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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Knuttinen MG, Machan L, Khilnani NM, Louie M, Caridi TM, Gupta R, Winokur RS. Diagnosis and Management of Pelvic Venous Disorders: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:565-574. [PMID: 37095667 DOI: 10.2214/ajr.22.28796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Pelvic venous disorders (PeVD), previously known by various imprecise terms including pelvic congestion syndrome, have historically been underdiagnosed as a cause of chronic pelvic pain (CPP), a significant health problem associated with reduced quality of life. However, progress in the field has helped to provide heightened clarity with respect to definitions relating to PeVD, and evolution in algorithms for PeVD workup and treatment has been accompanied by new insights into the causes of a pelvic venous reservoir and associated symptoms. Ovarian and pelvic vein embolization, as well as endovascular stenting of common iliac vein compression, should be considered as management options for PeVD. Both treatments have been shown to be safe and effective for patients with CPP of venous origin, regardless of age. Current therapeutic protocols for PeVD exhibit significant heterogeneity owing to limited prospective randomized data and evolving understanding of the factors driving successful outcomes; forthcoming clinical trials are anticipated to improve understanding of CPP of venous origin as well as algorithms for PeVD management. This Expert Panel Narrative Review provides a contemporary update relating to PeVD, summarizing the entity's current classification, diagnostic workup, endovascular treatments, management of persistent or recurrent symptoms, and future research directions.
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Affiliation(s)
- M-Grace Knuttinen
- Department of Radiology, Division of Interventional Radiology, Mayo Clinic Arizona, 5777 Mayo Blvd, Phoenix, AZ 85255
| | - Lindsay Machan
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Neil M Khilnani
- Department of Radiology, Weill Cornell Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY
| | - Michelle Louie
- Department of Medical and Surgical Gynecology, Mayo Clinic Arizona, Phoenix, AZ
| | - Theresa M Caridi
- Department of Radiology, Division of Interventional Radiology, UAB Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Ramona Gupta
- Department of Radiology, Division of Vascular and Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ronald S Winokur
- Department of Radiology, Weill Cornell Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY
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Emad El Din M, Soliman M, El Kiran Y, Regal S, Youssef H, Elwakeel H, Soliman R. Ovarian vein surgical ablation versus endovascular technique for treatment of pelvic vein incompetence. J Vasc Surg Venous Lymphat Disord 2023; 11:801-808. [PMID: 37003463 DOI: 10.1016/j.jvsv.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/01/2022] [Accepted: 10/16/2022] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Chronic pelvic pain in women is a disorder brought on by pelvic vein incompetence (PVI). In this prospective, randomized study, the effects of percutaneous coil embolization and surgical ovarian vein ligation and division combined with retrograde sclerotherapy were compared with regard to ovarian vein occlusion, improvement of pelvic congestion symptoms, and their influence on estradiol level after intervention. METHODS A total of 50 patients with PVI were enrolled, with a mean age of 31.9 ± 4.7 years and a pain score of 9 (range, 0-10; from 0 [no pain] to 10 [the highest level of pain]). Both percutaneous coil embolization of ovarian veins (endovascular group) and surgical ovarian vein ablation with retrograde sclerotherapy were offered to the patients at random. RESULTS In the open group, the pain level decreased to 2, whereas in the endovascular group, it decreased to 1 (range, 0-10). Estradiol levels were 224 (range, 9-612) in the open group and 478 (range, 18-613) in the endovascular group before the intervention, with no significant change (P = .1120). After 1 week of intervention, estradiol levels in the open group were 89 (range, 18-243) and 124 (range, 22-298) in the endovascular group, respectively, with statistical insignificance (P = .225). After 1 month of intervention, the endovascular group's estradiol level was 101 (range, 20-196) and the open group's was 89 (range, 15-190) (P = .382). After 3 months of intervention, the open group's estradiol level was 78 (range, 12-132) and the endovascular group's was 65 (range, 18-110) (P = .045). CONCLUSIONS In addressing PVI, both methods seemed to have promising results. Nevertheless, endovascular management was more effective at decreasing estrogen levels and relieving discomfort. Three months should be the time at which estradiol levels are measured, because this is when they are at their lowest. In both the open and endovascular groups as well as in the pooled data, there was a significant association between estradiol level from before the intervention and improvement in pain scores (P = .005). Because it was linked to a lower pain score, the high preoperative estradiol level can be used to predict postintervention improvement.
