scholarly journals Pelvic Congestion Syndrome: A Missed Opportunity

2021 ◽  
Author(s):  
Claire Kaufman ◽  
Nancy Ann Little
Keyword(s):  
Pelvic Pain ◽  
Clinical Symptoms ◽  
Local Population ◽  
Complex Nature ◽  
Imaging Findings ◽  
Pelvic Congestion Syndrome ◽  
Average Body Mass ◽  
N 93 ◽  
Pelvic Congestion

Abstract Background/Aims Chronic pelvic pain (CPP) is pelvic pain for greater than 6 months with many potential causes one being pelvic congestion syndrome (PCS). PCS is diagnosed by clinical symptoms, exclusion of other etiologies, and imaging. Given the complex nature and diagnosis of CPP, we examined ordering and referral patterns in our local population to understand how the imaging findings of PCS correlate with patient symptoms and referral and treatment. Materials and Methods After IRB approval, we searched all 18 to 70-year-old females with CT of the pelvis between March 2015 and March 2018 with the terms “pelvic” plus “congestion,” “varices,” or “vein dilation” in the dictation. Via electronic medical record and image review we collected data regarding demographics, clinical presentation, symptoms, imaging findings, ordering provider, and any follow-up/referrals or interventions regarding PCS. Results A total of 96 patients were included of the 197 studies, with an average age of 47 years and average body mass index of 19.3 (n = 93) at the time of imaging. The reason for imaging was often acute abdominal or flank pain (n = 22) with 38% of cases ordered from the emergency room. Only 72 patients had documentation of clinical evaluation for symptoms of PCS. Notably, only 20 were referred for their symptoms, and only two patients were referred to IR. Both patients underwent successful endovascular intervention. Conclusion CPP is a common cause of morbidity with PCS representing an underdiagnosed cause. We demonstrate that while imaging findings may be incidental, we are failing to capture and triage patients with clinical symptoms of PCS. Radiologists can play a key role in the care of these patients.

scholarly journals Ovarian Vein Embolization with N-butyl-2 Cyanoacrylate Glubran-2® for the Treatment of Chronic Pelvic Pain Secondary to Pelvic Congestion Syndrome

2020 ◽  
Author(s):  
Maofeng Gong ◽  
Xu He ◽  
Boxiang Zhao ◽  
Jie Kong ◽  
Haobo Su
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Symptom Relief ◽  
Attractive Alternative ◽  
Ovarian Vein ◽  
Medical Database ◽  
Pelvic Congestion Syndrome ◽  
Glubran 2 ◽  
Pelvic Congestion

Abstract Objective: To evaluate the safety and efficacy of ovarian vein embolization using N- butyl-2 cyanoacrylate (NBCA) Glubran-2® in the treatment of chronic pelvic pain (CPP) secondary to pelvic congestion syndrome (PCS).Materials and Methods: Between January 2013 and June 2019, seven wo-men (mean age, 45.6±15.9 y) presenting with CPP secondary to PCS were evaluated for ovarian vein embolization with Glubran-2®. PCS was initially diagnosed by transva-ginal Doppler Ultrasound or CT and further confirmed by pelvic venography. Medical database was retrospectively reviewed.Results: Glubran-2 was employed as a sole embolic material in two cases, four cases subsequently underwent added microcoils in the opening of varicose ovarian vein trunk during the same procedure. Secondary embolization was achieved in one case due to CPP recurrence one month after initial embolization with microcoils. Technical success of ovarian vein embolization with Glubran-2 was achieved in all patients. There were no Glubran-2 related complications mid procedure and postintervention. With mean 62±40 months (range, 12-102 months) follow-up, neither persistent nor recurrent CPP was observed. Clinical efficacy was evaluated on the 1st, 3rd, 6th, 12th months, complete or slight improvement of CPP after embolization were achieved in all patients. VAS score used to identify preintervention and postintervention significantly decreased (p<0.001). Two patients after Glubran-2 embolization gave birth to a healthy baby during follow-up.Conclusions: Ovarian vein embolization with Glubran-2 is a feasible and safe treatment of CPP secondary to PCS. In particularly, it appears to be a potential and attractive alternative when patients with the desires of symptom relief and reproduction.

