexed: 01/06/2023] Open
Abstract
Acute gynaecologic disorders are commonly encountered in daily clinical practice of emergency departments (ED) and predominantly occur in reproductive-age women. Since clinical presentation may be nonspecific and physical findings are often inconclusive, imaging is required for a timely and accurate diagnosis. Although ultrasound is the ideal non-invasive first-line technique, nowadays multidetector computed tomography (CT) is extensively used in the ED, particularly when a non-gynaecologic disorder is suspected and differential diagnosis from gastrointestinal and urologic diseases is needed. As a result, CT often provides the first diagnosis of female genital emergencies. If clinical conditions and scanner availability permit, magnetic resonance imaging (MRI) is superior to CT for further characterisation of gynaecologic abnormalities, due to the excellent soft-tissue contrast, intrinsic multiplanar capabilities and lack of ionising radiation. The purpose of this pictorial review is to provide radiologists with a thorough familiarity with gynaecologic emergencies by illustrating their cross-sectional imaging appearances. The present first section will review the CT and MRI findings of corpus luteum and haemorrhagic ovarian cysts, gynaecologic haemoperitoneum (from either ruptured corpus luteum or ectopic pregnancy) and adnexal torsion, with an emphasis on differential diagnosis. Additionally, comprehensive and time-efficient MRI acquisition protocols are provided.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Valeria Costanzo
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Luca Mammino
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical-Surgical Specialties, Institute of Obstetrics and Ginecology, University of Catania, Catania, Italy
| | - Giovanni Carlo Ettorre
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
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Nishijima S, Sugaya K, Kadekawa K, Ashitomi K, Ueda T, Yamamoto H. Mechanisms underlying the effects of propiverine on bladder activity in rats with pelvic venous congestion and urinary frequency. Biomed Res 2019; 40:145-152. [PMID: 31413235 DOI: 10.2220/biomedres.40.145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We investigated the mechanisms by which propiverine hydrochloride influenced bladder activity in rats with pelvic venous congestion (PC) and urinary frequency. To create PC rats, female rats were anesthetized with isoflurane and the bilateral common iliac veins and bilateral uterine veins were ligated. At 4 weeks after ligation, we assessed voiding behaviour, locomotor activity, and urinary 8-hydroxydeoxyguanosine (8-OHdG) and nitric oxide metabolites (NOx). We also performed cystometry and measured mRNAs for nitric oxide synthase (NOS) and several receptors in the bladder wall. PC rats showed a decrease in locomotor activity and an increased frequency of urination. There was a decrease in endothelial NOS (eNOS), M3, and TRPV1 mRNA expression in the bladder wall, as well as an increase in inducible NOS (iNOS) mRNA. Administration of propiverine to PC rats increased locomotor activity to the level in sham rats, improved bladder function, decreased urinary 8-OHdG excretion, and increased urinary NOx excretion. In addition, propiverine increased neuronal NOS (nNOS) mRNA expression, and decreased expression of iNOS, M3 and TRPV1 mRNA in the bladder wall. Therefore, propiverine not only improved bladder dysfunction through its previously reported actions (anti-muscarinic effect, Ca antagonist effect, and inhibition of noradrenaline re-uptake), but also by reducing inflammation.
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Affiliation(s)
| | | | | | | | - Tomoyuki Ueda
- Institute for Animal Experiments, Faculty of Medicine, University of the Ryukyus
| | - Hideyuki Yamamoto
- Department of Biochemistry, Graduate School of Medicine, University of the Ryukyus
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Jurga-Karwacka A, Karwacki GM, Schoetzau A, Zech CJ, Heinzelmann-Schwarz V, Schwab FD. A forgotten disease: Pelvic congestion syndrome as a cause of chronic lower abdominal pain. PLoS One 2019; 14:e0213834. [PMID: 30939134 PMCID: PMC6445463 DOI: 10.1371/journal.pone.0213834] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/03/2019] [Indexed: 02/04/2023] Open
Abstract
Objectives Pelvic congestion syndrome is defined as chronic pelvic pain due to incompetent (dilated and refluxing) pelvic veins. The aim of this study was to investigate the prevalence of this condition by examining the prevalence of dilated ovarian and para-uterine veins in pre- and postmenopausal female patients, irrespective of their symptoms. We subsequently investigated how many women with dilated veins suffered from chronic pelvic pain. Additionally, we attempted to define diagnostic criteria that may allow for early identification of affected patients. Methods We reassessed 2384 abdomino-pelvic computed tomography scans performed on women at our institution. The maximal diameters of the ovarian and para-uterine veins were measured. Patients with a pathological process in the abdomen or pelvis affecting the veins were excluded. We considered ovarian vein dilation to be 6 mm or more in the axial plane. For patients that met these criteria, we performed a retrospective chart review to evaluate the clinical presentation and/or symptoms of these patients. Results Dilated pelvic veins were present in 293/2384 (12%) patients, 118/559 premenopausal (21%) and 175/1825 postmenopausal (10%). Chronic pelvic pain of unclear etiology had been documented prior to the CT in 54/293 (18%) women with dilated veins—2% of the whole study collective (54/2384); 8% of all premenopausal (44/559) and 0.5% of all postmenopausal (10/1825). It was often accompanied by urological symptoms such as hematuria, dysuria, and urinary frequency, in the absence of infection (p<0.05). We identified a strong correlation between the presence of dilated ovarian veins and chronic pelvic pain in premenopausal parous patients with hematuria. Conclusions Pelvic congestion syndrome appears to be an underdiagnosed and undertreated disease. In our study, 8% of all premenopausal women had documented chronic pelvic pain of unclear etiology and dilated ovarian and pelvic veins on cross-sectional imaging studies. The features we identified in this study as most relevant should enable a faster identification of patients who could benefit from a specific treatment regimen for this condition.