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Affiliation(s)
| | - Mosaad Soliman
- Vascular Surgery Department, Mansoura Faculty of Medicine, Mansoura, Egypt.
| | - Yasser El Kiran
- Vascular Surgery Department, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Samer Regal
- Vascular Surgery Department, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Hamed Youssef
- Obstetrics and Gynecology Department, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Hossam Elwakeel
- Vascular Surgery Department, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Reem Soliman
- Vascular Surgery Department, Mansoura Faculty of Medicine, Mansoura, Egypt
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Shahat M, Hussein RS, Ahmed AKS. Foam Sclerotherapy in Pelvic Congestion Syndrome. Vasc Endovascular Surg 2023:15385744231154332. [PMID: 36692078 DOI: 10.1177/15385744231154332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Chronic pelvic pain (CPP) is a prevalent condition in middle-aged women that represents a heavy social impact on the quality of life of those females. Treatment of pelvic congestion syndrome is a complex and controversial issue, but treatment can be one of 3 lines: medical therapy, endovascular treatment, and surgical intervention. The endovascular line was first introduced in 1993 and has been popular over other lines of treatment methods. This retrospective study was conducted in a tertiary university hospital over 24 months, from March 2019 to March 2021. Forty patients with PGS were managed by left ovarian vein TCFS. The Institutional Review Board waived the need for ethics approval or informed consent to use anonymized and retrospectively analyzed data. The mean age of enrolled women was 33.80 ± 6.54 years, ranging between 20 and 45 years. Trans-catheter ethanolamine foam embolization is an effective and safe method to treat pelvic and atypical lower limb varices.
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Affiliation(s)
- Mohammed Shahat
- Lecturer of Vascular Surgery, Faculty of Medicine, 2068797Assiut University, Assiut, Egypt
| | - Reda S Hussein
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
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Valero I, Garcia-jimenez R, Valdevieso P, Garcia-mejido JA, Gonzalez-herráez JV, Pelayo-delgado I, Fernandez-palacin A, Sainz-bueno JA. Identification of Pelvic Congestion Syndrome Using Transvaginal Ultrasonography. A Useful Tool. Tomography 2022; 8:89-99. [PMID: 35076614 PMCID: PMC8788446 DOI: 10.3390/tomography8010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 11/18/2022] Open
Abstract
The gold standard for the diagnosis of pelvic congestion syndrome (PCS) is venography (VG), although transvaginal ultrasound (TVU) might be a noninvasive, nonionizing alternative. Our aim is to determine whether TVU is an accurate and comparable diagnostic tool for PCS. An observational prospective study including 67 patients was carried out. A TVU was performed on patients, measuring pelvic venous vessels parameters. Subsequentially, a VG was performed, and results were compared for the test calibration of TVU. Out of the 67 patients included, only 51 completed the study and were distributed in two groups according to VG results: 39 patients belonging to the PCS group and 12 to the normal group. PCS patients had a larger venous plexus diameter (15.1 mm vs. 12 mm; p = 0.009) and higher rates of crossing veins in the myometrium (74.35% vs. 33.3%; p = 0.009), reverse or altered flow during Valsalva (58.9% vs. 25%; p = 0.04), and largest pelvic vein ≥ 8 mm (92.3% vs. 25%). The sensitivity and specificity of TVU were 92.3% (95% CI: 78.03–97.99%) and 75% (95% CI: 42.84–93.31%), respectively. In conclusion, transvaginal ultrasonography, with the described methodology, appears to be a promising tool for the diagnosis of PCS, with acceptable sensitivity and specificity.
