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.

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

VASA ◽  
2016 ◽  
Vol 45 (4) ◽  
pp. 275-282 ◽  
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.

Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux

2009 ◽  
Vol 24 (4) ◽  
pp. 183-188 ◽  
Author(s):  
P Chapman-Smith ◽  
A Browne
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Adverse Outcomes ◽  
Patient Acceptance ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Clinical Recurrence ◽  
Over Time

Objectives The purpose of this study was to determine the long-term efficacy, safety and rate of recurrence for varicose veins associated with great saphenous vein (GSV) reflux treated with ultrasound-guided foam sclerotherapy (UGFS). Methods A five-year prospective study was performed, recording the effect on the GSV and saphenofemoral junction (SFJ) diameters, and reflux in the superficial venous system over time. UGFS was the sole treatment modality used in all cases, and repeat UGFS was performed where indicated following serial annual ultrasound. Results No serious adverse outcomes were observed – specifically no thromboembolism, arterial injection, anaphylaxis or nerve damage. There was a 4% clinical recurrence rate after five years, with 100% patient acceptance of success. Serial annual duplex ultrasound demonstrated a significant reduction in GSV and SFJ diameters, maintained over time. There was ultrasound recurrence in 27% at 12 months, and in 64% at five years, including any incompetent trunkal or tributary reflux even 1 mm in diameter being recorded. Thirty percent had pure ultrasound recurrence, 17% new vessel reflux and 17% combined new and recurrent vessels on ultrasound. Of all, 16.5% required repeat UGFS treatment between 12 and 24 months, but less than 10% in subsequent years. The safety and clinical efficacy of UGFS for all clinical, aetiological, anatomical and pathological elements classes of GSV reflux was excellent. Conclusion The popularity of this outpatient technique with patients reflects ease of treatment, lower cost, lack of downtime and elimination of venous signs and symptoms. Patients accept that UGFS can be repeated readily if required for recurrence in this common chronic condition. The subclinical ultrasound evidence of recanalization or new vein incompetence needs to be considered in this light.

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.

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 The role of MR venography with time-resolved imaging in diagnosis of pelvic congestion syndrome

2022 ◽  
Vol 53 (1) ◽  
Author(s):  
Noha M. Attia ◽  
Mohamed AbuDeif Sayed ◽  
Hossam ElDin Galal Mohamed ◽  
Mahmoud Ahmed AbdelAleem
Keyword(s):  
Ovarian Vein ◽  
Mr Venography ◽  
Venous Anatomy ◽  
Time Resolved ◽  
Pelvic Congestion Syndrome ◽  
Complex Anatomy ◽  
Venous Dilatation ◽  
Time Resolved Imaging ◽  
Vein Reflux ◽  
Pelvic Congestion

Abstract Background Pelvic congestion syndrome (PCS) represents a diagnostic challenge due to its variable clinical presentation, complex anatomy, and pathophysiology. Accurate delineation of the venous anatomy, detection of venous reflux or obstruction, its extent will enable interventional radiologists to successfully treat such patients and to avoid recurrence. Magnetic resonance imaging (MRI) allows a noninvasive examination of the anatomy and flow inside the pelvic veins in addition to its excellent soft-tissue contrast allowing evaluation of the pelvic organs. Our study is aiming to investigate the role and accuracy of MR venography with time-resolved imaging (TR-MRV) as a diagnostic tool for pretreatment planning of PCS. Results Our study included 25 female patients with mean age 48 ± 12.34, who were referred to the radiology department in the period from April/2019 to April/2020 with clinical and ultrasound features suggesting PCS. TR-MRV was performed and interpreted in a blind fashion evaluating the vascular anatomy, venous dilatation, and reflux. The results were compared to conventional venography as a reference. The sensitivity, specificity, and accuracy of TR-MRV in the detection of ovarian vein reflux were 87%, 80%, and 84%, respectively, versus 75%, 53%, and 72% in internal iliac vein reflux and 92%, 69%, and 64% for pelvic venous plexus reflux. Demonstration of the venous anatomy was excellent in 68% of the patients and was sufficient in 32%. Ovarian vein dilatation was detected in 16 patients by venography and in 10 patients by TR-MRV. The weighted k-values (Cohen's Kappa coefficient statistics) indicated excellent agreement between the two observers for identifying all the refluxing veins by TRI in each patient (k = 0.78). Conclusion MRI with TR imaging has shown high diagnostic accuracy when compared to conventional venography in evaluating pelvic congestion syndrome before endovascular treatment and thus facilitating treatment planning.

