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Sheikh AB, Fudim M, Garg I, Minhas AMK, Sobotka AA, Patel MR, Eng MH, Sobotka PA. The Clinical Problem of Pelvic Venous Disorders. Interv Cardiol Clin 2022; 11:307-324. [PMID: 35710285 DOI: 10.1016/j.iccl.2022.03.003] [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] [Indexed: 06/15/2023]
Abstract
Pelvic venous disorders are inter-related pathologic conditions caused by reflux and obstruction in the pelvic veins. It can present a spectrum of clinical features based on the route of transmission of venous hypertension to either distal or caudal venous reservoirs. Imaging can help to visualize pelvic vascular and visceral structures to rule out other gynecologic, gastrointestinal, and urologic diseases. Endovascular treatment, owing to its low invasive nature and high success rate, has become the mainstay in the management of pelvic venous disorders. This article reviews the pathophysiology, clinical presentations, and diagnostic and therapeutic approaches to pelvic venous disorders.
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Affiliation(s)
- Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, 1021 Medical Arts Avenue NE, Albuquerque, NM 87102, USA
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, 200 Trent Drive, Durham, NC 27710, USA; Duke Clinical Research Institute, 300 West Morgan Street, Durham, NC 27701, USA.
| | - Ishan Garg
- Department of Internal Medicine, University of New Mexico Health Sciences Center, 1021 Medical Arts Avenue NE, Albuquerque, NM 87102, USA
| | - Abdul Mannan Khan Minhas
- Department of Internal Medicine, Forrest General Hospital, 6051 US 49, Hattiesburg, MS 39401, USA
| | | | - Manesh R Patel
- Division of Cardiology, Duke University Medical Center, 200 Trent Drive, Durham, NC 27710, USA; Duke Clinical Research Institute, 300 West Morgan Street, Durham, NC 27701, USA
| | - Marvin H Eng
- Division of Cardiology, University of Arizona, Banner University Medical Center, 1111 E McDowell Rd, Phoenix, AZ 85006, USA
| | - Paul A Sobotka
- The Ohio State University, 281 West Lane Avenue, Columbus, OH 43210, USA.
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2
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Whiteley MS. Current Best Practice in the Management of Varicose Veins. Clin Cosmet Investig Dermatol 2022; 15:567-583. [PMID: 35418769 PMCID: PMC8995160 DOI: 10.2147/ccid.s294990] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/27/2022] [Indexed: 12/01/2022]
Abstract
This article outlines the current best practice in the management of varicose veins. “Varicose veins” traditionally means bulging veins, usually seen on the legs, when standing. It is now a general term used to describe these bulging veins, and also underlying incompetent veins that reflux and cause the surface varicose veins. Importantly, “varicose veins” is often used for superficial venous reflux even in the absence of visible bulging veins. These can be simply called “hidden varicose veins”. Varicose veins usually deteriorate, progressing to discomfort, swollen ankles, skin damage, leg ulcers, superficial venous thrombosis and venous bleeds. Patients with varicose veins and symptoms or signs have a significant advantage in having treatment over conservative treatment with compression stockings or venotropic drugs. Small varicose veins or telangiectasia without symptoms or signs can be treated for cosmetic reasons. However, most have underlying venous reflux from saphenous, perforator or local “feeding veins” and so investigation with venous duplex should be mandatory before treatment. Best practice for investigating leg varicose veins is venous duplex ultrasound in the erect position, performed by a specialist trained in ultrasonography optimally not the doctor who performs the treatment. Pelvic vein reflux is best investigated with transvaginal duplex ultrasound (TVS), performed using the Holdstock-Harrison protocol. In men or women unable to have TVS, venography or cross-sectional imaging is needed. Best practice for treating truncal vein incompetence is endovenous thermal ablation. Increasing evidence suggests that significant incompetent perforating veins should be found and treated by thermal ablation using the transluminal occlusion of perforator (TRLOP) approach, and that incompetent pelvic veins refluxing into symptomatic varicose veins in the genital region or leg should be treated by coil embolisation. Bulging varicosities should be treated by phlebectomy at the time of truncal vein ablation. Monitoring and reporting outcomes is essential for doctors and patients; hence, participation in a venous registry should probably be mandatory.
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3
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Faĭbushevich AG, Akulova AA, Shugushev ZK, Lobastov KV, Taranenko OV, Chaban AS, Maksimkin DA, Baranovich VI. [Diagnosis of arteriovenous compression in small pelvic varicose veins]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:68-76. [PMID: 34528590 DOI: 10.33529/angio2021302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM The study was aimed at assessing the incidence of arteriovenous compression in women with chronic venous insufficiency of the inferior vena cava and at developing an optimal diagnostic algorithm. PATIENTS AND METHODS During the period 2019-2020, we performed a cross-sectional study including a total of sixty-six 18-to-55-year-old (mean 33.5±5.0) women with clinical manifestations of chronic venous insufficiency of the basin of the inferior vena cava. A diagnostic algorithm included questionnaire, transvaginal ultrasound examination, multislice computed tomography, direct phlebography in combination with phlebotonometry. RESULTS Chronic venous insufficiency of lower limbs was diagnosed in 66 (100%) cases and was presented by the following clinical classes according to the CEAP classification: C0 - 4.5%, C1 - 60.6%, C2 - 27.2%, C3 - 3%. Symptoms of pelvic venous plethora were revealed in 36 (55.5%) examined patients. Arteriovenous compression syndrome according to the findings of multislice computed tomography was verified in 16 (24%) women, including May-Turner syndrome in 5 (7.6%), aortomesenteric compression syndrome in 8 (12%) women, with a combination of both syndromes observed in 3 cases; the frequency of their detection did not differ statistically in subgroups of women with and without clinical signs pelvic varicose veins. Direct phlebography in combination with phlebotonometry was performed in 9 women, the diagnosis of arteriovenous compression (May-Thurner syndrome) was confirmed in 1 case only. CONCLUSION In women with signs of chronic venous insufficiency in the system of the inferior vena cava the frequency of detecting arteriovenous compression on multislice computed tomography may reach 24% and does not depend on the presence of symptoms of pelvic venous plethora. The proportion of arteriovenous compression according to the findings of direct phlebography and phlebotonometry in the structure of causes of the development of pelvic varicose veins did not exceed 11%. An algorithm for diagnosing arteriovenous compression syndromes should obligatorily include multislice computed tomography, direct phlebography and phlebotonometry.
