Erratum to: Embolization of Incompetent Pelvic Veins for the Treatment of Recurrent Varicose Veins in Lower Limbs and Pelvic Congestion Syndrome

Abstract. Knowledge of the anatomy of the pelvic, gonadal and renal veins is important to understand pelvic congestion syndrome (PCS) and left renal vein compression syndrome (LRCS), which is also known as the nutcracker syndrome. LRCS is related to PCS and to the presence of vulvar, vaginal and pudendal varicose veins. The diagnosis of the two syndromes is difficult, and usually achieved with CT- or phlebography. The gold standard is the intravenous pressure measurement using conventional phlebography. The definition of PCS is described as pelvic pain, aggravated in the standing position and lasting for more than 6 months. Pain in the left flank and microhaematuria is seen in patients with LRCS. Women with multiple pregnancies are at increased risk of developing varicose vein recurrences with pelvic drainage and ovarian vein reflux after crossectomy and stripping of the great saphenous vein. The therapeutic options are: conservative treatment (medroxyprogesteron) or interventional (coiling of the ovarian vein) or operative treatment (clipping of the ovarian vein). Controlled prospective trials are needed to find the best treatment.

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Pelvic congestion syndrome as a predisposing factor of "two-level" varicose veins development

Acta Phlebologica ◽

10.23736/s1593-232x.18.00417-4 ◽

2019 ◽

Vol 19 (3) ◽

Author(s):

Larysa Chernukha ◽

Alla Guch ◽

Vadym Kondratyuk ◽

Olenka Vlasenko ◽

Alla Bobrova

Keyword(s):

Varicose Veins ◽

Predisposing Factor ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

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Successful ultrasound-guided foam sclerotherapy for vulval and leg varicosities secondary to ovarian vein reflux: a case study

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2009.009086 ◽

2010 ◽

Vol 26 (1) ◽

pp. 29-31 ◽

Cited By ~ 16

Author(s):

P Paraskevas

Keyword(s):

Varicose Veins ◽

Duplex Ultrasound ◽

Symptomatic Improvement ◽

Ovarian Vein ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

Pelvic Congestion Syndrome ◽

Vein Reflux ◽

Pelvic Congestion

Pelvic varicose veins secondary to ovarian vein reflux are common and can present with clinical pelvic congestion syndrome (PCS). After assessment with duplex ultrasound and venography, treatment often involves surgical ovarian vein ligation and more recently embolization of the ovarian vein(s) followed by ultrasound-guided foam sclerotherapy (UGFS) of the pelvic tributaries. This paper presents one out of many PCS patients treated with UGFS of the pelvic tributaries alone, with clinically symptomatic improvement.

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The Outcome of Treatment for Pelvic Congestion Syndrome

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2011.012s01 ◽

2012 ◽

Vol 27 (1_suppl) ◽

pp. 74-77 ◽

Cited By ~ 16

Author(s):

P Coleridge Smith

Keyword(s):

Lower Limb ◽

Varicose Veins ◽

Pelvic Congestion Syndrome ◽

Pelvic Vein ◽

Computed Tomographic ◽

Computed Tomographic Venography ◽

Clinical Series ◽

Pelvic Varices ◽

Pelvic Congestion

Pelvic congestion syndrome is one of many causes of chronic pelvic pain. It is generally accepted that this is attributable to ovarian and pelvic vein incompetence which may result in varices in the lower limb leading to presentation in varicose vein clinics. However, far more patients have pelvic varices associated with varicose veins in the lower limb than have pelvic congestion syndrome. Magnetic resonance imaging and computed tomographic venography are usually used in the diagnosis of this condition and criteria have been established to identify pelvic varices. Many different treatments have been used to manage the symptoms of pelvic congestion. Hysterectomy combined with oophrectomy open surgical ligation of ovarian veins and laparoscopic vein ligation have been used in the past. The most common treatments used currently involve embolization of pelvic and ovarian veins. The results of this treatment have been published in a limited number of clinical series, usually with fairly short follow-up periods. These treatments may be complicated by migration of embolization of coils used to occlude veins. The longest duration of follow-up currently reported is five years. Limited clinical evidence supports the use of embolotherapy in the management of pelvic congestion syndrome.

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Recurrent Varicose Veins of Both Lower Limbs due to Bilateral Ovarian Vein Incompetence

Annals of Vascular Surgery ◽

10.1007/s100169910075 ◽

2000 ◽

Vol 14 (4) ◽

pp. 397-400 ◽

Cited By ~ 19

Author(s):

Athanasios D. Giannoukas ◽

Janet E. Dacie ◽

John S.P. Lumley

Keyword(s):

Varicose Veins ◽

Lower Limbs ◽

Ovarian Vein ◽

Recurrent Varicose Veins

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Minimally-invasive procedure for pelvic leak points in women

Veins and Lymphatics ◽

10.4081/vl.2019.7789 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Roberto Delfrate ◽

Massimo Bricchi ◽

Claude Franceschi

Keyword(s):