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Kaufman C, Little NA. Pelvic Congestion Syndrome: A Missed Opportunity. Indian J Radiol Imaging 2021; 31:539-544. [PMID: 34790295 PMCID: PMC8590552 DOI: 10.1055/s-0041-1735497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background/Aims Chronic pelvic pain (CPP) is pelvic pain for greater than 6 months with many potential causes one being pelvic congestion syndrome (PCS). PCS is diagnosed by clinical symptoms, exclusion of other etiologies, and imaging. Given the complex nature and diagnosis of CPP, we examined ordering and referral patterns in our local population to understand how the imaging findings of PCS correlate with patient symptoms and referral and treatment. Materials and Methods After IRB approval, we searched all 18 to 70-year-old females with CT of the pelvis between March 2015 and March 2018 with the terms "pelvic" plus "congestion," "varices," or "vein dilation" in the dictation. Via electronic medical record and image review we collected data regarding demographics, clinical presentation, symptoms, imaging findings, ordering provider, and any follow-up/referrals or interventions regarding PCS. Results A total of 96 patients were included of the 197 studies, with an average age of 47 years and average body mass index of 19.3 ( n = 93) at the time of imaging. The reason for imaging was often acute abdominal or flank pain ( n = 22) with 38% of cases ordered from the emergency room. Only 72 patients had documentation of clinical evaluation for symptoms of PCS. Notably, only 20 were referred for their symptoms, and only two patients were referred to IR. Both patients underwent successful endovascular intervention. Conclusion CPP is a common cause of morbidity with PCS representing an underdiagnosed cause. We demonstrate that while imaging findings may be incidental, we are failing to capture and triage patients with clinical symptoms of PCS. Radiologists can play a key role in the care of these patients.
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Affiliation(s)
- Claire Kaufman
- Department of Radiology, University of Utah, Salt Lake City, Utah, United States
| | - Nancy Ann Little
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, United States
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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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Tiralongo F, Distefano G, Palermo M, Granata A, Giurazza F, Vacirca F, Palmucci S, Venturini M, Basile A. Liquid and Solid Embolic Agents in Gonadal Veins. J Clin Med 2021; 10:1596. [PMID: 33918908 DOI: 10.3390/jcm10081596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 12/05/2022] Open
Abstract
Male varicocele and pelvic congestion syndrome (PCS) are common pathologies with high predominance in young patients, having a high impact on the quality of life and infertility. Lately, the use of different endovascular embolization techniques, with various embolizing agents, shows good technical results and clinical outcomes. With the aim of presenting the “state of the art” of endovascular techniques for the treatment of male varicocele and PCS, and to discuss the performance of the different embolic agents proposed, we conducted an extensive analysis of the relevant literature and we reported and discussed the results of original studies and previous meta-analyses, providing an updated guide on this topic to clinicians and interventional radiologists. We have also underlined the technical aspects for the benefit of those who approach this type of interventional treatment. Our review suggests promising results in both the endovascular embolic treatment of male varicocele and PCS; for varicocele, a success rate of between 70% and 100% and a recurrence rate of up to 16% is reported, while for PCS it has been found that technical success is achieved in almost all cases of endovascular treatment, with a highly variable recurrence rate based on reports. Complications are overall rather rare and are represented by periprocedural pain, migration of embolic media and vascular perforations: severe adverse events have been reported very rarely.
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Gavrilov SG, Vasilyev AV, Krasavin GV, Moskalenko YP, Mishakina NY. Endovascular interventions in the treatment of pelvic congestion syndrome caused by May-Thurner syndrome. J Vasc Surg Venous Lymphat Disord 2020; 8:1049-1057. [DOI: 10.1016/j.jvsv.2020.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/08/2020] [Indexed: 11/17/2022]
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Abstract
Pelvic congestion syndrome (PCS) is often an underdiagnosed cause of chronic pelvic pain in female patients with radiology detection of gonadal vein dilatation and parauterine varices. It may occur either alone or in combination with vulvar varicosities and/or lower extremity venous insufficiency. Although transcatheter venography represent the gold standard for PCS diagnosis, it is performed after inconclusive noninvasive imaging such as Doppler Ultrasound, CT scan, and MRI. Once diagnosis has been confirmed, management of PCS include medical, surgical, and endovascular therapy. Medical and surgical treatments have been shown to be less effective than transcatheter pelvic vein embolization. This latter has been proven to be a safe, effective, and durable therapy for the treatment of PCS. Numerous studies have shown their results in PCS endovascular treatment, but neither of them has been subjected to an adequate randomized controlled trial. A well-designed randomized controlled trial is urgently needed to assess transcatheter embolization clinical success.