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Affiliation(s)
- A G Faĭbushevich
- Department of Hospital Surgery with a Course of Paediatric Surgery, Peoples' Friendship University of Russia, Moscow, Russia
| | - A A Akulova
- Department of Hospital Surgery with a Course of Paediatric Surgery, Peoples' Friendship University of Russia, Moscow, Russia
| | - Z Kh Shugushev
- Department of Cardiovascular Surgery of the Faculty of Continuing Medical Education, Peoples' Friendship University of Russia, Moscow, Russia
| | - K V Lobastov
- Department of General Surgery and Radiodiagnosis, N.I. Pirogov Russian National Research Medical University of the RF Ministry of Public Health, Moscow, Russia
| | - O V Taranenko
- Therapeutic Department, Scientific Centre of Obstetrics, Gynaecology and Perinatology named after Academician V.I. Kulakov, Moscow, Russia
| | - A S Chaban
- Joint-Stock Company 'Family Physician', Moscow, Russia
| | - D A Maksimkin
- Department of Hospital Surgery with a Course of Paediatric Surgery, Peoples' Friendship University of Russia, Moscow, Russia; Department of Cardiovascular Surgery of the Faculty of Continuing Medical Education, Peoples' Friendship University of Russia, Moscow, Russia
| | - V Iu Baranovich
- Department of Hospital Surgery with a Course of Paediatric Surgery, Peoples' Friendship University of Russia, Moscow, Russia
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Cuglan B, Ozturk S, Ozcan F, Atmaca H, Ensaroğlu F, Saçıkara A, Yetkin E. Assessment of venous leg symptoms in patients with hemorrhoidal disease (VEIN-HEMORRHOID study). Phlebology 2021; 37:42-47. [PMID: 34496696 DOI: 10.1177/02683555211030734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Coexistence of dilating venous diseases in different vascular territories has raised the idea that they have similar vascular wall abnormality in their evolutionary process. Accordingly, we aimed to evaluate venous leg symptoms in patients with hemorrhoidal disease (HD) by means of VEINES-Sym questionnaire. MATERIALS AND METHODS The study involved 249 consecutive patients who underwent colonoscopy and met the inclusion criteria. Presence and grading of HD were made according to Goligher's classification. All patients were examined for the existing of varicose vein and classified in respect of CEAP classification. All participants were requested to answer the VEINES-Sym questionnaire. RESULTS There was not statistically significant differences between the patients without HD (grade 0 or I) and with HD (Grade II or III) in respect to clinical characteristics except female predominance in hemorrhoid group (p = 0.07). Scores of heavy legs, swelling, burning sensation, restless leg, throbbing, tingling, and total VEINES score were significantly lower (ie: worse) in hemorrhoid group. Logistic regression analysis revealed that female gender and total VEINES score were independently associated with HD (OR: 2.03, 95% CI: 1.17-3.52, p = 0.01; OR: 0.96, 95% CI: 0.92-0.99, p = 0.02, respectively). Among all venous leg symptoms, severity of heavy legs, night cramps, swelling and aching were significantly correlated with the grades of HD. CONCLUSION We have shown significant association between the HD and venous leg symptoms reflected by total VEINES score and significant correlation between the HD grade and venous leg symptoms severity including heavy legs, swelling, night cramps and aching legs.
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Affiliation(s)
- Bilal Cuglan
- Faculty of Medicine, Department of Cardiology, Beykent University, Istanbul, Turkey
| | - Selcuk Ozturk
- Faculty of Medicine, Department of Cardiology, Bozok University, Yozgat, Turkey
| | - Fulya Ozcan
- Department of General Surgery, Private Derindere Hospital, Istanbul, Turkey
| | - Hasan Atmaca
- Private Okmeydanı Medical Center, Cardiology Clinic, Istanbul, Turkey
| | - Fatih Ensaroğlu
- Department of Gastroenterology, Istinye University Liv Hospital, Istanbul, Turkey
| | - Alparslan Saçıkara
- Private Okmeydanı Medical Center, Gastroenterology Clinic, Istanbul, Turkey
| | - Ertan Yetkin
- Department of Cardiology, Private Derindere Hospital, Istanbul, Turkey
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Meissner MH, Khilnani NM, Labropoulos N, Gasparis AP, Gibson K, Greiner M, Learman LA, Atashroo D, Lurie F, Passman MA, Basile A, Lazarshvilli Z, Lohr J, Kim MD, Nicolini PH, Pabon-Ramos WM, Rosenblatt M. The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. Phlebology 2021; 36:342-360. [PMID: 33849310 PMCID: PMC8371031 DOI: 10.1177/0268355521999559] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This Practice Guidelines document has been co-published in
Phlebology [DOI: 10.1177/0268355521999559] and Journal of
Vascular Surgery: Venous and Lymphatic Disorders [DOI:
10.1016/j.jvsv.2020.12.084]. The publications are
identical except for minor stylistic and spelling differences in keeping
with each journal’s style. The contribution has been published under a
Attribution-Non Commercial 4.0 International (CC BY-NC 4.0), (https://creativecommons.org/licenses/by-nc/4.0/)
With the support of the American College of Obstetricians and
Gynecologists, the American Vein & Lymphatic Society, the American
Venous Forum, the Canadian Society of Phlebology, the Cardiovascular and
Interventional Radiology Society of Europe, the European Venous Forum, the
International Pelvic Pain Society, the International Union of Phlebology,
the Korean Society of Interventional Radiology, the Society of
Interventional Radiology, and the Society for Vascular Surgery
As the importance of pelvic venous disorders (PeVD) has been increasingly
recognized, progress in the field has been limited by the lack of a valid and
reliable classification instrument. Misleading historical nomenclature, such as
the May-Thurner, pelvic congestion, and nutcracker syndromes, often fails to
recognize the interrelationship of many pelvic symptoms and their underlying
pathophysiology. Based on a perceived need, the American Vein and Lymphatic
Society convened an international, multidisciplinary panel charged with the
development of a discriminative classification instrument for PeVD. This
instrument, the Symptoms-Varices-Pathophysiology (“SVP”) classification for
PeVD, includes three domains—Symptoms (S), Varices (V), and Pathophysiology (P),
with the pathophysiology domain encompassing the Anatomic (A), Hemodynamic (H),
and Etiologic (E) features of the patient’s disease. An individual patient’s
classification is designated as SVPA,H,E. For patients with pelvic
origin lower extremity signs or symptoms, the SVP instrument is complementary to
and should be used in conjunction with the
Clinical-Etiologic-Anatomic-Physiologic (CEAP) classification. The SVP
instrument accurately defines the diverse patient populations with PeVD, an
important step in improving clinical decision making, developing
disease-specific outcome measures and identifying homogenous patient populations
for clinical trials.
