Etiopathogenetic Approach to Conservative Treatment of Pelvic Congestion Syndrome

2016 ◽  
pp. 52-57
Author(s):  
S.I. Zhuk ◽  
◽  
A.N. Grigorenko ◽  
A.A. Shluakhtina ◽  
◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Clinical Laboratory ◽  
Varicose Veins ◽  
Dynamic Balance ◽  
Blood Rheology ◽  
Reproductive Age ◽  
Complex Treatment ◽  
Women Of Reproductive Age ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Congestion

Aim of research is clinical, laboratory and instrumental evaluation of efficiency of proposed pathogenetic conservative treatment for Pelvic Congestion Syndrome in women of reproductive age. Complex treatment consisted of oral use of diosmin, chondroitin sulfate for 6 months and physiotherapy. The results of the study suggest that proposed treatment is effective enough. It provides recovery of varicose veins endothelium functions, dynamic balance between vasodilatory and vasoconstrictor factors, normalization of blood rheology and metabolic processes in connective tissue. Key words: Pelvic Congestion Syndrome, conservative treatment, venotonic therapy.

Tratamento Endovascular da Síndrome de Congestão Pélvica: Série de Casos/Endovascular Treatment of Pelvic Congestion Syndrome: Case Series

1970 ◽  
Vol 5 (2) ◽  
pp. 148-157
Author(s):  
Melissa Andreia de Moraes Silva ◽  
Danielle Ribeiro Pereira ◽  
Érica Ribeiro Cruz ◽  
Seleno Glauber de Jesus Silva ◽  
Rodolfo Souza Cardoso
Keyword(s):  
Pelvic Pain ◽  
Varicose Veins ◽  
Delayed Diagnosis ◽  
Case Series ◽  
Reproductive Age ◽  
Venous Disease ◽  
Percutaneous Embolization ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Varices ◽  
Pelvic Congestion

RESUMO                           Introdução: As varizes pélvicas fazem parte de uma entidade clínica, a síndrome da congestão pélvica (SCP), que acomete mulheres em idade reprodutiva, geralmente multíparas, e cursa com como dor e sensação de peso crônico na região pélvica, dispareunia, dismenorreia, congestão vulvar e disúria. A síndrome é  decorrente do refluxo de veias ovarianas incompetentes e dilatadas. O refluxo pélvico também apresenta-se como um fator causal importante no que diz respeito ao surgimento e recidiva da doença venosa nos membros inferiores. Casuística: Foram descritos três casos de pacientes portadoras de SCP com sintomas clássicos, com diagnóstico tardio. Todas foram submetidas à embolização percutânea das varizes através do implante de molas fibradas de liberação livre através do aceso femoral, e obtiveram resultado satisfatório, semelhantes aos citados na literatura. Discussão: O diagnóstico da SCP é difícil e o tratamento envolve terapia medicamentosa para melhora dos sintomas e, em casos refratários, o uso de técnicas minimamente invasivas como a embolização das veias gonadais. Trata-se de uma condição comum e subdiagnosticada, sendo muitas das vezes um achado de exclusão de outras patologias. Conclusão: A embolização percutânea das veias ovarianas é um método simples, eficaz, com baixos índices de complicações e com resultado satisfatório a curto e médio prazo. A recidiva é frequente no longo prazo, e pode estar relacionada à progressão da doença varicosa ao longo do tempo e suas diferentes manifestações clínicas.Palavras-chave: Varizes, Dor pélvica, Embolização terapêutica. ABSTRACTIntroduction: Pelvic varices are part of a clinical entity, Pelvic Congestion Syndrome. This disease affects women at reproductive age, multiparous and presents symptoms such as chronic pelvic pain, feeling of heaviness in the pelvic region, dyspareunia, dysmenorrhea, vulvar congestion and urinary symptoms such as dysuria. Case Report: The aim of this study is to report a small case series of treatment of pelvic varices by embolization. We described three cases of patients suffering from pelvic varices with classic symptoms, which showed a delayed diagnosis, that caused emotional, aesthetic and marital problems. All of them underwent percutaneous embolization of varices, achieved satisfactory results and have been in clinical monitoring. Discussion: The cause of the disturb is the reflux of incompetent and dilated ovarian veins. Pelvic reflux also presents itself as an important causative factor concerning the appearance and recurrence of venous disease in lower members. Diagnosis is difficult. It is a common and underdiagnosed condition, often being a finding that excludes other pathologies. The results found after treatment were similar to stated in literature. Conclusion: The embolization of pelvic varices has been shown simpler and effective, with lowest rates of complications and with satisfactory results at short and long term. However, more studies regarding the outcome of different treatment methods are needed.Keywords: Varicose veins, Pelvic pain, Therapeutic embolization.