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Affiliation(s)
- Agnieszka Jurga-Karwacka
- Department of Gynecology and Gynecological Oncology, University Women`s Hospital of Basel, University of Basel, Basel, Switzerland
| | - Grzegorz M. Karwacki
- Clinic of Radiology & Nuclear Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Andreas Schoetzau
- Ovarian Cancer Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Christoph J. Zech
- Clinic of Radiology & Nuclear Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Viola Heinzelmann-Schwarz
- Department of Gynecology and Gynecological Oncology, University Women`s Hospital of Basel, University of Basel, Basel, Switzerland
- Ovarian Cancer Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Fabienne D. Schwab
- Department of Gynecology and Gynecological Oncology, University Women`s Hospital of Basel, University of Basel, Basel, Switzerland
- * E-mail:
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27
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Khilnani NM, Meissner MH, Learman LA, Gibson KD, Daniels JP, Winokur RS, Marvel RP, Machan L, Venbrux AC, Tu FF, Pabon-Ramos WM, Nedza SM, White SB, Rosenblatt M. Research Priorities in Pelvic Venous Disorders in Women: Recommendations from a Multidisciplinary Research Consensus Panel. J Vasc Interv Radiol 2019; 30:781-789. [PMID: 30857986 DOI: 10.1016/j.jvir.2018.10.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 12/17/2022] Open
Abstract
Pelvic venous disorders (PeVDs) in women can present with chronic pelvic pain, lower-extremity and vulvar varicosities, lower-extremity swelling and pain, and left-flank pain and hematuria. Multiple evidence gaps exist related to PeVDs with the consequence that nonvascular specialists rarely consider the diagnosis. Recognizing this, the Society of Interventional Radiology Foundation funded a Research Consensus Panel to prioritize a research agenda to address these gaps. This paper presents the proceedings and recommendations from that Panel.
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Affiliation(s)
- Neil M Khilnani
- Division of Interventional Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, 2315 Broadway, Fourth Floor, New York, New York 10128.
| | - Mark H Meissner
- Division of Vascular Surgery, University of Washington Medical Center, Seattle, Washington
| | - Lee A Learman
- Department of Obstetrics and Gynecology, Charles A. Schmidt School of Medicine, Florida Atlantic University, Boca Raton, Florida
| | | | - Jane P Daniels
- Clinical Trials Unit, University of Nottingham, Nottingham, United Kingdom
| | - Ronald S Winokur
- Division of Interventional Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, 2315 Broadway, Fourth Floor, New York, New York 10128
| | | | - Lindsay Machan
- Departments of Radiology and Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony C Venbrux
- Division of Interventional Radiology, George Washington University School of Medicine, Washington, DC
| | - Frank F Tu
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois; Department of Obstetrics and Gynecology, North Shore University Medical Group, Skokie, Illinois
| | - Waly M Pabon-Ramos
- Division of Interventional Radiology, Duke University School of Medicine, Durham, North Carolina
| | - Susan M Nedza
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sarah B White
- Division of Interventional Radiology, Froedtert Hopsital, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mel Rosenblatt
- Connecticut Image-Guided Surgery, Fairfield, Connecticut
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Riding DM, Pond EJ, McCollum C, Caress AL. Seeking consensus amongst UK-based interventional radiologists on the imaging diagnosis of pelvic vein incompetence in women with chronic pelvic pain: A modified Delphi study. Phlebology 2019; 34:486-495. [PMID: 30621525 DOI: 10.1177/0268355518821554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives This modified Delphi study of vascular interventional radiologists sought to achieve consensus statements on the optimal imaging strategy and definitions of important imaging diagnostic features in women with pelvic vein incompetence. Method The UK-based interventional radiologists with the experience of investigating and treating pelvic vein incompetence responded to up to three rounds of online questionnaires. Results Three consensus statements emerged from 27 responders: (1) catheter venography is the ‘gold standard’ investigation for the diagnosis of pelvic vein incompetence; (2) pelvic vein incompetence should be defined as ‘retrograde flow along the ovarian or internal iliac veins’; (3) pelvic varices should be defined as ‘tortuous, often dilated, vulval, adnexal, para-uterine veins arising from incompetent internal iliac or ovarian veins.’ Conclusion This study achieved consensus statements on imaging diagnosis in women with suspected pelvic vein incompetence. These can be used to minimise heterogeneity of research protocols, and represent baseline positions which can, themselves, be tested.