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Affiliation(s)
- Antonio Basile
- Department of Medical and Surgical Sciences and Advanced Technologies, Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele," Catania, Italy
| | - Giovanni Failla
- Department of Medical and Surgical Sciences and Advanced Technologies, Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele," Catania, Italy.
| | - Cecilia Gozzo
- Department of Medical and Surgical Sciences and Advanced Technologies, Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele," Catania, Italy
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Antignani PL, Lazarashvili Z, Monedero JL, Ezpeleta SZ, Whiteley MS, Khilnani NM, Meissner MH, Wittens CH, Kurstjens RL, Belova L, Bokuchava M, Elkashishi WT, Jeanneret-Gris C, Geroulakos G, Gianesini S, de Graaf R, Krzanowski M, Al Tarazi L, Tessari L, Wikkeling M. Diagnosis and treatment of pelvic congestion syndrome: UIP consensus document. INT ANGIOL 2019; 38:265-283. [PMID: 31345010 DOI: 10.23736/s0392-9590.19.04237-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | | | - Javier L Monedero
- Unity of Vascular Pathology, Ruber Internacional Hospital, Madrid, Spain
| | - Santiago Z Ezpeleta
- Unity of Radiology for Vascular Diseases, Ruber Internacional Hospital, Madrid, Spain
| | | | - Neil M Khilnani
- Division of Interventional Radiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Mark H Meissner
- University of Washington School of Medicine, Seattle, WA, USA
| | - Cees H Wittens
- Department of Venous Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ralph L Kurstjens
- Department of Obstetrics and Gynecology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Ludmila Belova
- Faculty of Medicine, Ulyanovsk State University, Ulyanovsk, Russia
| | - Mamuka Bokuchava
- Tbilisi State Medical University, N. Bokhua Memorial Cardiovascular Center, Tbilisi, Georgia
| | | | - Christina Jeanneret-Gris
- Department of Angiology, University Clinic of Internal Medicine, KSBL Bruderholz, Baselland, Switzerland
| | - George Geroulakos
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
| | | | - Rick de Graaf
- Clinic for Diagnostic and Interventional Radiology/Nuclear Medicine, Clinical Center of Friedrichshafen, Friedrichshafen, Germany
| | | | - Louay Al Tarazi
- Varicose Veins and Vascular Polyclinic (VVVC), Damascus, Syria
| | - Lorenzo Tessari
- Bassi-Tessari Foundation, Veins&Lymphatics Association ONLUS, Varese, Italy
| | - Marald Wikkeling
- Department of Vascular Surgery Heelkunde Friesland, Location MCL and Nij Smellinghe Hospital, Drachten, the Netherlands
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Almeida GRD, Silvinato A, Simões RS, Buzzini RF, Bernardo WM. Pelvic congestion syndrome - treatment with pelvic varicose veins embolization. Rev Assoc Med Bras (1992) 2019; 65:518-523. [DOI: 10.1590/1806-9282.65.4.518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2018] [Indexed: 11/22/2022] Open
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Aikimbaev K, Balli T, Akgul E, Aksungur E. Ovarian vein diameters measured by MDCT in women without evidence of pelvic congestion syndrome. HVT 2017. [DOI: 10.24969/hvt.2017.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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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: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/10/2016] [Indexed: 11/30/2022]
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
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17
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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: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Galego GDN, Silveira PG, Bortoluzzi CT, Franklin RN, Ronchi TM. Síndrome da Congestão Venosa Pélvica e resultados do tratamento endovascular: série de casos. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ResumoA Síndrome da Congestão Venosa Pélvica (SCVP) é uma causa de dor pélvica crônica, que afeta principalmente mulheres multíparas em idade reprodutiva. Para o tratamento desta síndrome, a embolização de varizes pélvicas tem demonstrado excelentes resultados. Relatamos uma série inicial de pacientes submetidas a tratamento com embolização de varizes pélvicas e os respectivos resultados de acompanhamento pós-operatório. São apresentados dados clínicos, detalhes do procedimento e resultados do acompanhamento e de exames de imagem de seis pacientes. Dentre estas pacientes, o sucesso técnico foi de 100% e não houve relato de complicações trans ou pós-operatórias graves. Em todos os casos, pôde-se observar alívio dos sintomas e melhora nos resultados de exames de imagens no acompanhamento de curto prazo. Os resultados nesta pequena série de casos indicam que a embolização é um tratamento seguro e efetivo para a SCVP.
