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Dewald CLA, Becker LS, Meyer BC. Interventional Therapy of Pelvic Venous Disorders (PeVD). ROFO-FORTSCHR RONTG 2024; 196:921-927. [PMID: 38373714 DOI: 10.1055/a-2229-4100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Pelvic venous disorders (PeVD) are an underdiagnosed cause of chronic pelvic pain in women. They are caused by venous insufficiency of the pelvic or ovarian veins, leading to the development of mainly periuterine and periovarian varices. It is a progressive disease if left untreated and can cause swelling, dyspareunia, dysmenorrhea, and other symptoms, some non-specific, that affect the patient's quality of life. Interventional therapies are a central component of the treatment of PeVD, with a variety of techniques available for both diagnosis and treatment. METHOD This review provides an overview of the pathophysiologic background, diagnosis, and, most importantly, interventional treatment options for PeVD. RESULTS There is a lack of standardized nomenclature and internationally accepted diagnostic criteria for PeVD as well as randomized controlled trials demonstrating clinical success. However, in clinical trials, endovascular therapy for PeVD has been shown to be safe and effective. This review presents the various interventional techniques for the treatment of PeVD, including embolization, stenting, and sclerotherapy. CONCLUSION The importance of PeVD is receiving growing recognition. Recent advances, such as the development of the Symptoms-Varices-Pathophysiology (SVP) classification, provide an impetus to standardize nomenclature and are the first step toward systematizing disease management. Interventional therapies provide a safe and tailored minimally invasive treatment option for patients with PeVD. KEY POINTS · Pelvic venous disorders are an underdiagnosed condition with frequently delayed diagnosis and debilitating symptoms.. · Until now, the PeVD nomenclature has been imprecise, with terms like May-Thurner syndrome/Nutcracker syndrome.. · Interventional approaches are effective and play a central role in PeVD treatment.. CITATION FORMAT · Dewald CL, Becker LS, Meyer BC. Interventional Therapy of Pelvic Venous Disorders (PeVD). Fortschr Röntgenstr 2024; 196: 921 - 927.
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Affiliation(s)
| | - Lena Sophie Becker
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Patel SE, Chesnut SR. Relationships Among Pelvic Congestion Syndrome Pain, Daily Activities, and Quality of Life. J Obstet Gynecol Neonatal Nurs 2024; 53:416-426. [PMID: 38599242 DOI: 10.1016/j.jogn.2024.03.002] [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: 12/30/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVE To examine women's experiences of pelvic congestion syndrome (PCS) pain. DESIGN Descriptive, cross-sectional. SETTING Online questionnaires in a Facebook PCS support group. PARTICIPANTS Convenience sample of 143 women who self-identified as being diagnosed with PCS. METHODS We recruited women through a social media support group and invited them to participate in a self-reported questionnaire. We collected demographic information and used the McGill Pain Questionnaire to elicit responses related to pain quality, pain intensity, quality of life, and satisfaction with health care. We analyzed data using descriptive statistics and correlation coefficients. RESULTS Respondents characterized their PCS pain as exhausting, stabbing, sharp, shooting, and tender. Respondents indicated that 19 of 24 daily activities increased PCS pain, whereas only 5 reduced PCS pain. Pain intensity was negatively related to the quality of life, health satisfaction, sleep, and sexual relationships. CONCLUSION Chronic pelvic pain from PCS severely affected quality of life among respondents. These findings suggest a difference in the presentation of PCS from historical pain depictions and further highlight the need to identify pain profiles to increase timely and precise diagnosis. Further research is needed to evaluate interventions to increase the quality of life for women with PCS.