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Affiliation(s)
- Mark H Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Neil M Khilnani
- Department of Radiology (Interventional Radiology) Weill Cornell Medicine-New York Presbyterian Hospital, New York, USA
| | - Nicos Labropoulos
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA
| | - Antonios P Gasparis
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA
| | | | - Milka Greiner
- Interventional Radiology, Hopital Americain de Paris, Paris, France
| | - Lee A Learman
- Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Diana Atashroo
- Department of Obstetrics and Gynecology, Stanford Medicine, Palo Alto, USA
| | - Fedor Lurie
- Department of Surgery, Jobst Vascular Institute, Promedica, Toledo, USA
| | - Marc A Passman
- Department of Surgery, University of Alabama School of Medicine, Birmingham, USA
| | - Antonio Basile
- Department of Interventional Radiology, University of Catania, Catania, Italy
| | | | - Joann Lohr
- Department of Surgery, University of South Carolina School of Medicine, Columbia, USA
| | - Man-Deuk Kim
- Department of Radiology, Yonsei University School of Medicine, Seoul, South Korea
| | | | - Waleska M Pabon-Ramos
- Department of Radiology (Interventional Radiology), Duke University School of Medicine, Durham, USA
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Sheikh P, Mital K, Maheshwari U, Prabakaran J, Sharda P, Dumbre R. Clinical Presentation of Hemorrhoids and its Correlation with Chronic Venous Disease in India: a Subgroup Analysis of the International CHORUS Survey. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02426-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Osman AM, Mordi A, Khattab R. Female pelvic congestion syndrome: how can CT and MRI help in the management decision? Br J Radiol 2021; 94:20200881. [PMID: 33252986 DOI: 10.1259/bjr.20200881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Diagnosis of female pelvic congestion syndrome (PCS) is challenging. Although invasive venography is the gold-standard for diagnosis, however, CT and MRI are important in the assessment. In this study, we tried to highlight the role of CT and MRI as non-invasive tools in the diagnosis and management of PCS. METHODS AND MATERIAL This was a retrospective study of 50 patients confirmed clinically to have PCS. These patients had already done CT and MRI before venography or surgery. RESULTS The mean age of the patients was 48 years ± 12 years SD. Vaginal discharge and pelvic heaviness were the commonest symptoms (46 and 42% respectively). The commonest risk factor was multiparity (56%) followed by the RVF uterus (26%). No significant difference was found between CT, MRI, and venography as regarding the diameter of the ovarian vein, diameter, and the number of the varicose veins. The sensitivity of CT and MRI was 94.8 and 96%. CT and MRI discovered five cases with local pelvic obstructing cause,14 cases with evidence of vascular compression syndrome, and the rest 31 cases diagnosed to have primary non-obstructing PCS which was effective in decision-making with the surgery indicated in the first group while stenting of the vascular obstruction followed by bilateral ovarian veins coiling was the better option for the second group and only bilateral coiling was needed for the last group. CONCLUSION CT and MRI play important roles in the diagnosis and even management decision in cases of PCS. ADVANCES IN KNOWLEDGE: Identification of the importance of diagnostic radiology before management decisions of cases with PCS.