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Phillips D, Deipolyi AR, Hesketh RL, Midia M, Oklu R. Pelvic congestion syndrome: etiology of pain, diagnosis, and clinical management. J Vasc Interv Radiol 2014; 25:725-33. [PMID: 24745902 DOI: 10.1016/j.jvir.2014.01.030] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 01/14/2014] [Accepted: 01/24/2014] [Indexed: 02/06/2023] Open
Abstract
Pelvic congestion syndrome is associated with pelvic varicosities that result in chronic pelvic pain, especially in the setting of prolonged standing, coitus, menstruation, and pregnancy. Although the underlying pathophysiology of pelvic congestion syndrome is unclear, it probably results from a combination of dysfunctional venous valves, retrograde blood flow, venous hypertension, and dilatation. Asymptomatic women may also have pelvic varicosities, making pelvic congestion syndrome difficult to diagnose. This article explores the etiologies of pain, use of imaging techniques, and clinical management of pelvic congestion syndrome. Possible explanations for the spectrum of pain among women with pelvic varicosities are also discussed.
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Affiliation(s)
- Darci Phillips
- Harvard Medical School, and Department of Imaging, Massachusetts General Hospital, 55 Fruit Street, 290 Gray/Bigelow, Boston, MA 02114
| | - Amy R Deipolyi
- Harvard Medical School, and Department of Imaging, Massachusetts General Hospital, 55 Fruit Street, 290 Gray/Bigelow, Boston, MA 02114; Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, 290 Gray/Bigelow, Boston, MA 02114
| | | | - Mehran Midia
- Division of Interventional Radiology, McMaster University Medical Center, Hamilton, Ontario, Canada
| | - Rahmi Oklu
- Harvard Medical School, and Department of Imaging, Massachusetts General Hospital, 55 Fruit Street, 290 Gray/Bigelow, Boston, MA 02114; Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, 290 Gray/Bigelow, Boston, MA 02114.
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Whiteley MS, Dos Santos SJ, Harrison CC, Holdstock JM, Lopez AJ. Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women. Phlebology 2014; 30:706-13. [PMID: 25324278 DOI: 10.1177/0268355514554638] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To assess the suitability of transvaginal duplex ultrasonography to identify pathological reflux in the ovarian and internal iliac veins in women. METHODS A retrospective study of patients treated in 2011 and 2012 was performed in a specialised vein clinic. Diagnostic transvaginal duplex ultrasonography in women presenting with symptoms or signs of pelvic vein reflux were compared with the outcomes of treatment from pelvic vein embolisation. A repeat transvaginal duplex ultrasonography was performed 6 weeks later by a blinded observer and any residual reflux was identified. RESULTS Results from 100 sequential patients were analysed. Mean age 44.2 years (32-69) with mode average parity of 3 (0-5 deliveries). Pre-treatment, 289/400 veins were refluxing (ovarian - 29 right, 81 left; internal iliac - 93 right, 86 left). Coil embolisation was successful in 86/100 patients and failed partially in 14/100 - 5 due to failure to cannulate the target vein. One false-positive diagnosis was made. CONCLUSION Currently there is no accepted gold standard for pelvic vein incompetence. Comparing transvaginal duplex ultrasonography with the outcome from selectively treating the veins identified as having pathological reflux with coil embolisation, there were no false-negative diagnoses and only one false-positive. This study suggests that transvaginal duplex ultrasonography could be the gold standard in assessing pelvic vein reflux.
