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Hanna J, Bruinsma J, Temperley HC, Fernando D, O'Sullivan N, Hanna M, Brennan I, Ponosh S. Efficacy of embolotherapy for the treatment of pelvic congestion syndrome: A systematic review. Ir J Med Sci 2024; 193:1441-1451. [PMID: 38294607 PMCID: PMC11128397 DOI: 10.1007/s11845-024-03608-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
Pelvic congestion syndrome (PCS) poses a significant health, diagnostic, and economic challenges. Transcatheter embolisation has emerged as a promising treatment for PCS. A systematic review was performed in order to assess the safety and efficacy of transcatheter embolisation in the treatment of PCS. A systematic search of electronic databases was performed using 'PubMed', 'Embase', 'Medline (OVID)', and 'Web of Science', for articles pertaining to efficacy of embolotherapy for the treatment of pelvic congestion syndrome. A total of 25 studies were included in this systematic review with a combined total of 2038 patients. All patients included were female with a mean average age of 37.65 (31-51). Of the 25 studies, 18/25 studies reported pre- and post-procedural pelvic pain outcomes using a visual analogue scale (VAS). All studies showed a reduction in VAS post-procedure. Transcatheter embolisation had a high technical success rate (94%) and an overall complication rate of 9.0%, of which 10.4% were major and 89.6% were minor. Fifteen out of 19 (78.9%) major complications required a subsequent intervention. Transcatheter embolisation using various techniques is effective and safe in treating PCS. A low quality of evidence limits the currently available literature; however, embolisation has shown to improve symptoms in the majority of patients with low complication rates and recurrence rates.
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Affiliation(s)
- Joseph Hanna
- Department of Surgery, St. John of God Subiaco, Perth, WA, Australia
| | - Joshua Bruinsma
- Department of Surgery, St. John of God Subiaco, Perth, WA, Australia
| | | | | | | | - Mark Hanna
- Department of Surgery, St. John of God Subiaco, Perth, WA, Australia
| | - Ian Brennan
- Department of Radiology, St. James's Hospital, Dublin, Ireland
| | - Stefan Ponosh
- Department of Surgery, St. John of God Subiaco, Perth, WA, Australia
- Ponosh Vascular, Hollywood Consulting Centre, Perth, WA, Australia
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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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Kavallieros K, Pope T, Tan M, Kaur H, Gianesini S, Lazarashvili Z, Jaworucka-Kaczorowska A, Narayanan S, Gwozdz AM, Davies AH. Identification of outcomes in clinical studies for pelvic venous disorders. J Vasc Surg Venous Lymphat Disord 2024:101865. [PMID: 38452895 DOI: 10.1016/j.jvsv.2024.101865] [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: 11/20/2023] [Revised: 01/19/2024] [Accepted: 02/17/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE There is increasing recognition that health systems need to measure and improve the value of patient care by measuring outcomes. Chronic pelvic pain secondary to pelvic venous insufficiency can have a significant impact on the quality of life (QOL) of women affected. Despite growing recognition, pelvic venous disorders (PeVDs), an important cause of chronic pelvic pain, remain underdiagnosed. Developing a core outcome set (COS) for benchmarking care delivery enhances the standardization of care. However, there is no consensus regarding a standardized minimum set of outcomes for PeVD. We aimed to generate a list of outcomes reported in previous PeVD treatment studies to lay the foundation for developing a COS for PeVD. METHODS This scoping review was undertaken according to the PRISMA-ScR guidelines. Initially, screening, full-text review and extraction was conducted on studies published between 2018 and 2023. Subsequently, the search was expanded using 1-year intervals, until, over a 1-year interval, no new outcomes were recorded. Closely related outcomes were classified into domains, and domains into three core areas: disease-specific, treatment-related, and QOL-related outcomes. RESULTS Of the 1579 records identified, 51 publications were included. From these studies, 108 different outcomes were identified. The median number of outcomes per study was 8 (interquartile range, 6-13). Closely related outcomes were organized into 42 outcome domains, which were then categorized into 3 core outcome areas; 47.6% (20/42) were disease specific, 35.7% (15/42) treatment related, and 16.7% (7/42) were QOL related. Of the 51 included studies, disease-specific outcomes were identified in 96.1% of the studies (49/51), treatment-related outcomes in 94.1% (48/51), and QOL outcomes in only 13.7% (7/51). CONCLUSIONS There was significant heterogeneity in outcomes reported in PeVD studies. Most PeVD treatment studies evaluated disease-specific and treatment-related outcomes of PeVD, but few reported outcomes that measured the impact on QOL. These findings will inform the next steps in developing a COS for PeVD.
