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

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.

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

2010 ◽  
Vol 26 (1) ◽  
pp. 29-31 ◽  
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.

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

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.

Pelvic congestion syndrome: chronic pelvic pain caused by ovarian and internal iliac varices

2007 ◽  
Vol 22 (3) ◽  
pp. 100-104 ◽  
Author(s):  
A D Liddle ◽  
A H Davies
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Significant Proportion ◽  
Duplex Ultrasound ◽  
Childbearing Age ◽  
Pelvic Congestion Syndrome ◽  
Non Invasive ◽  
Internal Iliac ◽  
Mechanical Factors ◽  
Pelvic Congestion

Chronic pelvic pain is a common and disabling condition affecting women of childbearing age. A specific diagnosis for the condition is often difficult, and referred pain from the abdominal viscera, neurogenic and psychogenic factors have all been implicated, as have pelvic conditions such as endometriosis, pelvic inflammatory disease and ovarian cysts; no diagnosis is made in 60% of patients. Pelvic congestion syndrome (PCS), the presence of varices of the pelvic veins, has been shown to be the underlying aetiology in a significant proportion of patients with chronic pelvic pain; the development of these varices is caused by a combination of endocrine and mechanical factors. Given the positional nature of these varices, they are rarely diagnosed with conventional methods such as B-mode ultrasound and diagnostic laparoscopy. Diagnosis is best made with selective ovarian venography, although newer, non-invasive methods such as magnetic resonance imaging and duplex ultrasound are increasingly gaining favour. Pelvic varices are eminently treatable, either using ovarian suppression or by the ligation or embolization of the pelvic veins.

Successful Treatment of Pelvic Congestion Syndrome by Percutaneous Embolisation of Left Ovarian Vein

2015 ◽  
Vol 15 (1) ◽  
pp. 76-77
Author(s):  
Marija Petrovica ◽  
Ilze Strumfa ◽  
Svetlana Thora ◽  
Andrejs Vanags
Keyword(s):  
Young Women ◽  
Duplex Ultrasound ◽  
Transcatheter Embolization ◽  
Diagnostic Methods ◽  
Ovarian Vein ◽  
Digital Subtraction ◽  
Pelvic Congestion Syndrome ◽  
Ultrasound Evaluation ◽  
Venous Phase ◽  
Pelvic Congestion

Summary Pelvic congestion syndrome (PCS) is a frequently undiagnosed pathology, affecting mainly young women. According to literature, about one third of all women have this condition. The main symptoms include chronic pelvic pain, varicose pelvic veins, dysmenorrhea, and dyspareunia. The etiology of PCS is associated with valvular insufficiency in ovarian and pelvic veins. There are four main diagnostic methods: duplex ultrasound evaluation, computed tomography, magnetic resonance angiography including venous phase investigation and digital subtraction angiography. Nowadays percutaneous transcatheter embolization is an effective and safe treatment for ovarian vein reflux and thus PCS. In order to emphasize the need and possibilities to diagnose and treat PCS appropriately, here we present a well-documented case of PCS that was successfully cured by percutaneous transcatheter embolization.

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.

Sign in / Sign up

Export Citation Format

Share Document