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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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Szmygin M, Pyra K, Bèrczi V, Woźniak S, Światłowski Ł, Paszkowski T. Endovascular Treatment of Pelvic Venous Congestion Syndrome in Nulliparous Patients-Preliminary Results of 10 Years of Experience. Cardiovasc Intervent Radiol 2024; 47:822-828. [PMID: 38691123 PMCID: PMC11164802 DOI: 10.1007/s00270-024-03731-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE The aim of this article is to present our experience with minimally-invasive treatment for nulliparous patients with pelvic venous congestion syndrome (PVCS) with special attention to anatomical considerations, procedural and clinical outcome. MATERIALS AND METHODS In this retrospective, monocentric study, 21 patients with PVCS treated from January 2014 to June 2023 were included. The preprocedural imaging evaluation of PVCS was based on color Doppler ultrasound, contrast-enhanced CT and/or MRI. In all cases insufficient ovarian veins and/or internal iliac branches were occluded with coils and sclerosant. Procedural and clinical outcomes were measured 30 and 90 days after the procedure. RESULTS Average duration of pelvic pain was 44.8 ± 54.2 months (from 6 to 200) with the mean VAS-recorded pain intensity of 8.5 ± 1.1 (range from 7 to 10 where 0 was "no pain" and 10 "worst pain possible"). Most common symptoms included dysmenorrhea, dyspareunia and dysuria. Complete embolization was observed in in all cases. Targeted vessels included left ovarian vein (13/21, 62%), both ovarian veins (7/21, 33%) and left pudendal with left ovarian (1/21, 5%). Residual PVCS was noted in 1 patient. Mean VAS at 90-days after the procedure was 2.4 ± 1.4 (range from 0 to 6, p < 0.001). Nineteen patients (90%) were satisfied with the clinical outcome (13 "very satisfied", 6 "satisfied") and reported improvement in quality of life. Two patients (9.5%) reported to be "neutral" as the VAS reduction was less than 50%. CONCLUSION Our study confirms that endovascular coil embolization is safe and effective in treatment of nulliparous patients with PVCS that provides very high rate of clinical success and overall satisfaction.
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Affiliation(s)
- Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-954, Lublin, Poland.
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland.
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-954, Lublin, Poland
| | - Viktor Bèrczi
- Department of Radiology, Medical Imaging Clinic, Semmelweis University Budapest, Budapest, Hungary
| | - Sławomir Woźniak
- Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Łukasz Światłowski
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-954, Lublin, Poland
| | - Tomasz Paszkowski
- Department of Gynecology, Medical University of Lublin, Lublin, Poland
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Shreevastava AK, Das RS, Mishra A. Protean Drainage Patterns of the Left Renal Vein: A Cadaveric and Retrospective Clinical Study on the Surgical Implications and Technical Feasibility. Cureus 2024; 16:e63037. [PMID: 39050300 PMCID: PMC11268398 DOI: 10.7759/cureus.63037] [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] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The diverse drainage patterns of the left renal vein (LRV), often with asymptomatic congenital anomalies, present considerable challenges in renal and retroperitoneal surgical contexts. The potential for significant bleeding and subsequent renal compromise upon vascular injury highlights the need for increased surgical awareness. OBJECTIVE This study investigates the LRV's variable anatomical drainage patterns and morphometry. It also evaluates the embryological factors contributing to these variations and discusses their surgical implications and technical considerations. METHODS Anatomical dissections were conducted on 21 adult human cadavers within the Department of Anatomy. Concurrently, a retrospective analysis was conducted on 15 patients who underwent various retroperitoneal surgical interventions in the Urology Department. Demographic variables and intraoperative findings were recorded and analyzed. RESULTS Dissection analysis predominantly identified preaortic LRVs in 18 cadavers. Notable anatomical variations included a circumaortic left renal vein (CLRV), a delayed preaortic confluence of extrahilar duo LRVs, and an extrahilar tetramerous confluence with a retroiliac topography. The majority of LRVs usually end in the inferior vena cava. However, an extrahilar tetramerous variant had an unusual drainage pathway. Out of 15 cases, three (20%) had a retroaortic left renal vein (RLRV). One patient with a nonfunctioning kidney had type 1 RLRV, and another patient with pelvic ureteric junction obstruction had type 4 retroiliac left renal vein (RILRV). In both of these patients, symptoms were relieved after surgery. In a young patient with left varicocele and microscopic hematuria who had type 2 RLRV, symptoms resolved spontaneously after a few months. CONCLUSION A thorough understanding of the variable anatomical drainage patterns of the LRV is crucial for surgeons. Accurate preoperative identification can provide valuable insights, potentially leading to improved surgical outcomes in renal procedures.
