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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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Rochon PJ, Reghunathan A, Kapoor BS, Kalva SP, Fidelman N, Majdalany BS, Abujudeh H, Caplin DM, Eldrup-Jorgensen J, Farsad K, Guimaraes MS, Gupta A, Higgins M, Kendi AT, Khilnani NM, Patel PJ, Dill KE, Hohenwalter EJ. ACR Appropriateness Criteria® Lower Extremity Chronic Venous Disease. J Am Coll Radiol 2023; 20:S481-S500. [PMID: 38040466 DOI: 10.1016/j.jacr.2023.08.011] [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: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Lower extremity venous insufficiency is a chronic medical condition resulting from primary valvular incompetence or, less commonly, prior deep venous thrombosis or extrinsic venous obstruction. Lower extremity chronic venous disease has a high prevalence with a related socioeconomic burden. In the United States, over 11 million males and 22 million females 40 to 80 years of age have varicose veins, with over 2 million adults having advanced chronic venous disease. The high cost to the health care system is related to the recurrent nature of venous ulcerative disease, with total treatment costs estimated >$2.5 billion per year in the United States, with at least 20,556 individuals with newly diagnosed venous ulcers yearly. Various diagnostic and treatment strategies are in place for lower extremity chronic venous disease and are discussed in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Arun Reghunathan
- Research Author, University of Colorado Denver, Denver, Colorado
| | | | - Sanjeeva P Kalva
- Panel Chair, Massachusetts General Hospital, Boston, Massachusetts
| | - Nicholas Fidelman
- Panel Vice-Chair, University of California, San Francisco, San Francisco, California
| | - Bill S Majdalany
- Panel Vice-Chair, University of Vermont Medical Center, Burlington, Vermont
| | - Hani Abujudeh
- Detroit Medical Center, Tenet Healthcare and Envision Radiology Physician Services, Detroit, Michigan
| | - Drew M Caplin
- Zucker School of Medicine at Hofstra Northwell, Hempstead, New York
| | - Jens Eldrup-Jorgensen
- Tufts University School of Medicine, Boston, Massachusetts; Society for Vascular Surgery
| | | | | | - Amit Gupta
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | | | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | - Neil M Khilnani
- Weill Cornell Medicine-NewYork Presbyterian Hospital, New York, New York; American Vein and Lymphatic Society
| | - Parag J Patel
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
| | - Eric J Hohenwalter
- Specialty Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
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Smak Gregoor AM, Hamer MA, van den Bos RR, Moelker A, van Rijn MJ, Malskat WSJ. Efficacy of endovascular treatment of pelvic varicose veins: A single-center retrospective observational study. J Vasc Surg Venous Lymphat Disord 2023; 11:389-396.e2. [PMID: 36323401 DOI: 10.1016/j.jvsv.2022.10.007] [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: 06/13/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the efficacy of endovascular embolization of pelvic varicose veins in the treatment of pelvic venous disorders (PeVD). METHODS A single-center retrospective study was performed, including 156 women referred to the Erasmus University Medical Center between January 2011 and October 2020 for an evaluation of PeVD. Data on presenting symptoms, clinical workup, treatment, and clinical outcomes were collected. The primary end point was resolution of symptoms after treatment. Secondary outcomes were correlation between symptoms at presentation and relief of symptoms after treatment, minor or major procedural complications, recurrences, and additional treatments needed. RESULTS Ninety patients underwent a pelvic phlebography, of which 75 received embolization of pelvic varicose veins. Median follow-up after phlebography was 13.2 months (interquartile range, 6.0-40.1 months). Of the treated patients, 53 (70.7%) had partial or complete relief of symptoms. Forty-six women (61.3%) who received embolization of pelvic varicose veins required additional treatments for leg and/or vulvar varicose veins. CONCLUSIONS This study found that endovascular embolization of pelvic varicose veins can be an effective treatment for PeVDs. However, additional treatments are often required for leg and/or vulvar varicose veins.
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Affiliation(s)
- Anna M Smak Gregoor
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Merel A Hamer
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Marie Josee van Rijn
- Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Wendy S J Malskat
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands.
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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: 3] [Impact Index Per Article: 3.0] [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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Abstract
Pelvic venous disorders (PeVD) also known as Pelvic Congestion Syndrome (PCS) affect a great number of women worldwide and often remain undiagnosed. Gynecological symptoms caused by vascular background demand a holistic approach for appropriate diagnosis. This is a relevant cause of chronic pelvic pain and atypical varicose veins. The diagnosis is based on imaging studies and their correlation with clinical presentation. Although the aetiology of PCS still remains unclear, it may result from a combination of factors including genetic predisposition, anatomical abnormalities, hormonal factors, damage to the vein wall, valve dysfunction, reverse blood flow, hypertension and dilatation. The following paper describes an in-depth overview of anatomy, pathophysiology, symptoms, diagnosis and treatment of PCS. In recent years, minimally invasive interventions have become the method of first choice for the treatment of this condition. The efficacy of a percutaneous approach is high and it is rarely associated with serious complications.Key MessagesPelvic venous disorders demand a holistic approach for appropriate diagnosis.This article takes an in-depth look at existing therapies of Pelvic Congestion Syndrome and pathophysiology of this condition.Embolisation is an effective and safe treatment option.
