The effect of a subsequent pregnancy after transjugular coil embolisation for pelvic vein reflux

2016 ◽  
Vol 32 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Scott J Dos Santos ◽  
Judy M Holdstock ◽  
Charmaine C Harrison ◽  
Mark S Whiteley
Keyword(s):  
Varicose Veins ◽  
Iliac Vein ◽  
Subsequent Pregnancy ◽  
Duplex Ultrasonography ◽  
Venous Reflux ◽  
Coil Embolisation ◽  
Recurrent Reflux ◽  
Pelvic Vein ◽  
Internal Iliac ◽  
The Right

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.

scholarly journals Suprapubic varicose vein formation during pregnancy following pre-pregnancy pelvic vein embolisation with coils, without any residual pelvic venous reflux or obstruction

2017 ◽  
Vol 5 ◽  
pp. 2050313X1772471 ◽  
Author(s):  
Emma Dabbs ◽  
Jaya L Nemchand ◽  
Mark S Whiteley
Keyword(s):  
Varicose Vein ◽  
Varicose Veins ◽  
Iliac Vein ◽  
Subsequent Pregnancy ◽  
Common Iliac Vein ◽  
Venous Reflux ◽  
Foam Sclerotherapy ◽  
Pelvic Vein ◽  
Vein Formation ◽  
Collateral Vein

Suprapubic varicose veins are usually indicative of unilateral iliac vein occlusion and venous collateralisation. We report two cases of suprapubic varicose veins following pelvic vein embolisation and subsequent pregnancy; both presented without residual pelvic venous reflux or pelvic venous obstruction. In both cases, there was no significant flow in the suprapubic veins indicating that they were not acting as a collateral post-pregnancy. One patient had this venous abnormality treated successfully with TRansluminal Occlusion of Perforators, followed by foam sclerotherapy to the main part of the suprapubic vein. This patient has since completed the reminder of her lower limb varicose vein treatment. We suggest that pregnancy may have caused prolonged intermittent compression of the left common iliac vein, and that this, together with the physiological impact of previous embolisation procedures, obstructed venous drainage from the left leg resulting in collateral vein formation within the 9-month gestation period.

Haemorrhoids are associated with internal iliac vein reflux in up to one-third of women presenting with varicose veins associated with pelvic vein reflux

2014 ◽  
Vol 30 (2) ◽  
pp. 133-139 ◽  
Author(s):  
JM Holdstock ◽  
SJ Dos Santos ◽  
CC Harrison ◽  
BA Price ◽  
MS Whiteley
Keyword(s):  
Varicose Veins ◽  
Strong Association ◽  
Duplex Ultrasound ◽  
Iliac Vein ◽  
Venous Reflux ◽  
Foam Sclerotherapy ◽  
Pelvic Vein ◽  
Internal Iliac Vein ◽  
Internal Iliac ◽  
Vein Reflux

Objectives: To determine the prevalence of haemorrhoids in women with pelvic vein reflux, identify which pelvic veins are associated with haemorrhoids and assess if extent of pelvic vein reflux influences the prevalence of haemorrhoids. Methods: Females presenting with leg varicose veins undergo duplex ultrasonography to assess all sources of venous reflux. Those with significant reflux arising from the pelvis are offered transvaginal duplex ultrasound (TVS) to evaluate reflux in the ovarian veins and internal Iliac veins and associated pelvic varices in the adnexa, vulvar/labial veins and haemorrhoids. Patterns and severity of reflux were evaluated. Results: Between January 2010 and December 2012, 419 female patients with leg or vulvar varicose vein patterns arising from the pelvis underwent TVS. Haemorrhoids were identified on TVS via direct tributaries from the internal Iliac veins in 152/419 patients (36.3%) and absent in 267/419 (63.7%). The prevalence of the condition increased with the number of pelvic trunks involved. Conclusion: There is a strong association between haemorrhoids and internal Iliac vein reflux. Untreated reflux may be a cause of subsequent symptomatic haemorrhoids. Treatment with methods proven to work in conditions caused by pelvic vein incompetence, such as pelvic vein embolisation and foam sclerotherapy, could be considered.

scholarly journals Endovascular Treatment of Pelvic Congestion Syndrome: Visual Analog Scale Follow-Up

2021 ◽  
Vol 8 ◽  
Author(s):  
Quentin Senechal ◽  
Perrine Echegut ◽  
Marine Bravetti ◽  
Marie Florin ◽  
Lamia Jarboui ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lower Limb ◽  
Iliac Vein ◽  
Pelvic Vein ◽  
Internal Iliac Vein ◽  
Internal Iliac ◽  
The Right ◽  
Pelvic Congestion