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Affiliation(s)
- Ahmed M Osman
- Radiology, Faculty of Medicine - Ain shams University, Cairo, Egypt
| | - Ahmed Mordi
- EBIR Interventional Radiology, Faculty of Medicine- Ain shams University, Cairo, Egypt
| | - Rasha Khattab
- Radiology, Faculty of Medicine - Ain shams University, Cairo, Egypt
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8
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Meissner MH, Khilnani NM, Labropoulos N, Gasparis AP, Gibson K, Greiner M, Learman LA, Atashroo D, Lurie F, Passman MA, Basile A, Lazarshvilli Z, Lohr J, Kim MD, Nicolini PH, Pabon-Ramos WM, Rosenblatt M. The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. J Vasc Surg Venous Lymphat Disord 2021; 9:568-584. [PMID: 33529720 DOI: 10.1016/j.jvsv.2020.12.084] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/05/2020] [Indexed: 12/26/2022]
Abstract
As the importance of pelvic venous disorders (PeVD) has been increasingly recognized, progress in the field has been limited by the lack of a valid and reliable classification instrument. Misleading historical nomenclature, such as the May-Thurner, pelvic congestion, and nutcracker syndromes, often fails to recognize the interrelationship of many pelvic symptoms and their underlying pathophysiology. Based on a perceived need, the American Vein and Lymphatic Society convened an international, multidisciplinary panel charged with the development of a discriminative classification instrument for PeVD. This instrument, the Symptoms-Varices-Pathophysiology ("SVP") classification for PeVD, includes three domains-Symptoms (S), Varices (V), and Pathophysiology (P), with the pathophysiology domain encompassing the Anatomic (A), Hemodynamic (H), and Etiologic (E) features of the patient's disease. An individual patient's classification is designated as SVPA,H,E. For patients with pelvic origin lower extremity signs or symptoms, the SVP instrument is complementary to and should be used in conjunction with the Clinical-Etiologic-Anatomic-Physiologic (CEAP) classification. The SVP instrument accurately defines the diverse patient populations with PeVD, an important step in improving clinical decision making, developing disease-specific outcome measures and identifying homogenous patient populations for clinical trials.
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Affiliation(s)
- Mark H Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, Wash.
| | - Neil M Khilnani
- Department of Radiology (Interventional Radiology) Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY
| | - Nicos Labropoulos
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | - Antonios P Gasparis
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | | | - Milka Greiner
- Interventional Radiology, Hopital Americain de Paris, Paris, France
| | - Lee A Learman
- Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, Va
| | - Diana Atashroo
- Department of Obstetrics and Gynecology, Stanford Medicine, Palo Alto, Calif
| | - Fedor Lurie
- Department of Surgery, Jobst Vascular Institute, Promedica, Toledo, Ohio
| | - Marc A Passman
- Department of Surgery, University of Alabama School of Medicine, Birmingham, Ala
| | - Antonio Basile
- Department of Interventional Radiology, University of Catania, Catania, Italy
| | | | - Joann Lohr
- Department of Surgery, University of South Carolina School of Medicine, Columbia, Ohio
| | - Man-Deuk Kim
- Department of Radiology, Yonsei University School of Medicine, Seoul, South Korea
| | | | - Waleska M Pabon-Ramos
- Department of Radiology (Interventional Radiology), Duke University School of Medicine, Durham, NC
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9
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Bookwalter CA, VanBuren WM, Neisen MJ, Bjarnason H. Imaging Appearance and Nonsurgical Management of Pelvic Venous Congestion Syndrome. Radiographics 2020; 39:596-608. [PMID: 30844351 DOI: 10.1148/rg.2019180159] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pelvic venous congestion syndrome (PVCS) is a challenging and complex cause of chronic pelvic pain in female patients. PVCS due to incompetent vein valves is the combination of gonadal vein reflux and pelvic venous engorgement in patients with chronic pelvic pain without other causes. However, pelvic venous engorgement and gonadal vein reflux can be seen in patients without pelvic pain, which makes obtaining a detailed history and physical examination important for workup and diagnosis. The underlying cause of PVCS may be incompetent gonadal vein valves or structural causes such as left renal vein compression with an incompetent gonadal vein valve (nutcracker syndrome) or iliac vein compression (May-Thurner configuration) with reflux into the ipsilateral internal iliac vein. Venography is considered the criterion standard for imaging diagnosis; however, more recently, US and MRI have been shown to provide adequate accuracy for diagnosis. Noninvasive imaging studies aid in the diagnosis of PVCS and also aid in pretreatment planning. When PVCS is caused by incompetent gonadal vein valves, treatment typically is performed by means of embolization via a minimally invasive catheter with excellent technical and clinical success rates. When PVCS is caused by venous obstruction, the obstruction must be treated first before gonadal vein embolization and sclerotherapy are considered. ©RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Candice A Bookwalter
- From the Department of Radiology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905
| | - Wendaline M VanBuren
- From the Department of Radiology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905
| | - Melissa J Neisen
- From the Department of Radiology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905
| | - Haraldur Bjarnason
- From the Department of Radiology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905
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10
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Yetkin E, Ozturk S, Cuglan B, Turhan H. Symptoms in Dilating Venous Disease. Curr Cardiol Rev 2020; 16:164-172. [PMID: 32164514 PMCID: PMC7536814 DOI: 10.2174/1573403x16666200312101245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/08/2020] [Accepted: 02/14/2020] [Indexed: 11/22/2022] Open
Abstract
Lower extremity venous diseases or insufficiency include clinically deteriorating conditions with morphological and functional alterations of the venous system, including venous hypertension, vascular wall structural abnormality, and venous valvar incompetency in association with an inflammatory process. In fact, the same pathophysiological processes are the main underlying mechanisms of other venous insufficiencies in different vascular territories such as Peripheral Varicose Vein (PVV), varicocele, Pelvic Varicosities or Congestion Syndrome (PCS) and Hemorrhoidal Disease (HD). Regarding the anatomical continuity of lower extremity venous system, urogenital system (pampiniform plexus in male and broad ligament and ovarian veins in female) and anorectal venous system, it is reasonable to expect common symptoms such as pain, burning sensation, pruritis, swelling, which arise directly from the involved tissue itself. High coexistence rate of PVV, varicocele/PCS and HD between each other underlines not only the same vascular wall abnormality as an underlying etiology but also the existence of common symptoms originating from the involved tissue in dilating venous disease. Accordingly, it might be reasonable to query the common symptoms of venous dilating disease in other venous vascular regions in patients with complaints of any particular venous territory.