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Affiliation(s)
| | - Rajat S Das
- Anatomy, All India Institute of Medical Sciences, Raebareli, Raebareli, IND
| | - Amit Mishra
- Urology, All India Institute of Medical Sciences, Raebareli, Raebareli, IND
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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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Bindlish S. Obesity, thrombosis, venous disease, lymphatic disease, and lipedema: An obesity medicine association (OMA) clinical practice statement (CPS) 2023. OBESITY PILLARS (ONLINE) 2023; 8:100092. [PMID: 38125656 PMCID: PMC10728709 DOI: 10.1016/j.obpill.2023.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 12/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians with an overview on obesity, thrombosis, venous disease, lymphatic disease, and lipedema. Methods The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results Topics in this CPS include obesity, thrombosis, venous disease, lymphatic disease, and lipedema. Obesity increases the risk of thrombosis and cardiovascular disease via fat mass and adiposopathic mechanisms. Treatment of thrombosis or thrombotic risk includes healthful nutrition, physical activity, and the requisite knowledge of how body weight affects anti-thrombotic medications. In addition to obesity-related thrombotic considerations of acute coronary syndrome and ischemic non-hemorrhagic stroke, this Clinical Practice Statement briefly reviews the diagnosis and management of clinically relevant presentations of deep vein thromboses, pulmonary embolism, chronic venous stasis, varicose veins, superficial thrombophlebitis, lipodermatosclerosis, corona phlebectatica, chronic thromboembolic pulmonary hypertension, iliofemoral venous obstruction, pelvic venous disorder, post-thrombotic syndrome, as well as lymphedema and lipedema - which should be included in the differential diagnosis of other edematous or enlargement disorders of the lower extremities. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on obesity, thrombosis, and venous/lymphatic disease is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity.
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Affiliation(s)
- Shagun Bindlish
- Adjunct Faculty Touro University, 7554 Dublin Blvd, Dublin, CA, USA
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Ozsvath K. Are patients excluded from insurance coverage for venous treatment based on gender? J Vasc Surg Venous Lymphat Disord 2023; 11:1087-1088. [PMID: 37737787 DOI: 10.1016/j.jvsv.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Kathleen Ozsvath
- Department of Surgery, Samaritan Hospital, St Peters Health Partners, Vascular Associates, Troy, NY.
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Wilczko J, Szary C, Bodziony A, Celejewski K, Swieczkowski-Feiz S, Napierala M, Plucinska D, Leszczynski J, Zawadzki M, Grzela T. May the Number of Pregnancies Predict the Progression and the Outcome of Venous Disease Treatment? Diagnostics (Basel) 2023; 13:2535. [PMID: 37568897 PMCID: PMC10417260 DOI: 10.3390/diagnostics13152535] [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: 06/28/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Pregnancy is a well-known risk factor for venous insufficiency. However, even nulliparous women experience venous problems. Therefore, we aimed to assess the possible associations between the number of pregnancies, veins condition and treatment outcome in women with venous disease. The retrospective assessment concerned data of 297 women with diagnosed venous insufficiency. Based on their pregnancy history, the patients' records were divided into: nulliparous women (15.5%), those after 1-2 term pregnancies (57.9%) and those after ≥3 pregnancies (26.6%). The analysis concerned data from the diagnostics of the abdominal/pelvic and leg veins and the treatment results expressed as a symptoms/satisfaction score. Most of the nulliparous women developed venous disease due to mild anatomic abnormalities of the abdominal/pelvic veins. They responded to treatment (mostly unilateral embolization) very well. In the second group, the majority of the combined venous abnormalities responded to treatment with significant improvement, even after embolization alone, although nearly two-thirds still required further leg treatment. The third group was comprised of more advanced cases; nearly 40% of them with recurrence. In order to improve their condition, three-fourths of the cases required sequential treatment in both the pelvic and leg veins compartments. In conclusion, the number of pregnancies is a potent modifying factor in the pathogenesis of venous disease, especially in multiparous women. Together with abnormal venous anatomy, it may determine the treatment outcome.