Purpose: To evaluate medium-term clinical outcomes of transcatheter embolization and stenting in women with several pelvic venous disorders responsible for chronic pelvic pain and varicose veins of the lower limbs.Materials and Methods: The study population included 327 consecutively recruited patients referred to the interventional radiology unit from January 2014 to December 2019 due to chronic pelvic congestion (91; 27.83%), lower limb varices (15; 4.59%), or a combination of both the symptoms (221; 67.58%). Preprocedural pelvic, transvaginal Doppler ultrasound (US), and MRI were conducted in all the patients and revealed anatomical varicosities and incompetent pelvic veins in 312 patients. In all the patients, selective catheterization demonstrated uterine venous engorgement, ovarian plexus congestion, or pelvic vein filling. Retrograde flow was detected on catheter venography in the left ovarian vein (250; 78%), the right ovarian vein (85; 26%), the left internal iliac vein (222; 68%), and the right internal iliac vein (185; 57%). Patients were followed-up at 1, 6, and 12 months, and years thereafter systematically by the referring angiologist and the interventional radiologist of center. They were contacted by telephone in November and December 2020 to assess pain perception and quality of life by using the visual analog scales from 0 to 10 with assessments made at the baseline and last follow-up. Of the 327 patients (mean age, 42 ± 12 years), 312 patients were suffering from pelvic congestion syndrome and 236 patients was suffering from lower limb varices. All underwent embolization by using ethylene vinyl alcohol copolymer (Onyx®). Eighty-five right ovarian veins, 249 left ovarian veins, 510 tributaries of the right internal iliac vein, and 624 tributaries of the left internal iliac vein were embolized. A cohort of patients also underwent nutcracker syndrome angioplasty (6.7%) and May–Thurner syndrome angioplasty (14%) with a stent placement.Results: The initial technical success rate was 80.9% for embolization of pathological veins and 100% for stenting of stenoses. Overall, 307 patients attended 12-month follow-up visits and 288 (82%) patients completed the telephone survey at mean 39 (±18)-month postintervention. Main pelvic pain significantly improved from 6.9 (±2.4) pre- to 2.0 (±2.4) postembolization (p < 0.001), as did specific symptoms in each category. Improvement or disappearance of pain was achieved in 266/288 (92.36%) patients with improved quality of life in 276/288 (95.8%) patients. There were 16 minor and 4 major adverse events reported on the follow-up.Conclusion: Pelvic vein embolization (Onyx®) is an effective and safe procedure with high clinical success and quality of life improvement rates.

Long-term results of transjugular coil embolisation for pelvic vein reflux – Results of the abolition of venous reflux at 6–8 years

2016 ◽  
Vol 31 (7) ◽  
pp. 456-462 ◽  
Author(s):  
Scott J Dos Santos ◽  
Judy M Holdstock ◽  
Charmaine C Harrison ◽  
Mark S Whiteley
Keyword(s):  
Varicose Veins ◽  
Long Term Results ◽  
Duplex Ultrasonography ◽  
Venous Reflux ◽  
Pelvic Vein ◽  
Post Procedure ◽  
Long Term Follow Up ◽  
One Year

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.

Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women

2014 ◽  
Vol 30 (10) ◽  
pp. 706-713 ◽  
Author(s):  
MS Whiteley ◽  
SJ Dos Santos ◽  
CC Harrison ◽  
JM Holdstock ◽  
AJ Lopez
Keyword(s):  
False Positive ◽  
Gold Standard ◽  
False Negative ◽  
Duplex Ultrasonography ◽  
Coil Embolisation ◽  
Pelvic Vein ◽  
False Positive Diagnosis ◽  
Internal Iliac ◽  
Pre Treatment ◽  
Vein Reflux

Objectives To assess the suitability of transvaginal duplex ultrasonography to identify pathological reflux in the ovarian and internal iliac veins in women. Methods A retrospective study of patients treated in 2011 and 2012 was performed in a specialised vein clinic. Diagnostic transvaginal duplex ultrasonography in women presenting with symptoms or signs of pelvic vein reflux were compared with the outcomes of treatment from pelvic vein embolisation. A repeat transvaginal duplex ultrasonography was performed 6 weeks later by a blinded observer and any residual reflux was identified. Results Results from 100 sequential patients were analysed. Mean age 44.2 years (32–69) with mode average parity of 3 (0–5 deliveries). Pre-treatment, 289/400 veins were refluxing (ovarian – 29 right, 81 left; internal iliac – 93 right, 86 left). Coil embolisation was successful in 86/100 patients and failed partially in 14/100 – 5 due to failure to cannulate the target vein. One false-positive diagnosis was made. Conclusion Currently there is no accepted gold standard for pelvic vein incompetence. Comparing transvaginal duplex ultrasonography with the outcome from selectively treating the veins identified as having pathological reflux with coil embolisation, there were no false-negative diagnoses and only one false-positive. This study suggests that transvaginal duplex ultrasonography could be the gold standard in assessing pelvic vein reflux.

Pelvic venous reflux in males with varicose veins and recurrent varicose veins

2017 ◽  
Vol 33 (6) ◽  
pp. 382-387 ◽  
Author(s):  
Emma B Dabbs ◽  
Scott J Dos Santos ◽  
Irenie Shiangoli ◽  
Judith M Holdstock ◽  
David Beckett ◽  
...  
Keyword(s):  
Varicose Vein ◽  
Lower Limb ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Duplex Ultrasonography ◽  
Pelvic Vein ◽  
Male Cohort ◽  
Internal Iliac ◽  
Bilateral Lower Limb ◽  
Vein Reflux

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.