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.

scholarly journals ULTRASOUND GUIDED FOAM SCLEROTHERAPY AS A PREFERRED TREATMENT OPTION FOR VARICOSE VEINS IN TERMS OF SAFETY, EFFICACY AND COST EFFECTIVENESS

2021 ◽  
Vol 71 (4) ◽  
pp. 1332-35
Author(s):  
Muhammad Jamil ◽  
Rashid Usman ◽  
Muhammad Irfan Khan ◽  
Muhammad Afzal Randhawa ◽  
Aaiza Aman ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Military Hospital ◽  
Venous Reflux ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Vein Thrombosis ◽  
Ceap Classification ◽  
Deep Vein

Objective: To assess the safety, efficacy and cost effectiveness of ultrasound-guided foam sclerotherapy in superficial venous reflux in Clinical, Etiological, Anatomical and Pathological (CEAP) classification grade 2-6 disease. Study Design: Retrospective observational study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Sep 2018 to Feb 2020. Methodology: One thousand and sixty-seven patients (1312 legs) with varicose veins were treated by ultrasound-guided foam sclerotherapy using 3% sodium tetradecyl sulphate for truncal veins and 1% for smaller veins in 1:4 ratio with air. After 7 days, leg was assessed clinically and radiologically with Duplex ultrasound for occlusion of veins and complications. Second, third and fourth sclerotherapy sessions were performed for residual/recurrence/new varicosities. Compression bandage was used for at least 3 months after treatment. Results: The overall eradication of superficial venous reflux and healing of ulcers, was seen in 92.1% (1208 legs). It was 83.5% (1095 legs) after 1st session of UGFS. Second, 3rd and 4th session of UGFS further increases this percentage of benefitted patients Deep vein thrombosis developed post procedure in 2 (0.18%) patients and pulmonary embolus in one patient. Three (0.28%) patients had transient visual disturbances within half an hour of treatment. Retreatment was required due to formation of new superficial venous reflux in 39 (2.9%) legs and recurrence in 93 (7.1%) legs. Conclusion: Ultrasound guided foam sclerotherapy is a better option of treatment in varicose veins in terms of safety, efficacy and cost effectiveness.

scholarly journals Ultrasound-guided perisaphenous tumescence infiltration improves the outcomes of long catheter foam sclerotherapy combined with phlebectomy of the varicose tributaries

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Attilio Cavezzi ◽  
Giovanni Mosti ◽  
Sonia Di Paolo ◽  
Lorenzo Tessari ◽  
Fausto Campana ◽  
...  
Keyword(s):  
Observational Study ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Arbitrary System ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Group I ◽  
Diseased Segment ◽  
Occlusion Rate

A prospective comparative observational study was performed to assess the short--term efficacy and safety of the peri-saphenous infiltration of tumescence solution (PST) in great saphenous vein (GSV) long catheter foam sclerotherapy (LCFS) combined with phlebectomy of the varicose tributaries. Since November 2006 through November 2010 fifty-one consecutive patients (16 males and 35 females, mean age 51.5 years) who underwent LCFS of GSV + multiple phlebectomies were prospectively enrolled, without any pre-selection criteria, in three different groups (17 patients per group) and reviewed as to their outcomes: i) patients without additional PST; ii) with PST under visual control; iii) with ultrasound-guided PST. All procedures were performed in local anesthesia and an average of 7 mL [interquartile range (IQR) 6.5-7.5] of 3% sodiumtetradecylsulfate CO2+O2-based sclerosant foam was injected in the diseased segment of GSV (median caliber 7) (IQR 6-8) by means of a 4F long catheter. Clinical and color-duplex ultrasound (CDU) follow-up was performed at regular intervals, the last of which 14 months after the treatment. At 14 months follow-up no varicose veins were visible in 94%, 94% and 100% of the cases in group I, II and III respectively. The CDUbased outcomes were the following: 71%, 71% and 84% GSV occlusion rate in group I, II and III respectively; reflux was found in 5, 4 and 1 cases in group I, II and III respectively. Clinical and CDU morphologic and hemodynamic results were assembled and scored through an arbitrary system. The relative statistical analysis showed a significant (P<0.0001) improvement of the results for patients who received ultrasound guided PST over the other two groups. No relevant complications were recorded in all 51 cases. GSV treatment by means of LCFS + phlebectomy of varicose tributaries proved to be effective and safe in this prospective observational study. The addition of ultrasound guided PST resulted in a significant improvement of GSV occlusion rate and of varicose vein clinical resolution.

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