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Affiliation(s)
- David M Riding
- Academic Surgery Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma J Pond
- Academic Surgery Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Charles McCollum
- Academic Surgery Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ann L Caress
- Academic Surgery Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Sugaya K, Nishijima S, Kadekawa K, Noguchi K, Ashitomi K, Ueda T, Yamamoto H. Pelvic venous congestion induces lower urinary tract dysfunction in rats. Biomed Res 2018; 39:269-277. [PMID: 30531156 DOI: 10.2220/biomedres.39.269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pelvic venous congestion (PC) is thought to be related to several diseases of the lower urinary tract (LUT). We examined the characteristics of the LUT in rats with PC. To create PC, female rats were anesthetized with isoflurane, and the bilateral common iliac veins and bilateral uterine veins were ligated. At 1-8 weeks after either ligation or sham surgery, we performed cystometry with or without administration of carbazochrome sodium sulfonate hydrate or propiverine hydrochloride, histologic examination of the bladder, blood flow imaging, assessment of locomotor activity, measurement of urinary 8-hydroxydeoxyguanosine (8-OHdG) and nitric oxide metabolites (NOx), and the Evans blue dye extravasation test. PC elevated frequency of urination after 2-6 weeks, and caused a decrease of spontaneous locomotor activity. In addition, there was a decrease of bladder blood flow, an increase of bladder vascular permeability, an increase of urinary 8-OHdG, a decrease of urinary NOx, and mild inflammatory changes of the bladder. In rats with PC, frequency of urination was normalized by administration of propiverine or carbazochrome. Rats with PC may be used as a model of PC associated with high frequency of urination, and this model may be useful when developing treatment for LUT symptoms associated with PC.
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Affiliation(s)
| | | | | | | | | | - Tomoyuki Ueda
- The Institute for Animal Experiments, Faculty of Medicine, University of the Ryukyus
| | - Hideyuki Yamamoto
- Department of Biochemistry, Graduate School of Medicine, University of the Ryukyus
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30
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Maturen KE, Akin EA, Dassel M, Deshmukh SP, Dudiak KM, Henrichsen TL, Learman LA, Oliver ER, Poder L, Sadowski EA, Vargas HA, Weber TM, Winter T, Glanc P. ACR Appropriateness Criteria ® Postmenopausal Subacute or Chronic Pelvic Pain. J Am Coll Radiol 2018; 15:S365-S372. [PMID: 30392605 DOI: 10.1016/j.jacr.2018.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
Pelvic pain is common in both reproductive age and postmenopausal women, and the major etiologies change throughout the life cycle. Chronic pain is defined as lasting for at least 6 months. There are many gastrointestinal and urinary disorders associated with chronic pain in this age group, which are not discussed in this guideline. Pain may be localized to the deep pelvis, with potential causes including pelvic congestion syndrome, intraperitoneal adhesions, hydrosalpinx, chronic inflammatory disease, or cervical stenosis. Ultrasound is the initial imaging modality of choice, while CT and MRI may be appropriate for further characterization of sonographic findings. Alternatively, pain may be localized to the vagina, vulva, or perineum, with potential causes including vaginal atrophy, vaginismus, vaginal or vulvar cysts, vulvodynia, or pelvic myofascial pain. Imaging is primarily indicated in context of an abnormal physical exam and ultrasound is the initial modality of choice, while MRI may be appropriate for further characterization in select cases. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Mark Dassel
- Cleveland Clinic, Cleveland, Ohio; American Congress of Obstetricians and Gynecologists
| | | | | | | | - Lee A Learman
- Florida Atlantic University, Boca Raton, Florida; American Congress of Obstetricians and Gynecologists
| | - Edward R Oliver
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Liina Poder
- University of California San Francisco, San Francisco, California
| | | | | | | | - Tom Winter
- University of Utah, Salt Lake City, Utah
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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31
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Brown CL, Rizer M, Alexander R, Sharpe EE, Rochon PJ. Pelvic Congestion Syndrome: Systematic Review of Treatment Success. Semin Intervent Radiol 2018; 35:35-40. [PMID: 29628614 DOI: 10.1055/s-0038-1636519] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pelvic venous insufficiency is now a well-characterized etiology of pelvic congestion syndrome (PCS). The prevalence of CPP is 15% in females aged 18 to 50 years in the United States and up to 43.4% worldwide. In addition to individual physical, emotional, and quality-of-life implications of CPP, there are profound healthcare and socioeconomic expenses with estimated annual direct and indirect costs in the United States in excess of 39 billion dollars. PCS consists of clinical symptoms with concomitant anatomic and physiologic abnormalities originating in venous insufficiency. The etiology of PCS is diverse involving both mechanical and hormonal factors contributing to venous dilatation (>5 mm) and insufficiency. Factors affecting the diagnosis of PCS include variance of causes and clinical presentations of pelvic pain and relatively low sensitivity of noninvasive diagnostic imaging and laparoscopy to identify insufficiency compared with catheter venogram. A systematic review of the literature evaluating patient outcomes following percutaneous treatment of PCS is presented.
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Affiliation(s)
- Candace L Brown
- Diagnostic and Interventional Radiology, Advanced Radiology Services, Grand Rapids, Michigan
| | - Magda Rizer
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ryan Alexander
- Department of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Emerson E Sharpe
- Department of Interventional Radiology, Kaiser Permanente, Denver, Colorado
| | - Paul J Rochon
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Steenbeek MP, van der Vleuten CJM, Schultze Kool LJ, Nieboer TE. Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review. Acta Obstet Gynecol Scand 2018; 97:776-786. [PMID: 29381188 PMCID: PMC6033028 DOI: 10.1111/aogs.13311] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/22/2018] [Indexed: 12/28/2022]
Abstract
Introduction In the work‐up of patients with suspected pelvic congestion syndrome, venography is currently the gold standard. Yet if non‐invasive diagnostic tools are found to be accurate, invasive venography might no longer be indicated as necessary. Material and methods A literature search in Pubmed and EMBASE was performed from inception until 6 May 2017. Studies comparing non‐invasive diagnostic tools to a reference standard in the work‐up of patients with (suspected) pelvic congestion syndrome were included. Relevant data were extracted and methodological quality of individual included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS‐2) tool. Results Nine studies matched our inclusion criteria. Six studies compared ultrasonography to venography and three studies described a magnetic resonance imaging technique. In using transvaginal ultrasonography, the occurrence of a vein greater than five mm crossing the uterine body had a specificity of 91% (95% CI; 77–98%) and occurrence of pelvic varicoceles a sensitivity and specificity of 100% (95% CI; 89–100%) and 83–100% (95% CI; 66–93%), respectively. In transabdominal ultrasonography, reversed caudal flow in the ovarian vein accounted for a sensitivity of 100% (95% CI; 84–100%). Detection of pelvic congestion syndrome with magnetic resonance imaging techniques resulted in a sensitivity varying from 88 to 100%. Conclusions The sensitivity of ultrasonography and magnetic resonance imaging seem to be adequate, which indicates a role for both tests in an early stage of the diagnostic workup. However, due to methodological flaws and diversity in outcome parameters, more high standard research is necessary to establish a clear advice for clinical practice.