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Affiliation(s)
- Ertan Yetkin
- Address correspondence to this author at the Department of Cardiology, Istinye University Liv Hospital, Istanbul, Turkey; Tel: +90 532 713 6721; E-mail:
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11
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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: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [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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12
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Aslan R, Erbin A, Celik S, Ucpinar B, Sahinalp S, Yıldızhan M, Eryilmaz R, Taken K. Evaluation of hemorrhoidal disease and lower extremity venous insufficiency in primary adult varicocele: A prospective controlled study. Phlebology 2019; 34:621-626. [PMID: 30836835 DOI: 10.1177/0268355519834426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The study investigated the association between varicocele, lower extremity venous insufficiency and hemorrhoidal disease. Methods The study included 62 patients with varicocele and 60 voluntary subjects with no varicocele. Patients who were diagnosed as having varicocele on physical examination and Doppler ultrasonography were included in the study group. Examination of lower extremity venous insufficiency was performed by physical examination and Doppler ultrasonography. Examination of hemorrhoidal disease was performed by a general surgery specialist. Results The patients with varicocele had a statistically significant ( p < 0.05) higher rates of venous insufficiency of the lower extremities and had a borderline significant difference of higher hemorrhoidal disease rates ( p = 0.05). Therewithal incidences of hemorrhoidal disease and lower extremity venous insufficiency were significantly higher in body mass index > 25 and age > 30 years of varicocele patients. Conclusion There is a statistically significant relation between varicocele, lower extremity venous insufficiency, and hemorrhoidal disease. In particular, varicocele patients who are aged over 30 years and overweight are at higher risk.
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Affiliation(s)
- Rahmi Aslan
- Department of Urology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Sebahattin Celik
- Department of General Surgery, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Burak Ucpinar
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Sahin Sahinalp
- Department of Cardiovascular Surgery, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Murat Yıldızhan
- Department of Radiology, Viransehir Medical Center, Sanliurfa, Turkey
| | - Recep Eryilmaz
- Department of Urology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Kerem Taken
- Department of Urology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
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13
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García-Honduvilla N, Asúnsolo Á, Ortega MA, Sainz F, Leal J, Lopez-Hervas P, Pascual G, Buján J. Increase and Redistribution of Sex Hormone Receptors in Premenopausal Women Are Associated with Varicose Vein Remodelling. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:3974026. [PMID: 30250632 PMCID: PMC6140006 DOI: 10.1155/2018/3974026] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/12/2018] [Accepted: 08/05/2018] [Indexed: 02/07/2023]
Abstract
In chronic venous insufficiency of the lower limbs, data show that the clinical manifestation is varicose veins (VVs), and VV epidemiology suggests that sex hormones directly influence disease development through intracellular receptors. This study aimed to determine the presence and localization of oestrogen receptors (ERs), progesterone receptors (PRs), and androgen receptors (ARs) in both healthy and VV wall cells and their relationship with gender. In this study, samples from patients without a history of venous disease (CV) (n = 18) and with VV (n = 40) were used. The samples were divided by gender: CV women (CVw) = 6, CV men (CVm) = 12, VV women (VVw) = 25, and VV men (VVm) = 15. RT-qPCR and immunohistochemical techniques were performed, and increased ER and PR protein expression was found in VVw in all tunica layers. ARs were localized to the adventitial layer in the CV and were found in the neointima in VVs. mRNA expression was increased for ER and PR in VVw. AR gene expression was significantly decreased in VVm. The increase in the number of these receptors and their redistribution through the wall reinforces the role of sex hormones in varicose vein development.
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Affiliation(s)
- Natalio García-Honduvilla
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares. Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- University Center of Defense of Madrid (CUD-ACD), Madrid, Spain
| | - Ángel Asúnsolo
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares. Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Felipe Sainz
- Angiology and Vascular Surgery Service, Ruber International Hospital, Madrid, Spain
| | - Javier Leal
- Angiology and Vascular Surgery Service, Central University Hospital of Defense-UAH, Madrid, Spain
| | - Pedro Lopez-Hervas
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain
- General Surgery and Digestive Service, Ramón y Cajal University Hospital, Madrid, Spain
| | - Gemma Pascual
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares. Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Julia Buján
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares. Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
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14
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Ozturk S, Akbaba KT, Kılıc S, Cıcek T, Peskırcıoglu L, Tandogan I, Gurlek A, Aydemır O, Ilerı M, Yetkın E. Venous leg symptoms in patients with varicocele: A multicenter assessment study (VEIN-TURKEY study). Phlebology 2018; 34:128-136. [PMID: 29793400 DOI: 10.1177/0268355518777110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate chronic venous disease symptoms by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire in varicocele patients. MATERIAL AND METHODS The study was designed as a prospective, case controlled study and conducted in four hospitals from Turkey. A total of 600 patients who admitted to urology outpatient clinic were enrolled to the study. After the exclusion of 44 patients who do not match the inclusion criteria, the remaining 556 patients were examined for the presence and grade of varicocele and subsequently examined clinically for the presence of chronic venous disease findings. Finally, patients were asked to answer the VEINES-Sym questionnaire consisting of 10 items. All patients' demographic parameters, cardiovascular risk factors, other co-morbid diseases and drug usage were noted. RESULTS Patients were classified into two groups: varicocele (+) group ( n = 269) and varicocele (-) group ( n = 287). VEINES-Sym scores of varicocele patients were lower compared to patients without varicocele (41.41 ± 5.21, 43.19 ± 3.22, respectively, p < 0.001). Grades of varicocele significantly but inversely correlated with VEINES-Sym score ( r = 0, -206, p = 0.001). Logistic regression analysis revealed that presence of varicocele irrespective of grading significantly and independently associated with the presence of aching (odds ratio: 2.054, 95% confidence interval: 1.265-3.338, p = 0.004) and throbbing (odds ratio: 2.586, 95% confidence interval: 1.353-4.943, p = 0.004). CONCLUSION Varicocele patients have lower VEINES-Sym scores compared to patients without varicocele and this finding is inversely correlated with the degree of the varicocele. This association supports the hypothesis that there may be a systemic vessel wall abnormality in venous disease patients. Patients with symptoms related to vascular dilatation in any territory may deserve to be assessed systematically with the support of further clinical studies.