Surgical Treatment ◽

Minimally Invasive ◽

Lower Limb ◽

Varicose Veins ◽

Absorbable Suture ◽

Pelvic Congestion Syndrome ◽

Minimally Invasive Surgical ◽

Hemodynamic Assessment ◽

Pelvic Congestion

Pelvic leak points (PLP) may be responsible for vulvar, perineal and lower limb varicose veins, in women during and/or after pregnancy. The accurate anatomical and hemodynamic assessment of these points, the perineal (PP), inguinal (IP) and clitoral points (CP) and their surgical treatment under local anesthetics as defined by Claude Franceschi is a new therapeutic option. The aim of this study was to assess the reliability and durability of the PLP reflux ablation using a minimally-invasive surgical disconnection at the PLP level in women with varicose veins of the lower limbs fed by the PLP. In this open-label trial 273 pelvic leak points free of pelvic congestion syndrome, with at least a 12-month follow- up, were assessed. 273 PLP treated: PP (n=177), IP (n =91) and CP (n=5). Followup: Period =12 to 92 months (mean =30.51 months). Age from 29 to 77 years (mean=45). The only 3 patients over 70 years (71, 74, 77) showed a high-speed reflux from a I point that fed symptomatic varicose veins of the lower limb. Exclusion criteria: pelvic congestion syndrome, BMI>24, venous malformations, a post thrombotic varicose vein. Diagnosis was performed using echo duplex and PLPs selected for treatment when refluxing at Valsalva + Paraná + squeezing maneuvers. A surgical skin marking of the PLP had been performed using echo duplex before surgery. Surgery consisted of minimally invasive dissection and selective division and ligation with non-absorbable suture of the refluxing veins and fascias at the PP, IP and CP pelvic escape points, under local anesthesia in a single center. The follow-up consisted of an echo duplex ultrasound, searching for reflux at the PLP treated thanks to the Valsalva maneuver, within 2 weeks, after 6 and 12 months and then yearly. The main endpoint of the study was the immediate elimination of the reflux at the PLP treated. The second endpoint was the long-term durability of the reflux ablation at the PLP treated. 267 (97.8%) without PLP reflux redo. 6 (2.2%) PLP reflux recurrences (PP=4, IP=1, CP 1). 3 patients with PLP reflux recurrence undergo a redo surgery (1.1%) where PP=2 (0.7%) and IP=1 (0.3%). This study shows the feasibility and durability of reflux ablation at the PLP level thanks to a minimally-invasive surgical treatment of the PLP and it demonstrates that there is no need for pelvic varicose embolization in patients without clinical signs of pelvic congestion syndrome. The accurate ultrasound assessment of each specific pelvic leak as well as a special surgical technique (vein division, non-absorbable suture of veins and fascias) seems to be the key for satisfactory outcomes.

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An Inconvenient Truth: The Added Value of Transvaginal Imaging of the Internal Iliac and Adnexal Veins for Pelvic Congestion Syndrome

Journal for Vascular Ultrasound ◽

10.1177/1544316719870069 ◽

2019 ◽

Vol 43 (3) ◽

pp. 113-115

Author(s):

Michelle Walsh ◽

Mary Ahern ◽

Nazha Zahiri ◽

Angela David ◽

Shannon Lyons ◽

...

Keyword(s):

Varicose Veins ◽

Valsalva Maneuver ◽

Duplex Ultrasound ◽

Iliac Vein ◽

Added Value ◽

Intravenous Contrast ◽

Pelvic Congestion Syndrome ◽

Ultrasound Evaluation ◽

Internal Iliac ◽

Pelvic Congestion

Pelvic congestion syndrome is a chronic condition involving varicose veins in the pelvic area, resulting in dull aching pain, pelvic heaviness, palpable varicosities, and dyspareunia. The primary diagnostic modalities, computed tomography (CT) angiography and magnetic resonance (MR) angiography, can be time-consuming, expensive, and carry the risks of diagnostic radiation (CT) and intravenous contrast (CT and MR), and may not offer dynamic vascular information (CT). Recently, an increased role for ultrasound has been proposed in the diagnosis of pelvic congestion; however, the role of transvaginal (TV) duplex ultrasound has not been thoroughly investigated. Our study aims to evaluate the utility of a TV approach in the evaluation of valvular incompetence time (VIT) in seconds of the internal iliac and adnexal veins. A waiver of consent was granted by our Institutional Review Board for this retrospective review. A cohort of 36 women undergoing ultrasound evaluation for pelvic congestion syndrome was analyzed. Transvaginal and transabdominal (TA) images were obtained with reverse Trendelenburg positioning for imaging of the internal iliac veins with Valsalva maneuver to evaluate VIT, at the same visit, and the yield of each approach was compared for the presence of VIT. The number of vessels visualized, VIT, diagnostic success, and number of abnormal vessels were recorded. Between September 2018 and February 2019, 36 women underwent both TA and TV imaging. A total of 72 (100%) internal iliac veins were visualized by TV, but only 15 (21%) by TA. Of the 72 internal iliac veins imaged, 12 (17%) were shown to have valvular incompetence by TV exam, whereas only 2 (3%) were identified by TA, both of which were identified TV. Transabdominal images, when limited, were usually due to bowel gas. Transvaginal images had a higher yield for detection of internal iliac vein VIT, suggesting that the TV approach may be more sensitive and potentially more accurate versus a TA-only protocol.

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