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Affiliation(s)
- Miranda P Steenbeek
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Leo J Schultze Kool
- Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Theodoor E Nieboer
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
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33
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Abstract
Chronic pelvic pain (CPP) affects 24% of premenopausal women, accounts for 20%-30% of UK gynecology outpatient appointments, and has an annual pan-European economic cost of €3.8 billion. Despite extensive investigation, often including laparoscopy, up to 55% of women do not receive a diagnosis and endure persistent symptoms. In these patients, clinical management focuses on symptom control rather than treatment. It is possible that pelvic vein incompetence (PVI) is a cause of CPP, although the quality of studies investigating an association is generally low. PVI may develop during and after pregnancy, as uterine blood flow increases significantly, pushing venous valve leaflets apart, and enabling retrograde venous flow. Analogies with varicose veins of the lower limb are helpful, and symptoms are similar. Women with symptomatic PVI report a dull pelvic ache that is worse on standing and sitting and persists throughout the day. It can be relieved by lying down. Early treatments for PVI included laparoscopic ligation; however, since the advent of endovascular occlusive techniques, treatments have lower risk and lower cost, and can be undertaken without sedation or anesthetic. However, there have been no high-quality randomized controlled trials of interventions and, therefore, the evidence is limited to single-center case series.
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Affiliation(s)
| | - Vivak Hansrani
- Department of Vascular Surgery, University Hospital of South Manchester, Manchester, UK
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34
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Testa G, Koon EC, Johannesson L, McKenna GJ, Anthony T, Klintmalm GB, Gunby RT, Warren AM, Putman JM, dePrisco G, Mitchell JM, Wallis K, Olausson M. Living Donor Uterus Transplantation: A Single Center's Observations and Lessons Learned From Early Setbacks to Technical Success. Am J Transplant 2017; 17:2901-2910. [PMID: 28432742 DOI: 10.1111/ajt.14326] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/04/2017] [Accepted: 04/13/2017] [Indexed: 01/25/2023]
Abstract
Uterus transplantation is a vascularized composite allograft transplantation. It allows women who do not have a uterus to become pregnant and deliver a baby. In this paper, we analyze the first five cases of living donor uterus transplantation performed in the United States. The first three recipients lost their uterus grafts at days 14, 12, and 6, respectively, after transplant. Vascular complications, related to both inflow and outflow problems, were identified as the primary reason for the graft losses. Two recipients, at 6 and 3 mo, respectively, after transplant, have functioning grafts with regular menstrual cycles. Ultimate success will be claimed only after a live birth. This paper is an in-depth analysis of evaluation, surgical technique, and follow-up of these five living donor uterus transplants. The lessons learned were instrumental in allowing us to evolve from failure to technical and functional success. We aim to share our conclusions and build on knowledge in the evolving field of uterus transplantation.
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Affiliation(s)
- G Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - E C Koon
- Obstetrics and Gynecology/Gynecologic Oncology, Baylor University Medical Center, Dallas, TX
| | - L Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.,Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - G J McKenna
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - T Anthony
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - G B Klintmalm
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - R T Gunby
- Obstetrics and Gynecology, Baylor University Medical Center, Dallas, TX
| | - A M Warren
- Baylor Medical Psychology Consultants, Baylor University Medical Center, Dallas, TX
| | - J M Putman
- Obstetrics and Gynecology, Baylor University Medical Center, Dallas, TX
| | - G dePrisco
- Diagnostic Radiology, Baylor University Medical Center, Dallas, TX
| | - J M Mitchell
- Pathology, Baylor University Medical Center, Dallas, TX
| | - K Wallis
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - M Olausson
- Transplantation Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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35
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Nanavati R, Jasinski P, Adrahtas D, Gasparis A, Labropoulos N. Correlation between pelvic congestion syndrome and body mass index. J Vasc Surg 2017; 67:536-541. [PMID: 28943005 DOI: 10.1016/j.jvs.2017.06.115] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/28/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Previous studies of men suggested that patients with varicocele may be leaner than the normal population. No such work exists in women with pelvic congestion syndrome (PCS). This study evaluated the correlation between body mass index (BMI) and PCS. METHODS A case-control study at a single institution was performed of women who had the objective diagnosis of PCS. Data were prospectively collected for 100 consecutive patients with PCS. BMI was calculated for every patient and categorized into normal weight (BMI <25), overweight (BMI 25-29.9), and obese (BMI >30). Diagnosis of PCS was made by ultrasound and venography. Mean BMI was compared with that of the general female population of the United States from 1999 to 2002. Furthermore, analyses included comparison of patients with and without ovarian vein dilation and pelvic varices. RESULTS There were 100 women with a median age of 44 years (range, 24-73 years). The mean BMI of the study group was 25 ± 5.6 kg/m2. The cohort was categorized into 59 women with normal BMI, 23 overweight women, and 18 obese women. The study cohort's BMI was less than that of the general U.S. female population (P = .02). The majority of the study group were white with lower BMI (P < .0001). Leg varicosities were more prevalent in obese patients (100% obese vs 81% normal BMI; P = .01). Patients with ovarian vein dilation had significantly lower BMI (24.1 ± 5.6 kg/m2 and 26.7 ± 5.4 kg/m2; P = .036). No differences were identified for pelvic varices or reflux. CONCLUSIONS Women with PCS are more likely to have a normal BMI with ovarian vein dilation compared with obese women, who are more frequently affected by leg varicosities.