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Affiliation(s)
- M S Whiteley
- The Whiteley Clinic, Stirling House, Guildford, Surrey, UK Faculty of Health and Medical Sciences, University of Surrey, UK
| | - S J Dos Santos
- The Whiteley Clinic, Stirling House, Guildford, Surrey, UK Faculty of Health and Medical Sciences, University of Surrey, UK
| | - C C Harrison
- The Whiteley Clinic, Stirling House, Guildford, Surrey, UK
| | - J M Holdstock
- The Whiteley Clinic, Stirling House, Guildford, Surrey, UK
| | - A J Lopez
- The Imaging Clinic, Mount Alvernia Hospital, London, UK
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Edo Prades M, Ferrer Puchol M, Esteban Hernández E, Ferrero Asensi M. Pelvic congestion syndrome: Outcome after embolization with coils. Radiología (English Edition) 2014. [DOI: 10.1016/j.rxeng.2014.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cho SJ, Lee TH, Shim KY, Hong SS, Goo DE. Pelvic congestion syndrome diagnosed using endoscopic ultrasonography. Phlebology 2014; 29:126-8. [PMID: 24618909 DOI: 10.1258/phleb.2012.012067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pelvic congestion syndrome (PCS) presents with a non-cyclic pelvic pain lasting more than six months in duration in premenopausal women. Pelvic ultrasonography or computed tomography is usually the first imaging modality used to evaluate patients with suspected PCS. PCS is confirmed by visible congestion of the pelvic veins on selective ovarian venography. To our knowledge, the role of endoscopic ultrasonography (EUS) has not been reported. EUS showed multiple dilated structures especially on left side around the uterus and ovaries, which are compatible with other radiological investigations of PCS Although PCS is not typical areas within the scope of practice of endosonographers, it is useful to be familiar with the findings. We report a case of PCS that was diagnosed with the aid of EUS.
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Affiliation(s)
- S J Cho
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Hospital
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Shelkey J, Huang C, Karpa K, Singh H, Silvis M. Case report: pelvic congestion syndrome as an unusual etiology for chronic hip pain in 2 active, middle-age women. Sports Health 2014; 6:145-8. [PMID: 24587865 PMCID: PMC3931334 DOI: 10.1177/1941738113481940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: The past 2 decades have shown a dramatic increase in the number of pelvic and hip injuries in female athletes. Accurate diagnosis of hip pain in active women has proven to be a challenge, as there is an extensive differential including both musculoskeletal and visceral problems. While the incidence of pelvic congestion syndrome (PCS) is not known, this condition may manifest as chronic hip pain in this patient population. Evidence Acquisition: A PubMed search was undertaken for articles published in English from 1980 to 2012. Additional references were accrued from reference lists of research articles. Study Design: Case series. Level of Evidence: Level 3. Results: Diagnosis was established using magnetic resonance imaging. Both women were evaluated and treated by interventional radiology with gonadal vein embolization. Initial evaluation and subsequent follow-up was completed in the Sports Medicine Clinic to monitor chronic hip pain symptoms. Both patients experienced significant alleviation of chronic hip pain symptoms within several months after gonadal vein embolization, allowing for a return to the previous level of activity. Conclusion: Although PCS most commonly presents as pelvic pain, it is important to consider this condition in athletes with persistent hip pain. PCS may also present with the primary symptom of hip pain as in the 2 case reports described. With more awareness of this condition and appropriate diagnosis, PCS as an unusual etiology of chronic hip pain may be effectively treated with gonadal vein embolization.