Pelvic Congestion Syndrome: Surgical Treatment

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Zekilah SR ◽  
◽  
Sallam EM ◽  
Mashaal AB ◽  
Ageez MN ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pelvic Pain ◽  
Varicose Veins ◽  
University Hospital ◽  
Pelvic Congestion Syndrome ◽  
Pain Scores ◽  
Internal Iliac ◽  
Work Up ◽  
Pelvic Congestion

Aims: To evaluate the mid and long term efficacy of surgical interruption of the refluxing ovarian veins as a treatment modality for pelvic congestion syndrome. Study Design: A prospective non comparative interventional study. Place and Duration of Study: This study was conducted between February 2015 and October 2019 in Alexandria Medical Centre and Tanta Main University Hospital. Methodology: The study included a 27 patient’s undergone surgical interruption of refluxing ovarian veins with or without sclerotherapy of vulval, perineal or thigh varices, and data were collected prospectively. Detailed history was taken and clinical examination was done for every patient along with routine laboratory investigations and radiological work up was transvaginal and abdominal venous duplex. Follow up was done considering the change in pelvic venous images and pelvic pain scores in comparison to the pre-operative state. Results: Twenty seven female patients were treated for pelvic congestion syndrome using single session surgical intervention with or without sclerotherapy to pudendal varices. The patients age ranged from 21 to 43 (mean 33.1). All patients presented with chronic continuous pelvic pain. Other associated symptoms as dyspareunia, dysmenorrhea and pudendal varices were found in some cases. Surgical ligation of the ovarian veins were done to all cases, sclerotherapy/ligation of internal iliac varices was done for 6 cases and scerotherapy or surgical interruption of pudendal or thigh varicose veins was done in 21 cases. Technical success was achieved in all patients. Mean pelvic pain score was improved from 7.33 preoperatively to 1.33 and 0.89 in 6 and 12 months of the post-operative recordings. On sonographic basis pelvic reflux disappeared in 26 patients by the end of the follow up. Out of 27 patients treated there were 24 patients satisfied of the procedures at the end of the follow up. Conclusion: Surgical treatment for pelvic congestion syndrome combined with sclerotherapy to the associated varices was found to be effective, safe and affordable modality of treatment.

Pelvic pain syndrome caused by ovarian varices

1997 ◽  
Vol 38 (6) ◽  
pp. 1023-1025 ◽  
Author(s):  
P. G. Tarazov ◽  
K. V. Prozorovskij ◽  
V. K. Ryzhkov
Keyword(s):  
Chronic Pain ◽  
Pelvic Pain ◽  
Clinical Effect ◽  
Pain Syndrome ◽  
Therapeutic Embolization ◽  
Pelvic Pain Syndrome ◽  
Percutaneous Embolization ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Congestion

Purpose: the aim of this study was to evaluate the clinical effect of therapeutic embolization in the pelvic congestion syndrome caused by ovarian varices Material and Methods: Six women, aged 25–40 years, with pelvic pain syndrome and marked left (n=5) or bilateral (n=1) ovarian varicocele were treated by transcatheter retrograde venous embolization Results: the pelvic pain syndrome disappeared in all patients within 4 weeks, and there was regression of the periodic pain in 2 women with dysmenorrhoea. the patients were free of symptoms during the 1–4-year follow-up Conclusion: Marked ovarian varices may cause a pelvic pain syndrome. Percutaneous embolization improves both the chronic pain and the dysmenorrhea in these patients. Transcatheter treatment could be considered as an alternative to surgical or laparoscopic ligation in ovarian varicocele

scholarly journals Pelvic Congestion Syndrome: Systematic Review of Treatment Success

2018 ◽  
Vol 35 (01) ◽  
pp. 035-040 ◽  
Author(s):  
Magda Rizer ◽  
Ryan Alexander ◽  
Emerson Sharpe ◽  
Paul Rochon ◽  
Candace Brown
Keyword(s):  
United States ◽  
Systematic Review ◽  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Treatment Success ◽  
Percutaneous Treatment ◽  
The United States ◽  
Pelvic Congestion Syndrome ◽  
Venous Dilatation ◽  
Pelvic Congestion

AbstractPelvic venous insufficiency is now a well-characterized etiology of pelvic congestion syndrome (PCS). The prevalence of CPP is 15% in females aged 18 to 50 years in the United States and up to 43.4% worldwide. In addition to individual physical, emotional, and quality-of-life implications of CPP, there are profound healthcare and socioeconomic expenses with estimated annual direct and indirect costs in the United States in excess of 39 billion dollars. PCS consists of clinical symptoms with concomitant anatomic and physiologic abnormalities originating in venous insufficiency. The etiology of PCS is diverse involving both mechanical and hormonal factors contributing to venous dilatation (>5 mm) and insufficiency. Factors affecting the diagnosis of PCS include variance of causes and clinical presentations of pelvic pain and relatively low sensitivity of noninvasive diagnostic imaging and laparoscopy to identify insufficiency compared with catheter venogram. A systematic review of the literature evaluating patient outcomes following percutaneous treatment of PCS is presented.