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Affiliation(s)
- Ruhani Nanavati
- Division of Vascular and Endovascular Surgery, Stony Brook Medicine, Stony Brook, NY
| | - Patrick Jasinski
- Division of Vascular and Endovascular Surgery, Stony Brook Medicine, Stony Brook, NY
| | - Demetri Adrahtas
- Division of Vascular and Endovascular Surgery, Stony Brook Medicine, Stony Brook, NY
| | - Antonios Gasparis
- Division of Vascular and Endovascular Surgery, Stony Brook Medicine, Stony Brook, NY
| | - Nicos Labropoulos
- Division of Vascular and Endovascular Surgery, Stony Brook Medicine, Stony Brook, NY.
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Cimsit C, Yoldemir T, Tureli D, Aribal ME. Evaluation of sacroiliac joint MRI for pelvic venous congestion signs in women clinically suspected of sacroiliitis. Acta Radiol 2017; 58:849-855. [PMID: 27799571 DOI: 10.1177/0284185116675656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Pelvic congestion syndrome (PCS) is a commonly overlooked condition which is a potential cause of chronic pelvic pain. Magnetic resonance imaging (MRI) of the sacroiliac joint (SIJ) may demonstrate unexpected conditions that can mimic sacroiliitis (SI). Awareness of MRI-defined pelvic venous congestion (PVC) may help in identifying PCS, where vascular abnormality may be the sole manifestation of SIJ pain. Purpose To detect incidental MRI-defined PVC in patients who underwent SIJ-MRI for presumed SI and define the variance of its incidence. Material and Methods A total of 870 women who underwent SIJ-MRI were retrospectively evaluated. Incidental findings of PVC and other genitourinary and musculoskeletal system disorders were documented. Results Of the 774 included patients, 37% demonstrated incidentally detected imaging findings related to the genitourinary system, musculoskeletal system, and PVC. The prevalence of MRI-defined PVC signs was higher in patients without SI than with SI. The prevalence of musculoskeletal disorders was higher in patients with SI whereas prevalence for genitourinary disorders was similar. Binary logistic regression analysis revealed a statistically significant correlation between SI-PVC and SI-genitourinary disorders but not between SI-musculoskeletal disorders pairs ( P = 0.001, 0.001, and 0.057 > 0.05). The probability of observing SI in SIJ-MRI is positively correlated with the absence of PVC or genitourinary disorders. Conclusion Patients who underwent MRI for presumed SI demonstrated incidental PVC as well as other genitourinary and musculoskeletal findings. An awareness of these imaging findings can help identify PVC and may draw clinicians' attention to the possibility of PCS.
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Affiliation(s)
- Canan Cimsit
- Department of Radiology, Marmara University Training and Research Hospital, Istanbul, Turkey
| | - Tevfik Yoldemir
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Derya Tureli
- Department of Radiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Erkin Aribal
- Department of Radiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
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Siqueira FM, Monsignore LM, Rosa-e-Silva JC, Poli-Neto OB, de Castro-Afonso LH, Nakiri GS, Muglia VF, Abud DG. Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome. Clinics (Sao Paulo) 2016; 71:703-708. [PMID: 28076514 PMCID: PMC5175291 DOI: 10.6061/clinics/2016(12)05] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/02/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES: To evaluate the clinical response and success rate after periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome and to report the safety of endovascular treatment and its rate of complications. METHODS: Retrospective cohort of patients undergoing endovascular treatment of pelvic congestion syndrome in our department from January 2012 to November 2015. Data were analyzed based on patient background, imaging findings, embolized veins, rate of complications, and clinical response as indicated by the visual analog pain scale. RESULTS: We performed periuterine varices embolization in 22 patients during the study, four of which required a second embolization. Seventeen patients reported a reduction in pelvic pain after the first embolization and three patients reported a reduction in pelvic pain after the second embolization. Minor complications were observed in our patients, such as postural hypotension, postoperative pain, and venous perforation during the procedure, without clinical repercussion. CONCLUSION: Periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome appears to be an effective and safe technique.