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Affiliation(s)
- Julia Shelkey
- Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Kelly Karpa
- Department of Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Harjit Singh
- Departments of Cardiovascular and Interventional Radiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Matthew Silvis
- Departments of Family and Community Medicine & Orthopedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Huang C, Shelkey J, Singh H, Silvis M. Chronic hip pain as a presenting symptom in pelvic congestion syndrome. J Vasc Interv Radiol 2013; 24:753-5. [PMID: 23622048 DOI: 10.1016/j.jvir.2013.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/28/2012] [Accepted: 01/03/2013] [Indexed: 10/26/2022] Open
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Kim DW, Kim MH, Kim WH, Kim CG. Pelvic Congestion Syndrome Initially Detected by Contrast-Enhanced F-18 FDG-PET/CT. Nucl Med Mol Imaging 2013; 47:65-6. [DOI: 10.1007/s13139-012-0177-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 09/17/2012] [Accepted: 09/18/2012] [Indexed: 11/29/2022] Open
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Abstract
Background: The precise aetiology of pelvic congestion syndrome (PCS) remains poorly understood but is believed to be multifactorial having mechanical, hormonal and psychological components. Materials and methods: Minimally invasive techniques of embolisation or sclerotherapy of the ovarian veins has become the mainstay of treatment for PCS. Studies report a technical success rates from 89-100% and clinical success rates of 58-100%. Conclusions: Embolisation and sclerotherapy can be done as a day surgery procedure concurrently with diagnostic venography and given current evidence provide better long term pain relief than medical therapy.
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Affiliation(s)
- Meiri Robertson
- Fetal Medicine Unit Canberra Hospital Woden Australian Capital Territory Australia
| | - Ruth McCuaig
- Fetal Medicine Unit Canberra Hospital Woden Australian Capital Territory Australia
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van der Vleuten CJM, van Kempen JAL, Schultze-Kool LJ. Embolization to treat pelvic congestion syndrome and vulval varicose veins. Int J Gynaecol Obstet 2012; 118:227-30. [PMID: 22727416 DOI: 10.1016/j.ijgo.2012.04.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 04/13/2012] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the efficacy of embolization for treating the symptoms of pelvic congestion syndrome (PCS). METHODS Twenty-one women with PCS who were treated with embolization at Radboud University Nijmegen Medical Centre between 2003 and 2008 were sent a questionnaire about their symptoms before embolization, 2 months after the first embolization, and at the time the survey was conducted. RESULTS All patients completed the questionnaire. Two months after the first embolization, 14 (66.7%) women had some degree of improvement of symptoms. Nine (42.9%) patients underwent a second embolization. At the time the survey was conducted, 16 (76.2%) patients had some degree of improvement of symptoms. In addition to improvements in varicose veins and pelvic pain, there was improvement of hemorrhoids. CONCLUSION Embolization of pelvic varicosities may be an effective treatment in a well-selected group of patients with PCS. If there is no improvement of symptoms after initial embolization, a second procedure is unlikely to be effective.
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Edo Prades MA, Ferrer Puchol MD, Esteban Hernández E, Ferrero Asensi M. [Pelvic congestion syndrome: outcome after embolization with coils]. Radiologia 2012; 56:235-40. [PMID: 22633116 DOI: 10.1016/j.rx.2012.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 01/08/2012] [Accepted: 01/14/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To study the clinical manifestations and findings at venography in patients with pelvic congestion syndrome and to evaluate the outcome after percutaneous embolization using coils. MATERIALS AND METHODS We studied 34 women referred to the vascular radiology unit from the vascular surgery department for clinical suspicion of pelvic congestion syndrome. All patients underwent venography to assess the competence of the ovarian veins and to detect other varicose pelvic veins. When pelvic varicose veins were detected, they were embolized with coils. Clinical outcomes were recorded after reviewing the clinical history and administering a questionnaire over the phone. RESULTS In 22 of the 34 patients, signs of pelvic venous insufficiency were found. The symptoms were mainly pelvic and perineal heaviness (20/22) and pelvic pain (18/22). The technical success of venography and embolization was 100%, with three minor complications that did not require hospitalization. Pelvic heaviness improved in 14 patients (in 13 it was completely eliminated). Pain disappeared in 11 patients and was partially alleviated in another 2. CONCLUSION In patients with pelvic congestion syndrome, the embolization of insufficient pelvic veins achieves clinical improvement with short hospital stays and few complications.
