Gonadal Vein Embolization: Treatment of Varicocele and Pelvic Congestion Syndrome

Objective To evaluate phase-contrast velocity mapping (PCVM) as a diagnostic tool for pelvic congestion syndrome and comparing this approach with direct venography. Method We prospectively include nine women with clinical suspicion of pelvic congestion syndrome during a six-month period. All patients underwent a magnetic resonance phase-contrast scan before a direct venography. We considered a case of pelvic congestion syndrome when the PCVM showed a retrograde or slow (less than 5 cm/second) flow in any gonadal vein. This criterion was compared with the standard diagnostic criterion observed from a direct venography. Results Using direct venography we found 14 abnormal veins and all of them were correctly identified by the PCVM. The other four veins were found to be normal by the direct venography. However, two of them (the same patient) were abnormal in the PCVM, even though this patient had the classical symptoms of pelvic congestion syndrome. Conclusion PCVM is a useful tool for diagnosing pelvic contrast syndrome and can avoid invasive procedures such as direct venography.

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4:03 PM Abstract No. 368 Nutcracker syndrome as a cause of recurrent symptoms in pelvic congestion syndrome patients who underwent gonadal vein embolization

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2018.01.408 ◽

2018 ◽

Vol 29 (4) ◽

pp. S158

Author(s):

N. Viradia ◽

D. Middleton ◽

W. Pabon-Ramos ◽

D. Sopko ◽

M. Miller ◽

...

Keyword(s):

Nutcracker Syndrome ◽

Pelvic Congestion Syndrome ◽

Gonadal Vein ◽

Pelvic Congestion

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Role of trans-abdominal and trans-perineal venous duplex ultrasound in cases of pelvic congestion syndrome

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0099-3 ◽

2019 ◽

Vol 50 (1) ◽

Author(s):

Ahmed A. Baz

Keyword(s):

Left Renal Vein ◽

Duplex Ultrasound ◽

Iliac Vein ◽

Round Ligament ◽

Common Iliac Vein ◽

Pelvic Congestion Syndrome ◽

Gonadal Vein ◽

Mean Diameter ◽

Pelvic Congestion

Abstract Background For evaluation the role of trans-abdominal and trans-perineal venous duplex ultrasound in cases of pelvic congestion syndrome, fifty patients with pelvic congestion syndrome were included in the current research. All were evaluated by trans-abdominal and trans-perineal venous duplex. Results An incompetent left gonadal vein was detected in all cases with a mean diameter (± SD) = 7.9 ± 1.1 mm. The right gonadal vein was incompetent in 4 cases (8%) with a mean diameter (± SD) 5.9 ± 0.4 mm. A refluxing proximal internal iliac vein was detected in 3cases (6%). Left renal vein nutcracker was present in 41cases (82%) while the left common iliac vein compression was present in 3 cases (6%). Vulvoperineal varicosities were seen in all cases {right side = (36%, n = 18), left side = (30%, n = 15), and bilateral = (34%, n = 17)}.Thigh extension of the vulvoperineal varicosities was present in (74%, n = 37). Round ligament varicosities were present in (6%, n = 3). Conclusions Trans-abdominal and trans-perineal venous duplex offer a simple, noninvasive, and quick technique that can help in an accurate evaluation of the ovarian vein reflux, diameters as well as the presence of vulvoperineal, and round ligament varicosities, Moreover, it is useful in the assessment of the left renal and iliac veins compression.

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A Randomized Trial of Endovascular Embolization Treatment in Pelvic Congestion Syndrome: Fibered Platinum Coils versus Vascular Plugs with 1-Year Clinical Outcomes

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2017.09.011 ◽

2018 ◽

Vol 29 (1) ◽

pp. 45-53 ◽

Cited By ~ 9

Author(s):

Jose A. Guirola ◽

Maria Sánchez-Ballestin ◽

Sergio Sierre ◽

Celia Lahuerta ◽

Victoria Mayoral ◽

...