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Affiliation(s)
| | | | | | - Krzysztof Celejewski
- Clinic of Phlebology, 02-034 Warsaw, Poland
- Center of Biostructure Research and the Department of General, Endocrinological and Vascular Surgery, Central University Hospital, Medical University of Warsaw, 02-091 Warsaw, Poland
| | | | - Marcin Napierala
- Clinic of Phlebology, 02-034 Warsaw, Poland
- Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | | | - Jerzy Leszczynski
- Clinic of Phlebology, 02-034 Warsaw, Poland
- Center of Biostructure Research and the Department of General, Endocrinological and Vascular Surgery, Central University Hospital, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Michal Zawadzki
- Clinic of Phlebology, 02-034 Warsaw, Poland
- Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Tomasz Grzela
- Clinic of Phlebology, 02-034 Warsaw, Poland
- Center of Biostructure Research and the Department of General, Endocrinological and Vascular Surgery, Central University Hospital, Medical University of Warsaw, 02-091 Warsaw, Poland
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Szary C, Wilczko J, Bodziony A, Celejewski K, Swieczkowski-Feiz S, Napierala M, Plucinska D, Zawadzki M, Leszczynski J, Grzela T. Does the Treatment of Pelvic Venous Insufficiency Really Not Influence Lower Limb Venous Disease? Diagnostics (Basel) 2023; 13:2467. [PMID: 37568835 PMCID: PMC10416966 DOI: 10.3390/diagnostics13152467] [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: 06/29/2023] [Revised: 07/21/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
Pelvic venous insufficiency is a common problem in multiparous women. Besides burdensome symptoms, it correlates with the development of venous disease in the lower limbs. Therefore, the sequential treatment of abdominal/pelvic before leg veins could improve treatment effectiveness. The medical records of 243 patients with venous disease who were subjected to sequential treatment were analyzed retrospectively. The symptoms and patient satisfaction were assessed using dedicated questionnaires, both before and after treatment. Clinical effectiveness was verified using a Doppler scan, both before and after treatment. Among 243 analyzed cases, 195 underwent whole treatment; however, 48 women after embolization did not require further intervention. The total-symptom-score change (11.6 vs. 13.0, respectively) and the satisfaction score (1.6 vs. 1.5, respectively) did not differ between groups. After embolization, some patients, besides symptoms improvement, experienced reflux reduction and, hence, might avoid further intervention. A better explanation for this beneficial effect of the sequential/descending approach requires further studies.
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Affiliation(s)
| | | | | | - Krzysztof Celejewski
- Clinic of Phlebology, 02-034 Warsaw, Poland
- Medical University of Warsaw, 02-097 Warsaw, Poland
| | | | | | | | - Michal Zawadzki
- Clinic of Phlebology, 02-034 Warsaw, Poland
- Centre of Postgraduate Medical Education, 01-828 Warsaw, Poland
| | - Jerzy Leszczynski
- Clinic of Phlebology, 02-034 Warsaw, Poland
- Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Tomasz Grzela
- Clinic of Phlebology, 02-034 Warsaw, Poland
- Medical University of Warsaw, 02-097 Warsaw, Poland
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Darenskaya MA, Semendyaev AA, Stupin DA, Kolesnikov SI, Semenova NV, Pesterev KV, Kolesnikova LI. Blood Cytokines of the Ovarian Vein Basin in Different Stages of Pelvic Varicose Veins. Bull Exp Biol Med 2023; 175:311-314. [PMID: 37566251 DOI: 10.1007/s10517-023-05858-3] [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: 12/09/2022] [Indexed: 08/12/2023]
Abstract
We analyzed the blood concentration of pro- and anti-inflammatory cytokines in the ovarian vein basin area in women of the reproductive age with primary pelvic varices. Increase in the disease severity was accompanied by a significant increase in proinflammatory cytokines (TNFα, IL-1β, IL-2, IL-6, and IL-8) and the proinflammatory index (IL-6/IL-10), whereas anti-inflammatory cytokine production changed ambiguously (increase of IL-4 at stage I, decrease of IL-10 at stage II, significant decrease of IL-4 and IL-10 at stage III). Control of these changes in female patients should probably be an important component of treatment measures and prevention of morphofunctional disorders occurring at disease progression, in particular at stage III of the disease.
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Affiliation(s)
- M A Darenskaya
- Scientific Center for Family Health and Human Reproduction Problems, Irkutsk, Russia.