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Affiliation(s)
- Flavio Meirelles Siqueira
- Departamento de Medicina Interna, Divisão de Radiologia Intervencionista, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
| | - Lucas Moretti Monsignore
- Departamento de Medicina Interna, Divisão de Radiologia Intervencionista, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
| | - Julio Cesar Rosa-e-Silva
- Departamento de Ginecologia e Obstetricia, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
| | - Omero Benedicto Poli-Neto
- Departamento de Ginecologia e Obstetricia, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
| | - Luis Henrique de Castro-Afonso
- Departamento de Medicina Interna, Divisão de Radiologia Intervencionista, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
| | - Guilherme Seizem Nakiri
- Departamento de Medicina Interna, Divisão de Radiologia Intervencionista, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
| | - Valdair Francisco Muglia
- Departamento de Medicina Interna, Divisão de Radiologia, Ribeirão Preto/SP, Universidade de São Paulo, BrazilBrazil
| | - Daniel Giansante Abud
- Departamento de Medicina Interna, Divisão de Radiologia Intervencionista, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
- E-mail:
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Labropoulos N, Jasinski PT, Adrahtas D, Gasparis AP, Meissner MH. A standardized ultrasound approach to pelvic congestion syndrome. Phlebology 2016; 32:608-619. [PMID: 27799418 DOI: 10.1177/0268355516677135] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pelvic congestion syndrome is one of the many causes of chronic pelvic pain and is often diagnosed based on exclusion of other pathologies. Over the past decades, pelvic congestion syndrome was recognized to be a more common cause of chronic pelvic pain. Multiple diagnostic modalities including pelvic duplex ultrasonography, transvaginal ultrasonography, computed tomography, and magnetic resonance were studied. In the current literature, selective ovarian venography, an invasive imaging approach, is believed to be the gold standard for diagnosing pelvic congestion syndrome.
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Affiliation(s)
- Nicos Labropoulos
- 1 Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Patrick T Jasinski
- 1 Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Demetri Adrahtas
- 1 Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Antonios P Gasparis
- 1 Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Mark H Meissner
- 2 Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
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39
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Champaneria R, Shah L, Moss J, Gupta JK, Birch J, Middleton LJ, Daniels JP. The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness. Health Technol Assess 2016; 20:1-108. [PMID: 26789334 DOI: 10.3310/hta20050] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Pelvic congestion syndrome (PCS) is described as chronic pelvic pain (CPP) arising from dilated and refluxing pelvic veins, although the causal relationship between pelvic vein incompetence (PVI) and CPP is not established. Non-invasive screening methods such as Doppler ultrasound and magnetic resonance venography are used before confirmation by venography. Percutaneous embolisation has become the principal treatment for PCS, with high success rates often cited. OBJECTIVES Our proposal aimed to systematically and critically review the definitions and diagnostic criteria of PCS, the association between PVI and CPP, the accuracy of various non-invasive imaging techniques and the effectiveness of embolisation for PVI; and to identify factors associated with successful outcome. We also wished to survey clinicians and patients to assess awareness and management of PCS and gauge the enthusiasm for further research. DATA SOURCES A comprehensive search strategy encompassing various terms for pelvic congestion, pain, imaging techniques and embolisation was deployed in 17 bibliographic databases, including MEDLINE, EMBASE and Web of Science. There was no restriction on study design. METHODS Methodological quality was assessed using appropriate tools. Online surveys were sent to clinicians and patients. The quality and heterogeneity generally precluded meta-analysis and so results were tabulated and described narratively. RESULTS We identified six association studies, 10 studies involving ultrasound, two studies involving magnetic resonance venography, 21 case series and one poor-quality randomised trial of embolisation. There were no consistent diagnostic criteria for PCS. We found that the associations between CPP and PVI were generally fairly similar, with three of five studies with sufficient data showing statistically significant associations (odds ratios of between 31 and 117). The prevalence of PVI ranged widely, although the majority of women with PVI had CPP. Transvaginal ultrasound with Doppler and magnetic resonance venography are both useful screening methods, although the data on accuracy are limited. Early substantial relief from pain symptoms was observed in approximately 75% of women undergoing embolisation, a figure which generally increased over time and was sustained. Reintervention rates were generally low. Transient pain was a common occurrence following foam embolisation, while there was a < 2% risk of coil migration. Confidence in the embolisation technique is reasonably high, although there is a desire to strengthen the evidence base. Even among women with CPP, fewer than half had any knowledge about PCS. CONCLUSIONS The data supporting the diagnosis and treatment of PCS are limited and of variable methodological quality. There is some evidence to tentatively support a causative association, but it cannot be categorically stated that PVI is the cause of CPP in women with no other pathology, as the six most pertinent drew on clinically disparate populations and defined PVI inconsistently. Embolisation appears to provide symptomatic relief in the majority of women and is safe. However, the majority of included studies of embolism were relatively small case series and only the randomised controlled trial was considered at risk of potential biases. There is scope and demand for considerable further research. The question of the association of PVI and CPP requires a well-designed and well-powered case-control study, which will also provide data to derive a diagnostic standard. An adequately powered randomised trial is essential to provide evidence on the effectiveness of embolisation, but this faces methodological challenges. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002237 and CRD42012002238. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Rita Champaneria
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Laila Shah
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Jonathan Moss
- Department of Radiology, North Glasgow University Hospitals, Glasgow, UK
| | - Janesh K Gupta
- Institute of Metabolism and Systems Biology, University of Birmingham, Birmingham, UK
| | | | - Lee J Middleton
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Jane P Daniels
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Sugaya K, Nishijima S, Kadekawa K, Ashitomi K, Ueda T, Yamamoto H. Naftopidil improves locomotor activity and urinary frequency in rats with pelvic venous congestion. Biomed Res 2016; 37:221-6. [PMID: 27544997 DOI: 10.2220/biomedres.37.221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The α1D/A receptor antagonist, naftopidil, inhibits micturition reflex by acting on various different sites. We examined the effects of naftopidil on bladder activity and changes in the induced urinary frequency using female rats with pelvic venous congestion (PC). Twenty-four female rats were divided into sham, PC, and PC/naftopidil groups. After anesthetizing rats in the PC and PC/naftopidil groups, the bilateral common iliac veins and uterine veins were ligated. Rats in the sham and PC groups were fed a standard diet, while rats in the PC/naftopidil group were fed diets containing 0.04% naftopidil. After 4 weeks of treatment, locomotor activity, urinary nitric oxide metabolites (NOx), continuous cystometry, and plasma monoamine measurements were performed. PC rats exhibited a decrease of locomotor activity, a shorter interval between bladder contractions on continuous cystometry, and decreased urinary NOx and plasma serotonin levels than the sham rats. The PC/naftopidil rats exhibited an increase of locomotor activity, a longer interval between bladder contractions, and increased urinary NOx and plasma serotonin levels. Therefore, naftopidil might improve bladder dysfunction induced by pelvic venous congestion due to several actions in the central nervous system and bladder tissue, as well as acting as an α1 blocker to cause pelvic venous dilation.