scholarly journals Advances of Laparoscopy for the Diagnosis of Pelvic Congestion Syndrome

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1041
Author(s):  
Christos Arnaoutoglou ◽  
Rita S. Variawa ◽  
Paul Zarogoulidis ◽  
Aris Ioannidis ◽  
Nikolaos Machairiotis
Keyword(s):  
Chronic Pelvic Pain ◽  
High Accuracy ◽  
Reproductive Age ◽  
Diagnosis And Treatment ◽  
Hormonal Changes ◽  
Effective Algorithm ◽  
Promising Technique ◽  
Women Of Reproductive Age ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Congestion

The objective of this review is to describe the effectiveness of laparoscopy in the diagnosis and treatment of pelvic congestion syndrome (PCS). PCS is a cause of chronic pelvic pain (CPP) and is associated with dysfunction of the pelvic venous system. PCS is more common in women of reproductive age, and hormonal changes are associated with its development along with other reasons (e.g., working and living habits). There is an urgent need to establish an effective algorithm for the diagnosis and treatment of CPP, which could have a dramatic effect in patients’ everyday life. This algorithm should be able to overcome known issues that lead to the underdiagnosis of PCS, such as the overlap of its symptoms with other diseases. Here, we present our findings from literature articles about the methods used in practice today for the diagnosis of this syndrome. We also compare the methods to propose the most promising technique for providing a diagnosis with high accuracy. In our understanding, laparoscopy is superior when compared to other methods. It can provide a diagnosis of PCS while excluding or identifying other comorbidities and can also lead toward the next steps for the treatment of PCS.

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.

Pelvic congestion syndrome as a predisposing factor of "two-level" varicose veins development

2019 ◽  
Vol 19 (3) ◽  
Author(s):  
Larysa Chernukha ◽  
Alla Guch ◽  
Vadym Kondratyuk ◽  
Olenka Vlasenko ◽  
Alla Bobrova
Keyword(s):  
Varicose Veins ◽  
Predisposing Factor ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Congestion

scholarly journals The State of the Hemomycocirculatory Bed of Adventitia of Varicose Veins of the Small Pelvis in Women with Chronic Inflammatory Diseases of the Internal Genital Organs

2017 ◽  
Vol 23 (2) ◽  
Author(s):  
Natalya Drohomyretska
Keyword(s):  
Inflammatory Diseases ◽  
Varicose Veins ◽  
Morphological Changes ◽  
Complex Structure ◽  
The State ◽  
Reproductive Age ◽  
Ovarian Vein ◽  
Women Of Reproductive Age ◽  
Vein Wall ◽  
Inflammatory Processes

Hemomicrocirculatory system – is a complex structure that reacts in every pathological process even before the clinical period and takes the first blow. The study of microhemocirculation will provide an opportunity to solve the important for practical medicine questions of pathogenesis of many diseases, as for the prevention and treatment of regional disorders of blood circulation.The objective of the research is to study the state of the hemomicrocirculatory bed (HMCB) of adventitia of varicose veins of the small pelvis (VVSP) in women with chronic inflammatory processes of the organs of the small pelvis (CIPOSP).Materials and methods of research. To evaluate the restructuring of the HMCB of adventitia of VVSP, the operating material of 12 women of reproductive age was used. Mainly, there were pieces of the ovarian vein. The study of the HMCB in the vein wall was performed by the non-injecting method of silver impregnation according to V.V. Kupriyanov. To standardize the results, the condition of the HMCB of adventitia of the venous wall in norm was studied in 5 women of reproductive age, who died as a result of various traumas.Results of the research. After the performed studies, the structural-morphological changes of the HMCB of the adventitia of the small pelvis veins were revealed. The dilation of capillaries, postcapillaries, postcapillary venules was observed. The diameter of the vessels of the HMCB of the ovarian vein adventitia was: venule – 94.21 ± 1.38 μM in comparison with the norm – 48.78 ± 1.60 μM (p<0.001); post-capillary venules – 46.76 ± 1.04 μM in comparison with the norm – 28.29 ± 1.1.01 μM (p<0.001); the capillaries were 11.22 ± 0.14 μM in comparison with the norm – 8.24 ± 0.16 μM (p<0.05), arterioles – 29.02 ± 0.76 μM in comparison with the norm – 25.19 ± 1.15 μM (p<0.01). The architectonics of the arterioles is almost unchanged. Lumen of venules is filled with formed elements. The structure of capillaries is polymorphic. The capillary net was localized and concentrated or was formed as a thick planar net, the capillaries were expanded. There were arterio-venulous anastomoses. Endothelial nuclei are shortened. In some preparations, the diameter of the arterioles corresponded to the diameter of the collection venules.  Conclusions:1. The first discovered by us changes in HMCB of adventitia of varicose veins of the small pelvis in women with CIPOSP can be one of the pathogenetic links of the development and progression of the varicose vein itself, which in turn aggravates the course of chronic inflammation.      2. The timely appointment of drugs that improve microcirculation will enable to prevent the development of dystrophic changes in the vein wall, improve the course of chronic inflammatory processes and reduce or completely eliminate the syndrome of “chronic pelvic pain”.