| | - A A Semendyaev
- Irkutsk State Medical University, Ministry of health of the Russian Federation, Irkutsk, Russia
| | - D A Stupin
- Scientific Center for Family Health and Human Reproduction Problems, Irkutsk, Russia
- Irkutsk State Medical University, Ministry of health of the Russian Federation, Irkutsk, Russia
| | - S I Kolesnikov
- Scientific Center for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - N V Semenova
- Scientific Center for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - K V Pesterev
- Irkutsk State Medical University, Ministry of health of the Russian Federation, Irkutsk, Russia
| | - L I Kolesnikova
- Scientific Center for Family Health and Human Reproduction Problems, Irkutsk, Russia
- Irkutsk State University, Irkutsk, Russia
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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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14
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Tran M, Tran P. Giant Klebsiella pneumoniae pyogenic liver abscess in the left liver lobe presenting with dyspepsia and vaginal discharge. BMJ Case Rep 2023; 16:e254474. [PMID: 37185248 PMCID: PMC10151981 DOI: 10.1136/bcr-2022-254474] [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] [Indexed: 05/17/2023] Open
Abstract
Pyogenic liver abscess (PLA) commonly occurs in the right liver lobe, causing the typical symptoms of fever and right upper quadrant pain. Less than one-third of cases occur in the left lobe. We describe an unusual presentation of a giant left-sided PLA that was compressing the stomach and surrounding venous vasculature, causing the respective symptoms of gastro-oesophageal reflux and vaginal discharge from secondary pelvic congestion syndrome. CT revealed a solitary 14 cm×10 cm×10 cm multiloculated lesion, replacing most of the left liver lobe. It was successfully treated with intravenous antibiotics and percutaneous drainage, resulting in complete resolution at 1-year follow-up. This case explores the predisposing risk factor of diabetes in PLA and its association with Klebsiella pneumoniae, which was the offending pathogen in our patient. We also discuss the phenomenon of secondary pelvic venous congestion syndrome and compare similar cases of left-sided PLA, highlighting the different modes of presentation and treatment options.
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Affiliation(s)
- Melanie Tran
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Patrick Tran
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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15
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Darenskaya M, Semendyaev AA, Stupin DA, Kolesnikov SI, Semenova NV, Pesterev KV, Kolesnikova LI. CELLULAR AND HUMORAL IMMUNE PARAMETERS IN THE PERIPHERAL AND LOCAL BLOOD FLOW IN PATIENTS WITH PRIMARY PELVIC VARICOSE. RUSSIAN JOURNAL OF INFECTION AND IMMUNITY 2023. [DOI: 10.15789/2220-7619-cah-2108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Pelviс varicose veins (PVV) in women is of extremely high relevance due to a close relationship with reproductive disorders and disease relapse. Despite on research in the field, the results of the analysis on immune reactivity in PVV are rather contradictory, and mainly relate to general mechanisms. The study of cell-mediated and humoral arms of adaptive immunity will allow us to assess an intensity and dynamics of PVV progression as well as a potential for using immune status parameters to optimize diagnosis and immunological correction. The aim of this study was to assess characteristics of cellular and humoral immunity in peripheral (ulnar) and local (ovarian) venous pools in women with mild and moderate PVV. The study involved 142 women of reproductive age (mean age - 37.27.1 years) with diagnosed PVV - mild (Group 1) (n=79) and moderate (Group 2) (n=63) forms. Data from 30 apparently healthy women (mean age 33.56.3 years) were in control group. Flow cytometry was used to identify lymphocyte subsets. The functional state of the humoral immunity was assessed by measuring concentration of immunoglobulins IgA, IgG, IgM by using radial immunodiffusion in the gel. According to our data obtained, patients in group 1 had changes found only in the local blood flow such as prominent lymphocytopenia (decreased level of CD3+ and CD4+ lymphocytes). Patients in group 2 were featured with more pronounced changes: increased lymphocyte level, CD3+, CD4+/CD8+, IgA and lower levels of IgM, IgG in peripheral blood; high average leukocyte and lymphocyte count, IgA and reduced levels of CD3+, CD4+, CD4+/CD8+, IgM and IgG in the local area. It can be concluded that altered parameters in the local blood flow are of primary origin in mild PVV being characterized by disturbed cellular immune arm. Along with increasing disease severity, the host compensatory capabilities decline, which is manifested by pronounced combined immunodeficiency at the level of local blood flow less evident at peripheral level. These results may contribute to a more accurate assessment of intensity and dynamics of PVV progression to optimize diagnostics and immunological correction.
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16
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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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17
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Ali S, Pinto P, Huber S, Perez-Lozada JC, Attaran R, Ochoa Chaar CI. Complex pathologies in a patient referred for varicose veins. J Vasc Surg Cases Innov Tech 2023; 9:101107. [PMID: 36852313 PMCID: PMC9958068 DOI: 10.1016/j.jvscit.2023.101107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/05/2023] [Indexed: 01/22/2023] Open
Abstract
Varicose veins are commonly due to saphenous vein reflux, but they can manifest more complex venous pathologies. A 45-year-old woman presented with painful leg varicosities and pelvic pain. Duplex examination showed bilateral superficial venous reflux, and, on further interrogation, cross-sectional imaging demonstrated enlarged ovarian veins and nonthrombotic iliac vein compression. Ovarian vein embolization followed by iliac vein stenting and bilateral lower extremity venous ablations and sclerotherapy was performed. After 5 years, she reports no pelvic symptoms and minimal leg symptoms. This case highlights the complex interplay of these venous pathologies and their successful treatment.