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Affiliation(s)
- Selcuk Ozturk
- 1 Ankara Education and Research Hospital, Department of Cardiology, Ankara, Turkey
| | | | - Suleyman Kılıc
- 3 Batman Private Dünya Hospital, Urology Clinic, Batman, Turkey.,4 İstinye University, Department of Urology, Istanbul, Turkey
| | - Tufan Cıcek
- 5 Baskent University Konya Education and Research Hospital, Department of Urology, Konya, Turkey
| | - Levent Peskırcıoglu
- 6 Baskent University Ankara Education and Research Hospital, Department of Urology, Ankara, Turkey
| | - Izzet Tandogan
- 7 Private Malatya Gozde Hospital, Department of Cardiology, Malatya, Turkey
| | - Ahmet Gurlek
- 7 Private Malatya Gozde Hospital, Department of Cardiology, Malatya, Turkey
| | - Ozbay Aydemır
- 8 Private Malatya Gozde Hospital, Department of Urology, Malatya, Turkey
| | - Mehmet Ilerı
- 9 Ankara Numune Education and Research Hospital, Department of Cardiology Ankara, Turkey
| | - Ertan Yetkın
- 10 Private Yenisehir Hospital, Department of Cardiology, Mersin, Turkey
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15
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Beckett D, Dos Santos SJ, Dabbs EB, Shiangoli I, Price BA, Whiteley MS. Anatomical abnormalities of the pelvic venous system and their implications for endovascular management of pelvic venous reflux. Phlebology 2017; 33:567-574. [PMID: 29059022 DOI: 10.1177/0268355517735727] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Pelvic venous reflux is often treated with pelvic vein embolisation; however, atypical pelvic venous anatomy may provide therapeutic challenges. Methods We retrospectively reviewed seven patient files and reported symptoms, diagnostic imaging, aberrant anatomy and means by which the interventional radiologist successfully completed the procedure. Any follow-up data were included if available. Results Four anatomical abnormalities were found: internal iliac veins draining into the contralateral common iliac vein, duplicated inferior vena cava, reverse-angle renal veins with atypical left ovarian vein drainage and direct drainage of the internal iliac vein to the inferior vena cava. All patients were successfully treated with pelvic vein embolisation. Conclusion Abnormal embryologic development may cause variable pelvic venous anatomy. Knowledge of this will enable interventional radiologists to successfully treat such patients.
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Affiliation(s)
- David Beckett
- 1 The Whiteley Clinic, Guildford, UK.,2 Department of Radiology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Scott J Dos Santos
- 1 The Whiteley Clinic, Guildford, UK.,3 Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | | | | | - Barrie A Price
- 1 The Whiteley Clinic, Guildford, UK.,3 Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Mark S Whiteley
- 1 The Whiteley Clinic, Guildford, UK.,3 Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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16
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Whiteley MS, Lewis-Shiell C, Bishop SI, Davis EL, Fernandez-Hart TJ, Diwakar P, Beckett D. Pelvic vein embolisation of gonadal and internal iliac veins can be performed safely and with good technical results in an ambulatory vein clinic, under local anaesthetic alone - Results from two years' experience. Phlebology 2017; 33:575-579. [PMID: 28992753 DOI: 10.1177/0268355517734952] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Pelvic vein embolisation is increasing in venous practice for the treatment of conditions associated with pelvic venous reflux. In July 2014, we introduced a local anaesthetic "walk-in walk-out" pelvic vein embolisation service situated in a vein clinic, remote from a hospital. Methods Prospective audit of all patients undergoing pelvic vein embolisation for pelvic venous reflux. All patients had serum urea and electrolytes tested before procedure. Embolisation coils used were interlock embolisation coils (Boston Scientific, USA) as they can be repositioned after deployment and before release. We noted (1) complications during or post-procedure (2) successful abolition of pelvic venous reflux on transvaginal duplex scanning (3) number of veins (territories) treated and number of coils used. Results In 24 months, 121 patients underwent pelvic vein embolisation. Three males were excluded as transvaginal duplex scanning was impossible and six females excluded due to lack of complete data. None of these nine had any complications. Of 112 females analysed, mean age 45 years (24-71), 104 were for leg varices, 48 vulval varices and 20 for pelvic congestion syndrome (some had more than one indication). There were no deaths or serious complications to 30 days. Two procedures were abandoned, one completed subsequently and one was technically successful on review. One more had transient bradycardia and one had a coil removed by snare during the procedure. The mean number of venous territories treated was 2.9 and a mean of 3.3 coils was used per territory. Conclusion Pelvic vein embolisation under local anaesthetic is safe and technically effective in a remote out-patient facility outside of a hospital.