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.

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.

Immunomodulatory features of modern probiotic preparations in complex treatment of women of reproductive age with chlamydial infection in the lower genital

2016 ◽  
pp. 123-128
Author(s):  
V.A. Benyuk ◽  
◽  
A.I. Kurchenko ◽  
О.A. Shcherba ◽  
Bu Weiwei ◽  
...  
Keyword(s):  
Chlamydial Infection ◽  
Pathogenic Bacteria ◽  
Reproductive Age ◽  
Chlamydia Infection ◽  
Control Group ◽  
Complex Treatment ◽  
Women Of Reproductive Age ◽  
Nonspecific Resistance ◽  
Vaginal Suppository ◽  
Complex Therapy

The aim of the study: assessment of influence of complex treatment of chronic recurrent chlamydial cervical infection with probiotics of various forms of the use on the immune status and the vaginal microbiocenosis in women of reproductive age. Materials and methods. The study surveyed 87 women of age from 18 to 35 years, from which 67 patients of recurrent chlamydial cervicitis, which (according to the protocol) were eligible for inclusion. The control group included 20 gynecologicaly healthy women. All surveyed women were representative by age and data of the obstetric-gynecologic and somatic anamnesis. In accordance with the objectives of the study, all patients with chlamydia infection (CHI) before the appointment of therapy were randomized into two groups matched for age, symptoms and duration of the inflammatory process. The I (main) group included 35 patients who underwent complex therapy. Part of therapy included drugs Sumamed 250 mg (1 capsule) 1 time a day for 5-7 days according to the scheme: 1st day – 1 g (4 capsules) with the 2nd -3rd day – 500 mg per day (2 capsules) and 4th – 7th day – 250 mg per day (1 capsule). Topically applied combination of reparative, anti-inflammatory and antimicrobial drug Depantol in the form of suppositories – appointed standard one vaginal suppository twice a day for 10 days. Later was appointed eubiotic Lacto® 2 capsules 3 times a day during 3 weeks. The II group included 32 patients (comparison group) who underwent treatment involving Sumamed and Depantol, but with the subsequent appointment of local eubiotiks (1 vaginal suppository at night) – 10 days. Results. The results of the survey of women of reproductive age with chronic recurrent chlamydial cervicitis during colposcopic study found a high frequency of cervical pathologies, namely, inflammatory changes – 100%, ectopia prismatic epithelium – 32.8%, the true erosion – 19.4%, that in 5.9% cases was combined with leukoplakia, and dysplasia – 16.4%, which correlated with cytological examination (ASCUS – 68.6%, LSIL – 25.5%, HSIL and 2.9%). Most women with CHI noted deep violations of microbiocenosis of the vagina with a predominance of opportunistic pathogenic bacteria: Peptostreptococcus – in 43.3%, Corynebacterium – in 56.7%, epidermal staph in 65.7% and gardnerellas – in 74.6%, candida – in 46.3% of cases. Patients with CHI were stated a lack of interferon Genesis – reduction of IFN-a 1.4-fold and IFN-g – 1.8 times. Conclusion. The complex therapy of chronic recurrent chlamydial cervicitis in women of reproductive age was conducted by the developed algorithm with the inclusion of oral probiotic Lacto® contributed to the increase of parameters of nonspecific resistance of the organism in 88% of cases, which was reflected in the reduction of titers of specific IgM 1.4-fold, IgG – 1.8 times, raising the level of lysozyme in cervical mucus – 1.5 times and sIgA – 1.2 times, the restoration of cytokine profile and normalization of microbiocenosis of the vagina in 76.4% of women. Key words: probiotics, immunity, cytokines, T-lymphocytes, microbiocenosis, Saccharomyces, Bifidobacterium, antibiotic-associated diarrhea, chlamydial infection, efficiency.

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