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Sugaya K, Nishijima S, Kadekawa K, Ashitomi K, Ueda T, Yamamoto H. Effects of silodosin on bladder activity in rats with frequent urination induced by pelvic venous congestion. Int J Urol 2016; 23:881-887. [DOI: 10.1111/iju.13158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/05/2016] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | | | - Tomoyuki Ueda
- Faculty of Medicine; The Institute for Animal Experiments; University of the Ryukyus; Okinawa Japan
| | - Hideyuki Yamamoto
- Department of Biochemistry; Graduate School of Medicine; University of the Ryukyus; Okinawa Japan
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Mahmoud O, Vikatmaa P, Aho P, Halmesmäki K, Albäck A, Rahkola-Soisalo P, Lappalainen K, Venermo M. Efficacy of endovascular treatment for pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord 2016; 4:355-70. [DOI: 10.1016/j.jvsv.2016.01.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/10/2016] [Indexed: 11/30/2022]
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Pyra K, Woźniak S, Drelich-Zbroja A, Wolski A, Jargiełło T. Evaluation of Effectiveness of Embolization in Pelvic Congestion Syndrome with the New Vascular Occlusion Device (ArtVentive EOS™): Preliminary Results. Cardiovasc Intervent Radiol 2016; 39:1122-7. [PMID: 27250353 PMCID: PMC4923086 DOI: 10.1007/s00270-016-1380-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 05/08/2016] [Indexed: 02/05/2023]
Abstract
Purpose This study aimed to collect confirmatory data in support of the safety and efficiency of the ArtVentive EOS™ for the treatment of the pelvic congestion syndrome (PCS). This study was based on the OCCLUDE 1 Study Protocol approved by the Local Ethics Committee. Materials and Methods A prospective study carried out in June and July 2014 included 12 women aged 21–48 years (mean 31 years) scheduled for PCS embolization using the ArtVentive EOS™. The inclusion criteria were clinical symptoms of PCS documented by transvaginal Doppler ultrasound and pelvic MRI. The pelvic pain was assessed by VAS score from 0 to 10 (0 represents lack of pain and 10 unbearable pain). A decrease in pelvic pain intensity based on the VAS was considered a clinical success. Results Successful embolization procedures with ArtVentive EOS™ were performed in 11 out of 12 patients. Nine patients underwent unilateral embolization of the left ovarian vein, and two had bilateral embolization of the ovarian veins. Complete ovarian vein occlusion confirmed by post deployment venography was achieved in all 11 patients. Procedures lasted from 19 to 45 min (average 28 min). Pain intensity decrease was observed in all 11 patients—a decrease of 5.6 points—from 7.3 pre-procedure to 1.6 post-embolization (standard deviation: 0.67). In one case, the left ovarian vein was injured by guide wire manipulation with contrast extravasation—not clinically significant. Conclusions The use of ArtVentive EOS™ for occlusion of the ovarian veins in PCS patients is safe and effective.
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Affiliation(s)
- Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Street, 20-954, Lublin, Poland.
| | - Sławomir Woźniak
- III Gynecology Clinic, Medical University of Lublin, Jaczewskiego 8 Street, 20-954, Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Street, 20-954, Lublin, Poland
| | - Andrzej Wolski
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Street, 20-954, Lublin, Poland
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Street, 20-954, Lublin, Poland
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Lawson JA, Toonder IM. A review of a new Dutch guideline for management of recurrent varicose veins. Phlebology 2016; 31:114-24. [PMID: 26916778 DOI: 10.1177/0268355516631683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 2013, the new Dutch guideline for "Venous Pathology" was published. The guideline was a revision and update from the guideline "Diagnostics and Treatment of Varicose Veins" from 2009 and the guideline "Venous Ulcer" from 2005. A guideline for "Deep Venous Pathology" and one for "Compression Therapy" was added to the overall guideline "Venous Pathology." The chapter about treatment of recurrent varicose veins after initial intervention was recently updated in 2015 and is reviewed here. The Dutch term "recidief varices" or the French "récidive de varices" should be used analogous to the English term "recurrent varicose veins." The DCOP Guideline Development Group Neovarices concluded that "recidief" in Dutch actually suggests recurrence after apparent successful treatment and ignores the natural progression of venous disease in its own right. So the group opted to use the term "neovarices." In the Dutch guideline, neovarices is meant to be an all embracing term for recurrent varicose veins caused by technical or tactical failure, evolvement from residual refluxing veins or natural progression of varicose vein disease at different locations of the treated leg after intervention. This report reviews the most important issues in the treatment of varicose vein recurrence, and discusses conclusions and recommendations of the Dutch Neovarices Guideline Committee.