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Affiliation(s)
- Konstantinos Kavallieros
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tasneem Pope
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Matthew Tan
- Section of Vascular Surgery, Department of Surgery and Cancer, London, UK
| | - Harmeena Kaur
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sergio Gianesini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD
| | | | | | - Sriram Narayanan
- Venus Clinic and 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, UK.
| | - Alun H Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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De Gregorio MÁ, Yamamoto-Ramos M, Fredes A, Serrano-Casorran C, Sierre S, Ciampi-Dopazo JJ, Méndez S, Abadal JM, Urtiaga I, Bonastre C, Rodríguez J, Urbano J, Guirola JA. A Comparative Study of a Small Series of Patients (50 Patients) with Pelvic Varicose Veins Treated with Plugs Alone or Plugs and Polidocanol. J Clin Med 2023; 12:5408. [PMID: 37629450 PMCID: PMC10455180 DOI: 10.3390/jcm12165408] [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: 07/14/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
LEVEL OF EVIDENCE Level 2. PURPOSE To compare the safety and efficacy of vascular plug (VP) and vascular plug and polidocanol foam (VPPF) treatments for embolization in pelvic congestion syndrome (PCS). MATERIALS AND METHODS A comparative, prospective, two-center study enrolled 50 women with PCS from January 2019 to January 2020. The patients were divided into two groups, and embolization was performed with VP (n = 25) and VPPF (n = 25) treatments. The mean age of the patients was 45.6 years ± 6.9. Three clinical parameters were assessed: abdominal pain, dyspareunia, and lower limb pain. The primary outcome (clinical success at 1 yr using a VAS), number of devices, procedure and fluoroscopy times, radiation doses, costs, and complications were compared. The participants were followed-up at 1, 3, 6, and 12 months. RESULTS At the 1-year follow-up, clinical success did not significantly differ between the two groups (VP vs. VPPF) regarding the improvement of the symptoms analyzed (pelvic pain, dyspareunia, lower extremity pain, and other symptoms (p < 0.05)). The mean number of devices per case was 4 ± 1.1 for the VP group and 2 ± 0.31 for the VPPF group (p < 0.001). No major complications were recorded in either group. The VPPF group had a significantly longer fluoroscopy time (42.8 min ± 14.2 vs. 25.4 min ± 7) and longer radiation dose (VPPF air kerma 839.4 ± 513 vs. VP air kerma 658.4 mGy ± 355 (all p < 0.001)). CONCLUSIONS Embolization for PCS resulted in pain relief in 90% of patients; the use of polidocanol did not demonstrate changes in the clinical outcome. The use of a VP alone was associated with decreased fluoroscopy time and radiation dose.
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Affiliation(s)
- Miguel Ángel De Gregorio
- Minimally Invasive Techniques Research Group—GITMI, University of Zaragoza, Clínica Quirón, 50013 Zaragoza, Spain
| | - Masao Yamamoto-Ramos
- Interventional Radiology, Minimally Invasive Techniques Research Group—GITMI, Clínica Quirón, 50013 Zaragoza, Spain;
| | - Arturo Fredes
- Interventional Radiology, Clinica Quiron Salud Zaragoza, 50006 Zaragoza, Spain;
| | - Carolina Serrano-Casorran
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, 50013 Zaragoza, Spain; (C.S.-C.); (C.B.); (J.R.)
| | - Sergio Sierre
- Interventional Radiology, Hospital Universitario Austral, Buenos Aires B1629, Argentina;
| | | | - Santiago Méndez
- Interventional Radiology, Hospital Universitario Puerta de Hierro, 28222 Madrid, Spain
| | - Jose Maria Abadal
- EBIR Intereventional Radiology, Hospital Universitario Severo Ochoa, 28914 Madrid, Spain;
| | - Ignacio Urtiaga
- Vascular Surgery, Minimally Invasive Techniques Research Group (GITMI), 50013 Zaragoza, Spain;
| | - Cristina Bonastre
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, 50013 Zaragoza, Spain; (C.S.-C.); (C.B.); (J.R.)