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Affiliation(s)
- Mark S Whiteley
- 1 The Whiteley Clinic, Guildford, UK.,2 Faculty of Health and Biomedical Sciences, University of Surrey, Guildford, UK
| | | | | | - Eluned L Davis
- 1 The Whiteley Clinic, Guildford, UK.,3 The Whiteley Clinic, One Chapel Place, London, UK
| | - Tim J Fernandez-Hart
- 1 The Whiteley Clinic, Guildford, UK.,3 The Whiteley Clinic, One Chapel Place, London, UK
| | | | - David Beckett
- 1 The Whiteley Clinic, Guildford, UK.,3 The Whiteley Clinic, One Chapel Place, London, UK
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17
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Dabbs EB, Dos Santos SJ, Shiangoli I, Holdstock JM, Beckett D, Whiteley MS. Pelvic venous reflux in males with varicose veins and recurrent varicose veins. Phlebology 2017; 33:382-387. [PMID: 28857674 DOI: 10.1177/0268355517728667] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To report on a male cohort with pelvic vein reflux and associated primary and recurrent lower limb varicose veins. Methods Full lower limb duplex ultrasonography revealed significant pelvic contribution in eight males presenting with bilateral lower limb varicose veins. Testicular and internal iliac veins were examined with either one or a combination of computed tomography, magnetic resonance venography, testicular, transabdominal or transrectal duplex ultrasonography. Subsequently, all patients received pelvic vein embolisation, prior to leg varicose vein treatment. Results Pelvic vein reflux was found in 23 of the 32 truncal pelvic veins and these were treated by pelvic vein embolisation. Four patients have since completed their leg varicose vein treatment and four are undergoing leg varicose vein treatments currently. Conclusion Pelvic vein reflux contributes towards lower limb venous insufficiency in some males with leg varicose veins. Despite the challenges, we suggest that pelvic vein reflux should probably be investigated and pelvic vein embolisation considered in such patients.
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Affiliation(s)
| | - Scott J Dos Santos
- 1 The Whiteley Clinic, Guildford, Surrey, UK.,2 Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Irenie Shiangoli
- 1 The Whiteley Clinic, Guildford, Surrey, UK.,2 Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | | | - David Beckett
- 1 The Whiteley Clinic, Guildford, Surrey, UK.,3 Department of Radiology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Mark S Whiteley
- 1 The Whiteley Clinic, Guildford, Surrey, UK.,2 Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
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18
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Dos Santos SJ, Whiteley MS. Pelvic congestion syndrome masquerading as osteoarthritis of the hip. SAGE Open Med Case Rep 2016; 4:2050313X16683630. [PMID: 27994874 PMCID: PMC5153020 DOI: 10.1177/2050313x16683630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/14/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Pelvic congestion syndrome (PCS) is associated with pelvic vein reflux (PVR), occasionally secondary to venous compression. Its symptoms, usually intra-pelvic, are alleviated following the abolition of this reflux by pelvic vein embolisation (PVE). The objective of this report is to present two cases of left hip pain, erroneously diagnosed as osteoarthritis, which disappeared after successful PVE and abolition of PVR. METHODS Two females presented with lower limb varicose veins, and also had a history of left-sided hip pain. Both had previously been investigated for the hip pain and diagnosed as osteoarthritis despite minimal arthritic changes on pelvic X-rays. During investigation for lower limb varicose veins, both showed a pelvic origin for their leg veins and hence underwent transvaginal duplex ultrasound. This revealed PVR, and PVE was planned in both patients. RESULTS Both patients underwent PVE and reported 'miraculous' resolution of left hip pain and also PCS symptoms including pelvic pain, irritable bowel issues and the disappearance of pelvic dragging, with almost immediate disappearance of vulval and vaginal varicosities. One patient also noted reduced clitoral sensitivity. CONCLUSION Manifestations of PCS may vary in terms of intra- or extra-pelvic signs. PCS and PVR should be considered in the differential diagnosis of patients with arthritic symptoms in the hip without evident radiographic evidence.
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Affiliation(s)
- Scott J Dos Santos
- The Whiteley Clinic, Guildford, UK; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Mark S Whiteley
- The Whiteley Clinic, Guildford, UK; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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19
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Hansrani V, Dhorat Z, McCollum CN. Diagnosing of pelvic vein incompetence using minimally invasive ultrasound techniques. Vascular 2016; 25:253-259. [PMID: 27688293 DOI: 10.1177/1708538116670499] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Pelvic vein incompetence is a cause for pelvic pain and recurrent varicose veins in women. The gold standard diagnostic method is reflux venography involving radiation, nephrotoxic contrast and jugular puncture. Trans-vaginal ultrasound (TVU) is increasingly being used as a diagnostic tool for pelvic vein incompetence. Methods Fifty women with clinical suspicion of pelvic vein incompetence and aged between 18 and 55 years were recruited prospectively over two years at a large UK University Teaching Hospital. Trans-vaginal ultrasound was performed using a standardised protocol which included assessment of the ovarian and internal iliac veins bilaterally in the supine and semi-standing position with provocative manoeuvres. Diagnostic readability and inter-observer variability was determined. Results Mean (range) age of 43 (23-51). Visibility of all four pelvic veins was better in the supine position compared with semi-standing position (76% vs 64%). Pelvic vein incompetence was identified in 34 of 50 (68%) women in the supine position compared with 38 of 50 (76%) women in the semi-standing position. Pelvic vein incompetence was demonstrated in 35 of 50 (70%) women with Valsalva manoeuvre. Inter-observer variability was 0.84 (kappa, very good agreement, p = 0.001). Conclusion Trans-vaginal ultrasound is effective at demonstrating pelvic vein incompetence. All trans-vaginal ultrasound protocols should include assessment of pelvic veins in the supine and semi-standing position with Valsalva manoeuvre.