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Affiliation(s)
- Sahar Ali
- Vascular Surgery Department, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Paula Pinto
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
- Correspondence: Paula Pinto, MD, Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510
| | - Steffen Huber
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT
| | - Juan Carlos Perez-Lozada
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT
| | - Robert Attaran
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
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18
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Sharma A, Eapen CE. Pelvic congestion needs attention in infertile women with Budd-Chiari syndrome. Indian J Gastroenterol 2023; 42:14-16. [PMID: 36763250 DOI: 10.1007/s12664-023-01341-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Anand Sharma
- Department of Gastroenterology, All India Institute of Medical Sciences, Rishikesh, 249 203, India
| | - C E Eapen
- Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu, 632 004, India.
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19
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Rezaei-Kalantari K, Fahrni G, Rotzinger DC, Qanadli SD. Insights into pelvic venous disorders. Front Cardiovasc Med 2023; 10:1102063. [PMID: 36742076 PMCID: PMC9892065 DOI: 10.3389/fcvm.2023.1102063] [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: 11/18/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Pelvic venous disorders (PeVD), sometimes referred to as pelvic congestion syndrome (PCS), widely impact affected patients-mainly young women's quality of life, causing puzzling, uncomfortable symptoms sometimes requiring months or years to get an explanation, while simply remaining undiagnosed in other cases. Because pelvic pain is a non-specific symptom, an appropriate diagnosis requires a careful patient workup, including a correlation between history and non-invasive imaging. Invasive imaging is frequently required to confirm the diagnosis and plan treatment. Current therapeutic approaches principally rely on minimally invasive techniques delivered through endovascular access. However, while comprehensive descriptive classifications such as the symptoms-varices-pathophysiology (SVP) classification exist, universally accepted guidelines regarding therapy to apply for each SVP category are still lacking. This review strongly focuses on PeVD imaging and discusses available therapeutic approaches with regard to pathophysiological mechanisms. It proposes a new classification scheme assisting clinical decision-making about endovascular management to help standardize the link between imaging findings and treatment.
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Affiliation(s)
- Kiara Rezaei-Kalantari
- Department of Radiology, Rajaie Cardiovascular, Medical and Research Center, Cardio-Oncology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Guillaume Fahrni
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,*Correspondence: Guillaume Fahrni,
| | - David C. Rotzinger
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Salah D. Qanadli
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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20
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Xiang H, Zhang T, Al-Danakh A, Yang D, Wang L. Neuromodulation in Chronic Pelvic Pain: A Narrative Review. Pain Ther 2022; 11:789-816. [PMID: 35834103 PMCID: PMC9314476 DOI: 10.1007/s40122-022-00405-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/14/2022] [Indexed: 01/11/2023] Open
Abstract
Chronic primary pelvic pain syndrome (CPPPS) is a heterogeneous disease with unknown pathogenesis and a lack of distinct pathological features, which complicates diagnosis and therapy and has a significant impact on patients' daily life. Because pharmacological management is ineffective and long-term use may result in additional system damage, developing a more effective treatment is critical. Neuromodulation has advanced rapidly over the last few decades, and various types of neuromodulations have demonstrated efficacy in the treatment of CPPPS. In this article we discuss the evolution of neuromodulation technology in the treatment of chronic pelvic pain, its application to various subtypes of chronic pelvic pain, and the comparison of relevant efficacy and parameter differences, as well as assess the relative advantages and disadvantages of sacral neuromodulation, percutaneous tibial nerve stimulation , transcutaneous electrical nerve stimulation, electroacupuncture, and pudendal neuromodulation. Furthermore, it was noted that chronic pelvic pain should be evaluated in terms of pain, associated symptoms, psychological problems, and quality of life. Although neuromodulation approaches have been shown to be effective in treating chronic pelvic pain, more extensive multicenter trials are required to confirm this.
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Affiliation(s)
- Hao Xiang
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116021, China
| | - Tingting Zhang
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116011, China
| | - Abdullah Al-Danakh
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116021, China
| | - Deyong Yang
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116021, China.
- Healinghands (Dalian) Clinic, Dalian, Liaoning, China.
| | - Lina Wang
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116021, China.
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