| | - Jose Rodríguez
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, 50013 Zaragoza, Spain; (C.S.-C.); (C.B.); (J.R.)
| | - Jose Urbano
- Interventional Radiology, Minimally Invasive Techniques Research Group (GITMI), Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | - José Andrés Guirola
- Minimally Invasive Techniques Research Group (GITMI), Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, 50009 Zaragoza, Spain;
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Clark MR, Taylor AC. Pelvic Venous Disorders: An Update in Terminology, Diagnosis, and Treatment. Semin Intervent Radiol 2023; 40:362-371. [PMID: 37575340 PMCID: PMC10415053 DOI: 10.1055/s-0043-1771041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Pelvic venous disorder (PeVD) is a term that encompasses all the interrelated causes of chronic pelvic pain (CPP) and perineal/lower extremity varicose veins of pelvic venous origin historically known as nutcracker syndrome, pelvic congestion syndrome, and May-Thurner syndrome, resulting in a more precise diagnosis that accounts for the underlying pathophysiology and anatomy. PeVD manifests as CPP with associated vulvar and lower-extremity varicosities, left flank pain and hematuria, and lower extremity pain and swelling secondary to obstruction or reflux in the left renal, ovarian, or iliac veins. This article will focus specifically on the most current nomenclature, evaluation, and management of CPP of venous origin.
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Affiliation(s)
- Meghan R. Clark
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - Amy C. Taylor
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
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Matei SC, Dumitru CȘ, Oprițoiu AI, Marian L, Murariu MS, Olariu S. Female Gonadal Venous Insufficiency in a Clinical Presentation Which Suggested an Acute Abdomen-A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050884. [PMID: 37241116 DOI: 10.3390/medicina59050884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023]
Abstract
Pelvic venous insufficiency (PVI) is frequently associated with symptoms of abdominal pain or discomfort that is overlooked or under-diagnosed in women. Despite the fact that pelvic venous insufficiency in men is very well documented, its occurrence in women needs to be further studied. Patients with pelvic varicose veins undergo a long and inconclusive diagnostic work-up before the exact cause of the symptoms is identified. Gonadal venous insufficiency (GVI) is a condition that can present acutely, leading to diagnostic challenges. We present a case report of a 47-year-old female with acute abdominal pain and GVI, where endovascular embolization was used for successful treatment. The patient was diagnosed with GVI based on imaging findings of an enlarged left ovarian vein with retrograde flow and dilated pelvic veins seen on magnetic resonance imaging (MRI) with contrast material. Due to the severity of her symptoms and imaging findings, endovascular embolization was chosen as the treatment modality. The embolization was successful, and the patient's symptoms resolved completely. This case highlights the challenge of diagnosing GVI with acute clinical expression and the potential benefits of endovascular embolization as a treatment option. Further studies are needed to determine the optimal management strategies for acute GVI, but endovascular embolization should be considered a safe and effective option. At the same time, we present a short review of the recent literature data related to this topic.
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Affiliation(s)
- Sergiu-Ciprian Matei
- Abdominal Surgery and Phlebology Research Center, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- 1st Surgical Clinic, "Pius Brînzeu" Emergency County Hospital, Liviu Rebreanu Boulevard No. 156, 300723 Timișoara, Romania
| | - Cristina Ștefania Dumitru
- Department of Microscopic Morphology/Histology, Angiogenesis Research Center, "Victor Babes" University of Medicine and Pharmacy, Sq. Eftimie Murgu No. 2, 300041 Timișoara, Romania
| | - Andrei-Ion Oprițoiu
- 1st Surgical Clinic, "Pius Brînzeu" Emergency County Hospital, Liviu Rebreanu Boulevard No. 156, 300723 Timișoara, Romania
| | - Lucian Marian
- Urology Clinic, "Pius Brînzeu" Emergency County Hospital, Liviu Rebreanu Boulevard No. 156, 300723 Timișoara, Romania
| | - Marius-Sorin Murariu
- Abdominal Surgery and Phlebology Research Center, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- 1st Surgical Clinic, "Pius Brînzeu" Emergency County Hospital, Liviu Rebreanu Boulevard No. 156, 300723 Timișoara, Romania
| | - Sorin Olariu
- Abdominal Surgery and Phlebology Research Center, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- 1st Surgical Clinic, "Pius Brînzeu" Emergency County Hospital, Liviu Rebreanu Boulevard No. 156, 300723 Timișoara, Romania
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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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