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Affiliation(s)
- Vivak Hansrani
- Institute of Cardiovascular Sciences, University of Manchester, Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK
| | - Zainab Dhorat
- Institute of Cardiovascular Sciences, University of Manchester, Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK
| | - Charles N McCollum
- Institute of Cardiovascular Sciences, University of Manchester, Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK
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20
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Dos Santos SJ, Holdstock JM, Harrison CC, Whiteley MS. Long-term results of transjugular coil embolisation for pelvic vein reflux – Results of the abolition of venous reflux at 6–8 years. Phlebology 2016; 31:456-62. [DOI: 10.1177/0268355515591306] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Pelvic venous reflux is known to be associated with lower limb varicose veins in 20% of women with a history of at least one previous vaginal delivery. Pelvic vein embolisation with coils has been shown to be a successful treatment in the short term. The objective of this study was to ascertain the long-term outcomes of pelvic vein embolisation for pelvic venous reflux. Methods Patients who had undergone pelvic vein embolisation in 2005–2007 were invited back to a specialist vein unit for transvaginal duplex ultrasonography in the summer of 2013. A total of 110 women were contacted. Pre-embolisation transvaginal duplex ultrasonography results were compared to those obtained six weeks post-procedure and at long-term follow-up. Results Twenty-eight female patients aged 40 to 75 years (mean 53.5) attended (response rate 25.5%), with parity prior to embolisation ranging from 1–5 children (mean 2.8). Mean follow-up time was 7.5 years. Six weeks post-procedure, 25 women had complete or virtual elimination of all reflux, and three had persistent reflux in at least one vein. At long-term follow-up, 11 women had complete elimination of all reflux, seven had elimination of all truncal reflux but minor reflux in vulval veins, six had minor reflux in one truncal vein, and four had significant reflux in one or more truncal veins (one of these gave birth one-year post-pelvic vein embolisation and another had coils removed during gynaecological surgery). Conclusions Transjugular pelvic vein embolisation is a durable technique for the abolition of reflux in the pelvic veins and is particularly adept at treating reflux in the ovarian veins.
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Affiliation(s)
- Scott J Dos Santos
- The Whiteley Clinic, Guildford, Surrey, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | | | | | - Mark S Whiteley
- The Whiteley Clinic, Guildford, Surrey, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
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21
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Biological findings from the PheWAS catalog: focus on connective tissue-related disorders (pelvic floor dysfunction, abdominal hernia, varicose veins and hemorrhoids). Hum Genet 2016; 135:779-95. [DOI: 10.1007/s00439-016-1672-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/17/2016] [Indexed: 01/31/2023]
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22
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Yetkin E, Ileri M. Dilating venous disease: Pathophysiology and a systematic aspect to different vascular territories. Med Hypotheses 2016; 91:73-76. [PMID: 27142148 DOI: 10.1016/j.mehy.2016.04.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 04/06/2016] [Accepted: 04/09/2016] [Indexed: 12/13/2022]
Abstract
Venous disease is a common but overlooked clinical problem and is an important mortality and morbidity factor depending on the effected vascular territory. Different contributing factors play role on the clinical manifestation of the disease. Peripheral varices of lower extremities, hemorrhoids, varicoceles, pelvic varicose veins are the vasculopathy of veins running toward heart but against gravity. We hypothesize that all these clinical entities share common pathophysiologic steps in terms of vascular wall remodeling and vessel wall damage. A systematic approaches to both arterial and venous dilating disease in further studies and research would increase our understanding on the pathophysiology of dilating vascular disease and would provoke to find out new treatment modalities. Varicose remodeling of veins occurs by a complex interplay of various factors including both physical forces and extracellular matrix remodeling mechanisms. This article focuses on the systematic aspects of dilating venous disease with a focus on pathophysiology under the term of "Dilating Venous Disease".
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Affiliation(s)
- Ertan Yetkin
- Yenisehir Hospital, Division of Cardiology, Mersin, Turkey.
| | - Mehmet Ileri
- Numune Training and Research Hospital, Department of Cardiology, Ankara, Turkey
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23
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Dos Santos SJ, Holdstock JM, Harrison CC, Whiteley MS. The effect of a subsequent pregnancy after transjugular coil embolisation for pelvic vein reflux. Phlebology 2016; 32:27-33. [PMID: 26769721 DOI: 10.1177/0268355515623898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Pelvic venous reflux has been proven to contribute to the development of primary and recurrent varicose veins, vulval/labial varicose veins and pelvic congestion syndrome. It is associated with lower limb varicose veins in 20% of patients who have a history of at least one prior vaginal delivery. Pelvic vein embolisation is known to be a safe and effective treatment for the abolition of pelvic venous reflux. However, the effect of a subsequent pregnancy on a previously embolised patient remains largely unknown. This study aims to report the effect of pregnancy on patients that have undergone pelvic vein embolisation. Methods Patients that had previously undergone pelvic vein embolisation for pelvic venous reflux at our unit were sent a questionnaire asking if they had had a pregnancy and subsequently delivered post-embolisation. Patients responding positively were invited to attend our unit for transvaginal duplex ultrasonography of their pelvic veins. Post-pregnancy transvaginal duplex ultrasonography results were compared to pre-embolisation and 6-week post-embolisation scans. Results Eight women, aged 32-48 years (mean 38.8), were retrospectively analysed. Parity prior to embolisation ranged from 1 to 5 (mean 2.8). Initial outcomes at 6 weeks Pelvic venous reflux was completely eliminated in five patients, two patients achieved complete elimination of truncal reflux with very minor vulval reflux and one patient had persistent, mild reflux in the right internal iliac vein. Post-pregnancy outcomes Pelvic venous reflux was completely eliminated in three patients and five patients displayed pelvic venous reflux in at least one truncal vein, with or without concurrent vulval reflux. No patient showed any coil displacement or embolisation as a result of the pregnancy. Conclusions Pregnancy is associated with recurrent reflux in the pelvic veins in women who had previously been treated with coil embolisation. Following recovery from pregnancy, repeat embolisation can eliminate recurrent reflux. Pregnancy appears to be safe following coil embolisation of pelvic veins.
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Affiliation(s)
- Scott J Dos Santos
- 1 The Whiteley Clinic, Stirling House, Guildford, Surrey, UK.,2 Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | | | | | - Mark S Whiteley
- 1 The Whiteley Clinic, Stirling House, Guildford, Surrey, UK.,2 Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
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