Anatomical abnormalities of the pelvic venous system and their implications for endovascular management of pelvic venous reflux

2017 ◽  
Vol 33 (8) ◽  
pp. 567-574 ◽  
Author(s):  
David Beckett ◽  
Scott J Dos Santos ◽  
Emma B Dabbs ◽  
Irenie Shiangoli ◽  
Barrie A Price ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Venous Reflux ◽  
Venous Anatomy ◽  
Pelvic Vein ◽  
Internal Iliac ◽  
Anatomy Knowledge

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.

scholarly journals Considerations on the caliber of the internal iliac vein

2015 ◽  
Vol 21 (1) ◽  
pp. 12-16 ◽  
Author(s):  
Oana Popa ◽  
P. Bordei ◽  
C. Ionescu ◽  
D.M. Iliescu
Keyword(s):  
Iliac Vein ◽  
Statistical Distribution ◽  
Common Iliac Vein ◽  
Internal Iliac Vein ◽  
Distribution Of Values ◽  
Internal Iliac ◽  
The Common ◽  
The Right

Abstract The diameter at the origin of the internal iliac vein was found between 4.7 to 9.9 mm; for the right internal iliac vein between 4.7 to 9.7 mm; the statistical distribution groups value in ascending order being as follows: 4.7 to 5.5 mm: 4 cases (22.22% of cases); 6.9 to 7.8 mm: 6 cases (33.33% of cases); 8.4-8.8 mm: 4 cases (22.22% of cases); 9.1 to 9.7 mm: 4 cases (22.22% of cases). The diameter at the origin of the left internal iliac vein was between 4.8 to 9.9 mm, while the distribution statistics on groups of values, in ascending order, being as follows: 4.8-5.2 mm: 4 cases (22.22 % of cases); 6.8-7.1 mm: 8 cases (44.44% of cases); 8.3 to 9.9 mm: 6 cases (33.33% of cases). The diameter at the end of the internal iliac vein was between 5.9 to 10.2 mm; the diameter at the end of the right internal iliac vein was between 6.1 to 10.2 mm, the statistical distribution of values groups in ascending order being follows: 6.1 to 7.5 mm: 6 cases (33.33% of cases); 8.4 to 8.7 mm: 8 cases (44.44% of cases); 9.3 to 10.2 mm: 4 cases (22.22% of cases). The diameter at the end of the left internal iliac vein was between 5.9 to 9.9 mm, while the distribution statistics on groups of values in ascending order being as follows: 5.9 to 6.2 mm: 4 cases (22.22 % of cases); 7 to 7.6 mm: 3 cases (16.67% of cases); 8.3-8.4 mm: 5 cases (27.28% of cases); 9.1 to 9.9 mm: 6 cases (33.33% of cases). Comparing the common iliac vein caliber of the two, right and left, we found that in 10 cases (55.56% of cases), the right internal iliac vein has a greater diameter than the left one by 0.3 mm. In 8 cases (44.44% of cases), the left internal iliac vein has a larger diameter than the right one with 0.1-0.6 mm; between the two values there is a difference of 0.5 mm

Strip-tract revascularization as a source of recurrent venous reflux following high saphenous tie and stripping: results at 5–8 years after surgery

2014 ◽  
Vol 30 (8) ◽  
pp. 569-572 ◽  
Author(s):  
Alexandra E Ostler ◽  
Judy M Holdstock ◽  
Charmaine C Harrison ◽  
Barrie A Price ◽  
Mark S Whiteley
Keyword(s):  
Response Rate ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasonography ◽  
Venous Reflux ◽  
Primary Varicose Veins ◽  
And Inversion ◽  
Saphenofemoral Junction ◽  
Subfascial Endoscopic Perforator Surgery

Objective We have previously reported strip-tract revascularization 1 year following high saphenous ligation and inversion stripping. This study reports the 5–8 year results in the same cohort. Methods Between 2000 and 2003, 72 patients presented with primary varicose veins and had undergone high saphenous ligation and inversion stripping plus phlebectomies with or without subfascial endoscopic perforator surgery. Of the 64 patients who had attended for follow-up at 1 year, 35 patients (male:female, 16:19; 39 legs) underwent duplex ultrasonography 5–8 years after surgery (response rate 55%). Duplex ultrasonography was performed and all strip-tract revascularization and reflux and groin neovascularization was documented. Results Eighty-two percent of legs of patients showed some evidence of strip-tract revascularization and reflux. Full and partial strip-tract revascularization and reflux was seen in 12.8% and 59% of limbs of patients, respectively, and 10.2% limbs of patients had neovascularization only at the saphenofemoral junction only. Seven limbs of patients showed no revascularization. Conclusion Five to eight years after high saphenous tie and stripping, 82% of legs of patients showed some strip-tract revascularization and reflux and 12% showed total revascularization and reflux of the stripped great saphenous vein.

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