scholarly journals Non-resolving Findings in a Long-term Radiographic Follow-up of an Infant with Acute Paraffin Oil Aspiration

2014 ◽  
Vol 4 ◽  
pp. 2 ◽  
Author(s):  
George Stathis ◽  
Konstantinos N. Priftis ◽  
Maria Moustaki ◽  
Efthymia Alexopoulou
Keyword(s):  
Clinical Symptoms ◽  
Male Infant ◽  
Mineral Oil ◽  
Imaging Findings ◽  
Radiological Findings ◽  
Lipoid Pneumonia ◽  
Paraffin Oil ◽  
Computed Tomography Scans

Acute lipoid pneumonia (LP) in children is a rare disorder caused by the aspiration of oil-based substances and is difficult to diagnose due to non-specific clinical symptoms and radiological findings. We report the case of a 5-month-old male infant with acute LP caused by accidental aspiration of a large amount of mineral oil. We present the imaging findings in the computed tomography scans performed during his hospitalization and focus on the residual abnormalities seen on a scan performed 7-years after the incident. This, to the best of our knowledge, is the longest follow-up report of an acute exogenous LP patient and the only case that demonstrates non-resolving abnormalities in a pediatric patient after a single acute episode of mineral oil aspiration.

The Outcome of Treatment for Pelvic Congestion Syndrome

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 74-77 ◽  
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.

scholarly journals Minimally-invasive procedure for pelvic leak points in women

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.

Compression treatment of pelvic congestion syndrome

2017 ◽  
Vol 33 (6) ◽  
pp. 418-424 ◽  
Author(s):  
SG Gavrilov ◽  
AV Karalkin ◽  
OO Turischeva
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Clinical Manifestations ◽  
Class Ii ◽  
Emission Computed Tomography ◽  
Compression Stockings ◽  
Pelvic Congestion Syndrome ◽  
Compression Treatment ◽  
Positive Effect ◽  
Pelvic Congestion

Aim To study the influence of compression treatment on clinical manifestations and venous hemodynamics of the pelvis in patients with pelvic congestion syndrome. Materials and methods A prospective study of the various options and modes of compression treatment was carried out and included 74 patients with pelvic congestion syndrome in 2008–2015. The patients were divided into three groups. The first group consisted of 48 patients with symptoms of pelvic congestion syndrome and chronic pelvic pain. They used Class II compression shorts. In the second group, there were 14 patients with pelvic congestion syndrome, vulvar varicosities without pelvic pain. They used Class II compression shorts and stockings. In the third group, 12 women with pelvic congestion syndrome and chronic pelvic pain used only the Class II compression stockings. The treatment continued for 14 days. A clinical criterion was the change of severity of chronic pelvic pain. The evaluation of the treatments has been performed using radionuclide venography and emission computed tomography with labeled in vivo red blood cells. Results Group 1: The compression shorts had a positive effect on the disease in 81.3% of patients. Chronic pelvic pain decreased from 6.4 ± 1.6 to 1.2 ± 0.7 points. The coefficient of pelvic congestion syndrome (Cpcs) decreased from 1.73 ± 0.32 to 1.12 ± 0.27 (p < 0.05). In 18.8% of patients, no positive effect was observed. Group 2: The results of radionuclide venographyshowed accelerating outflow of blood from the lower limbs and reduction of insufficiency of perforating veins. Mean radionuclide transit time decreased in all patients in the tendon, muscle pump parts, popliteal vein and was respectively: 23.6 ± 2.2 s, 29.6 ± 3.4 s, 32.3 ± 4.2 s and after treatment 16.4 ± 3.1 s, 22.1 ± 2.5 s, 25.7 ± 1.9 s (p < 0.05). Group 3: The use of compression stockings class II on the clinical manifestations of pelvic congestion syndrome in the patients. Cpcs also remained unchanged. Conclusion Research has shown the efficiency of class II compression shorts in the treatment of patients with isolated extension of intrapelvic venous plexuses. Class II compression stockings do not have any impact on the clinical manifestations of pelvic congestion syndrome.

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