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Affiliation(s)
- Kamil Bałabuszek
- Department of Radiography, Medical University of Lublin, Lublin, Poland
| | - Michał Toborek
- Department of Radiography, Medical University of Lublin, Lublin, Poland
| | - Radosław Pietura
- Department of Radiography, Medical University of Lublin, Lublin, Poland
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CARVALHO SFCD, METZGER. PB, FERNANDEZ MG, RIBEIRO WB, NOGUEIRA AKS, SOUZA JPRE. PELVIC VENOUS REFLUX EMBOLIZATION IN THE TREATMENT OF SYMPTOMATIC PELVIC CONGESTIVE SYNDROME: A SYSTEMATIC REVIEW WITH META-ANALYSIS. J Vasc Surg Venous Lymphat Disord 2022. [DOI: 10.1016/j.jvsv.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cifuentes S, Ulloa JH, Uden EV, Figueroa V, Solano A, Montenegro AC. Painful Ejaculation In A Patient With Pelvic Venous Insufficiency. J Vasc Surg Cases Innov Tech 2022; 8:602-605. [PMID: 36248386 PMCID: PMC9556572 DOI: 10.1016/j.jvscit.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/15/2022] [Indexed: 11/27/2022] Open
Abstract
Pelvic venous insufficiency (PVI) is common in women but has been rarely diagnosed in men. The clinical manifestations include varicocele and pelvic disturbances; however, we were unable to find a previous description of painful ejaculation as a symptom of PVI. We present the case of a 36-year-old man with a 7-year history of severe sharp ejaculatory pain. PVI was suspected after previous treatment attempts. The diagnosis was confirmed by descending phlebography, and he underwent coil embolization of the pelvic vessels and phlebotonic therapy. At 6 months after treatment, he reported a 75% improvement in his condition. Therefore, painful ejaculation should be considered an uncommon manifestation of PVI.
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A systematic review on isolated coil embolization for pelvic venous reflux. J Vasc Surg Venous Lymphat Disord 2021; 10:224-232.e9. [PMID: 34358670 DOI: 10.1016/j.jvsv.2021.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 07/11/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Pelvic venous reflux (PVR) can present with symptoms such as chronic pelvic pain, dysmenorrhea, and dyspareunia, resulting in a decreased quality of life among those affected. Percutaneous coil embolization (CE) is a common intervention for PVR; however, the efficacy and safety of its use in isolation has yet to be reviewed. METHODS The MEDLINE and EMBASE databases were systematically searched from 1990 to July 20, 2020, for studies reporting on adult patients undergoing isolated CE for PVR. Articles not in English, case reports, studies reporting on pediatric patients, and studies not performing isolated CE were excluded. Search, review, and data extraction were performed by two independent reviewers (S.S. and M.T.). Changes in pain before and after CE was evaluated through a pooled analysis of visual analogue scale scores in seven studies. RESULTS A total of 970 patients (range, 3-218, 100% female) undergoing isolated ovarian vein or mixed veins embolization from 20 studies were included. Pooled analysis revealed mean improvements of 5.47 points (95% CI, 4.77-6.16) on the visual analogue scale. Common symptoms such as urinary urgency and dyspareunia reported significant improvements of 78-100% and 60-89.5% respectively. Complications were rare, with coil migration (n = 19) being the most common. Recurrence rates differed based on the varying symptoms and studies, with recurrence in pain 1-2 years after CE ranging from 5.9-25%. Two randomized controlled trials revealed improved clinical outcomes with CE as compared with vascular plugs and hysterectomy. CONCLUSIONS The current data suggests that isolated CE is technically effective and can result in clinical improvement among patients with PVR. However, further trials are required to ascertain its long-term effects.
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Increased prevalence of pelvic venous congestion sign on sacroiliac MRI in women with clinically suspected sacroiliitis. North Clin Istanb 2021; 7:551-556. [PMID: 33381693 PMCID: PMC7754859 DOI: 10.14744/nci.2020.48030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/29/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: To compare the prevalence of pelvic venous congestion (PVC) sign on sacroiliac and hip MRI in women of reproductive age as a possible cause of pain mimicking sacroiliitis. METHODS: This retrospective study included 727 MRI examinations (401 sacroiliac joint MRI and 326 hip joint MRI) that were performed between January 2010 and December 2017. Images were evaluated for the presence of sacroiliitis, presence of PVC sign and presence of other incidental findings of musculoskeletal and genitourinary disorders. After removing patients with other musculoskeletal and genitourinary disorders that may cause pain (n=188), remaining 539 (322 sacroiliac and 217 hip), MRI examinations were re-analyzed for the presence of PVC sign. RESULTS: Four hundred one patients with sacroiliac MRI examination had 120 (29.9%) PVC sign and 326 patients with hip MRI examinations had 54 (16.6%) PVC sign (p<0.001). After removing patients with other musculoskeletal and genitourinary disorders that may cause pain, 322 patients with sacroiliac MRI had 102 (31.7%) PVC sign and 217 patients with hip MRI examinations had 38 (17.5%) PVC sign (p<0.001). No significant difference was found between patients with acute sacroiliitis and patients without acute sacroiliitis concerning PVC prevalence (p>0.05). There were also no significant differences between other comparable incidental findings. CONCLUSION: Significantly increased PVC prevalence in sacroiliac MRI exams may be attributable to PCS simulating clinical sacroiliitis.
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Comprehensive review of pelvic congestion syndrome: causes, symptoms, treatment options. Curr Opin Obstet Gynecol 2020; 32:237-242. [DOI: 10.1097/gco.0000000000000637] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Almeida GRD, Silvinato A, Simões RS, Buzzini RF, Bernardo WM. Pelvic congestion syndrome - treatment with pelvic varicose veins embolization. Rev Assoc Med Bras (1992) 2019; 65:518-523. [DOI: 10.1590/1806-9282.65.4.518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2018] [Indexed: 11/22/2022] Open
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