Keyword(s):

Randomized Trial ◽

Clinical Outcomes ◽

Endovascular Embolization ◽

Pelvic Congestion Syndrome ◽

Embolization Treatment ◽

Platinum Coils ◽

Pelvic Congestion

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Atypical presentations and treatment variations of pelvic congestion syndrome: A four patient case series

F1000Research ◽

10.12688/f1000research.10477.1 ◽

2016 ◽

Vol 5 ◽

pp. 2906

Author(s):

David Greuner ◽

Andrew Amorosso ◽

Arno Rotgans ◽

Chris Hollingsworth ◽

Adam Tonis

Keyword(s):

Case Series ◽

Duplex Ultrasound ◽

Chronic Lower Back Pain ◽

Case Review ◽

Retrospective Case ◽

Pelvic Congestion Syndrome ◽

Atypical Symptoms ◽

Gonadal Vein ◽

Atypical Presentations ◽

Pelvic Congestion

This is a retrospective case review of four patients randomly selected from a pool of 43 patients who presented to our practice with historically atypical symptoms for pelvic congestion syndrome, and the treatment they received. These 43 patients were treated between June and December of 2016. Each patient presented with various atypical symptoms including chronic lower back pain, urinary frequency and incontinence, hip pain, tenesmus, and uncontrollable flatulence. Diagnostic abdominal and pelvic duplex ultrasound and fluoroscopic venography was performed on all patients with informed consent. The four selected patients for this study were all positive for pelvic venous reflux, pelvic venous insufficiency and ovarian/gonadal vein reflux and varicosities. All four of the patients selected in this retrospective study were examined at 1 week from date of intervention and again at 1 month from date of intervention. At the 1 week postoperative exam all four patients had experienced significant resolution of their symptoms, although all had residual congestion present on their right side. After re-intervention to treat right sided congestion via the right gonadal vein, at the 1 month postoperative exam all four patients had experienced an almost complete resolution of symptoms.

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Pelvic congestion syndrome is an interdisciplinary issue

Russian Journal of Woman and Child Health ◽

10.32364/2618-8430-2021-4-4-346-350 ◽

2021 ◽

Vol 4 (4) ◽

pp. 346-350

Author(s):

E.Yu. Antropova ◽

◽

B.M. Sharafutdinov ◽

M.I. Mazitova ◽

E.A. Gaziev ◽

...

Keyword(s):

Primary Care Physicians ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Diagnostic Tools ◽

Venous Plexus ◽

Surgical Interventions ◽

Pelvic Congestion Syndrome ◽

Gonadal Vein ◽

And Child Health ◽

Pelvic Congestion

This paper discusses an essential interdisciplinary issue, pelvic congestion syndrome (PGS). PGS is a venous disorder with gonadal vein and/or pelvic venous plexus dilation that results in pelvic venous plethora. The authors address PGS prevalence, causes, underlying pathophysiological mechanisms, major clinical manifestations, diagnostic tools, and treatment approaches. Pharmacotherapy (gonadotropin-releasing hormone agonists, danazol, combined oral contraceptives, progestins, phlebotonics, etc.) is the first-line treatment that provides only a temporary effect. Image-guided vascular surgery (embolization, stenting) is of particular importance among surgical interventions. Surgical technique and critical results of the studies on the efficacy of gonadal vein embolization (from 47% to 100%) are described. The paper details major complications of surgical interventions and highlights issues requiring further researches, i.e., the effects on female fertility, predicted full recovery considering compromised somatic and/or gynecological anamnesis. Finally, the importance of timely diagnosis, greater awareness of primary care physicians on the signs and symptoms of this disorder, and a need to refer these women to vascular surgeons are addressed. KEYWORDS: pelvic congestion syndrome, gonadal vein embolization, pelvic pain, May–Thurner syndrome, nutcracker syndrome. FOR CITATION: Antropova E.Yu., Sharafutdinov B.M., Mazitova M.I. et al. Pelvic congestion syndrome is an interdisciplinary issue. Russian Journal of Woman and Child Health. 2021;4(4):346–350 (in Russ.). DOI: 10.32364/2618-8430-2021-4-4-346-350.

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Pelvic congestion syndrome and left renal compression syndrome - clinical features and therapeutic approaches

VASA ◽

10.1024/0301-1526/a000538 ◽

2016 ◽

Vol 45 (4) ◽

pp. 275-282 ◽

Cited By ~ 8

Author(s):

Christina Jeanneret ◽

Konstantin Beier ◽

Alexander von Weymarn ◽

Jürg Traber

Keyword(s):

Varicose Veins ◽

Left Renal Vein ◽

Standing Position ◽

Ovarian Vein ◽

Pelvic Congestion Syndrome ◽

Compression Syndrome ◽

Abstract Knowledge ◽

Increased Risk ◽

Definition Of ◽

Pelvic Congestion

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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