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Affiliation(s)
- M A Edo Prades
- Sección de Radiología Vascular e Intervencionista, Hospital Universitario de la Ribera. Alzira, Valencia, España.
| | - M D Ferrer Puchol
- Sección de Radiología Vascular e Intervencionista, Hospital Universitario de la Ribera. Alzira, Valencia, España
| | - E Esteban Hernández
- Sección de Radiología Vascular e Intervencionista, Hospital Universitario de la Ribera. Alzira, Valencia, España
| | - M Ferrero Asensi
- Sección de Radiología Vascular e Intervencionista, Hospital Universitario de la Ribera. Alzira, Valencia, España
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Wassong C, Shah B, Kanayama M, Bjarnason H, Milla SS. Radiologic findings of pelvic venous congestion in an adolescent girl with angiographic confirmation and interventional treatment. Pediatr Radiol 2012; 42:636-40. [PMID: 21912968 DOI: 10.1007/s00247-011-2232-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 07/26/2011] [Indexed: 10/17/2022]
Abstract
We present a case of pelvic venous congestion in a 13-year-old girl who complained of pelvic pain for 9 months. The diagnosis of pelvic congestion syndrome was suggested by imaging modalities, including sonography, CT and MRI, with classically described imaging findings. The girl underwent diagnostic laparoscopy, where visual inspection demonstrated congested pelvic veins and endometriosis. After removal of endometrial implants, the child's pain persisted and she subsequently underwent venography and embolization of the ovarian veins. We found no literature describing pelvic venous congestion (PVC) in children. Knowledge that PVC exists in children is important, particularly for pediatric radiologists who are imaging patients with complaints of pelvic pain.
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Greiner M, Dadon M, Lemasle P, Cluzel P. How Does the Pathophysiology Influence the Treatment of Pelvic Congestion Syndrome and is the Result Long-lasting? Phlebology 2012; 27 Suppl 1:58-64. [DOI: 10.1258/phleb.2011.012s07] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objectives of this study are to consider the influence of pathophysiology in the treatment of pelvic congestion syndrome (PCS) and to determine the criteria which impact on the long-term results. A classification of venous pathology including three types of pathophysiological conditions, independent of the location of the pelvic venous pathology, is developed and illustrated. These types, diagnosed by cross-sectional imaging and confirmed by phlebography, are associated with a specific therapeutic plan. The long-term results are dependent on the quality of the initial Phlebographic mapping that must be selective and complete, the angiographic findings, in particular the study of collaterals feeding the venous anomalies, the treatment of all venous anomalies, the respect of contraindications, the use of appropriate materials and the occurrence of new pregnancies. In conclusion, the feasibility and satisfactory short-term results of endovascular treatment of PCS are admitted. Questions remain regarding the effectiveness of the different embolic agents and the long-term results of this treatment.
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Affiliation(s)
- M Greiner
- American Hospital of Paris, Unité de Pathologie Vasculaire 51, 92202 Neuilly Sur Seine Cedex
- Hôpital Pitié-Salpêtrière, Bâtiment Cœur, Service de Radiologie Vasculaire Interventionnelle, 47–83, Boulevard de l'Hôpital, 75651 Paris Cedex 13
| | - M Dadon
- American Hospital of Paris, Unité de Pathologie Vasculaire 51, 92202 Neuilly Sur Seine Cedex
- Hôpital Pitié-Salpêtrière, Bâtiment Cœur, Service de Radiologie Vasculaire Interventionnelle, 47–83, Boulevard de l'Hôpital, 75651 Paris Cedex 13
| | - P Lemasle
- Centre d'Angiologie, 15 rue Pottier, 78150 LE Chesnay, France
| | - P Cluzel
- Hôpital Pitié-Salpêtrière, Bâtiment Cœur, Service de Radiologie Vasculaire Interventionnelle, 47–83, Boulevard de l'Hôpital, 75651 Paris Cedex 13
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