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Affiliation(s)
- James A Lawson
- Section of Phlebology and Vascular Surgery, Centrum Oosterwal, The Netherlands
| | - Irwin M Toonder
- Section of Phlebology and Vascular Surgery, Centrum Oosterwal, The Netherlands Department of Vascular Surgery, Maastricht University Medical Centre, The Netherlands
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Abstract
The treatment of acute deep vein thrombosis has developed significantly over the past few years, and catheter-directed thrombolysis is now widely accepted. Controversy still exists over the decision to treat residual or underlying lesions with a venous stent. Magnetic resonance techniques have evolved considerably, which together with intravenous ultrasound can provide a detailed assessment of the deep venous system. Nevertheless, there is still no single perfect imaging modality that can identify a functional stenosis in the venous system. The decision to proceed to stent placement following lysis is multifactorial, reliant on the use of a number of imaging modalities in combination but most importantly good clinical acumen and experience.
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Affiliation(s)
| | - Prakash Saha
- Department of Vascular Surgery, Guy's and St Thomas' Hospital, London, UK
| | - Stephen Black
- Department of Vascular Surgery, Guy's and St Thomas' Hospital, London, UK
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Borghi C, Dell’Atti L. Pelvic congestion syndrome: the current state of the literature. Arch Gynecol Obstet 2015; 293:291-301. [DOI: 10.1007/s00404-015-3895-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
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Dos Santos SJ, Holdstock JM, Harrison CC, Lopez AJ, Whiteley MS. Ovarian Vein Diameter Cannot Be Used as an Indicator of Ovarian Venous Reflux. Eur J Vasc Endovasc Surg 2015; 49:90-4. [PMID: 25457295 DOI: 10.1016/j.ejvs.2014.10.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/17/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Previous research into pelvic venous reflux has suggested that the size of the ovarian veins indicates the presence or absence of reflux. It is already known that vessel diameter is not an indicator of reflux in the great saphenous vein. However, to this day, physicians still use vein size to plan treatment of refluxing ovarian veins. The authors aimed to investigate whether or not vessel diameter can be used as an indicator of reflux in the ovarian veins. METHODS Nineteen female patients (mean 40.2 years, range 29-60) presenting to a specialist vein unit with leg varicose veins underwent duplex ultrasonography (DUS). All were found to have a significant pelvic contribution to their leg reflux on transvaginal duplex ultrasonography (TVS) and were referred to an interventional radiologist for treatment by transjugular coil embolization. During the procedure, the diameter of the ovarian veins was measured using digital subtraction venography. RESULTS Thirty-four ovarian veins were measured (17 right, 17 left) and of these 18 were found to be non-refluxing while 16 displayed reflux. The mean diameter of the non-refluxing veins was 7.2 mm (range 3-13 mm)and that of the refluxing veins was 8.5 mm (range 4-13 mm). This difference was found to be insignificant at a 95% confidence level (Student t test, p = .204). CONCLUSIONS There is no significant difference between the diameters of competent and refluxing ovarian veins and, as such, techniques that measure vein diameter may not be suitable for the diagnosis of venous reflux in the ovarian veins.
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Revisiting the role of MRI in gynecological emergencies – An institutional experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Massenburg BB, Himel HN, Blue RC, Marin ML, Faries PL, Ting W. Magnetic Resonance Imaging in Proximal Venous Outflow Obstruction. Ann Vasc Surg 2015; 29:1619-24. [PMID: 26315799 DOI: 10.1016/j.avsg.2015.06.083] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 06/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Proximal venous outflow obstruction (PVOO) in the abdomen and pelvis is increasingly recognized as an important contributor to venous disease of the lower extremity. There are currently no guidelines regarding a noninvasive screening tool for PVOO, although magnetic resonance venography (MRV) is commonly used in many practices. The objective of this study was to determine the value and utility of MRV in diagnosis and screening for PVOO. METHODS This retrospective study consisted of 46 consecutive patients, all of whom presented with signs and/or symptoms of PVOO and were evaluated with MRV followed by intravascular ultrasound (IVUS) and venography. Of these 46 patients suspected to have PVOO based on clinical evaluation, 24 patients had PVOO confirmed with IVUS and venography and PVOO was not observed on IVUS and venography in the remaining 22 patients. The MRV of these 46 patients was retrospectively reviewed in a blinded fashion and then correlated with IVUS and venography by 1 vascular surgeon. A scoring system was developed to define the types of radiography findings that were observed: normal, suspicious, and abnormal. RESULTS When compared with IVUS and multiplane venography, the interpretation of MRV had a sensitivity of 100% and a specificity of 22.7%. The positive predictive value of MRV was 58.5%, and the negative predictive value was 100%. CONCLUSIONS The high sensitivity (100%) and low specificity (22.7%) of MRV suggest that it can be a screening tool at best, used only to rule out PVOO; it cannot be used to confirm PVOO, given its a 41.5% false positive rate. Thus, the development of a different, noninvasive diagnostic test that can more accurately assess patients with suspected PVOO during the initial evaluation of their lower-extremity venous disease should be explored.
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Affiliation(s)
- Benjamin B Massenburg
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Harvey N Himel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert C Blue
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael L Marin
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter L Faries
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
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