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

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.

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.

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.

scholarly journals Pelvic congestion syndrome as a cause of chronic pelvic pain

2021 ◽  
Vol 15 (4) ◽  
pp. 451-460
Author(s):  
N. Yu. Novikova ◽  
V. I. Tsibizova ◽  
P. D. Puzdriak ◽  
E. V. Komlichenko ◽  
I. G. Tsnobiladze ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Pelvic Pain Syndrome ◽  
Clinical Criteria ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Congestion

Altered pelvic venous circulation, which may occur due to pelvic venous congestion and varicose veins of the vulva, may be among the causes for developing chronic pelvic pain syndrome. Pelvic congestion syndrome (PCS) is characterized by chronic discomfort in the pelvic area, which may be aggravated during coitus or acquire orthostatic position, and result in severe dysfunction of the pelvic organs. Varicose veins of the vulva develop due to obstruction of the veins, increased venous pressure, and venous insufficiency in the pelvis. Varicose veins may be isolated or associated with varicose veins of the lower extremities. The diagnosis and treatment of such patients are limited by the lack of definitive clinical criteria for early diagnostics, which were discussed in the current study.

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 Female pelvic congestion syndrome: how can CT and MRI help in the management decision?

2020 ◽  
pp. 20200881
Author(s):  
Ahmed M. Osman ◽  
Ahmed Mordi ◽  
Rasha Khattab
Keyword(s):  
Varicose Veins ◽  
Management Decision ◽  
Vascular Compression ◽  
Pelvic Congestion Syndrome ◽  
Non Invasive ◽  
Significant Difference ◽  
Vein Diameter ◽  
Vascular Obstruction ◽  
Ct And Mri ◽  
Pelvic Congestion

Objective: Diagnosis of female pelvic congestion syndrome (PCS) is challenging. Although invasive venography is the gold-standard for diagnosis, however, CT and MRI are important in the assessment. In this study, we tried to highlight the role of CT and MRI as non-invasive tools in the diagnosis and management of PCS. Methods and material: This was a retrospective study of 50 patients confirmed clinically to have PCS. These patients had already done CT and MRI before venography or surgery. Results: The mean age of the patients was 48 years ± 12 years SD. Vaginal discharge and pelvic heaviness were the commonest symptoms (46 and 42% respectively). The commonest risk factor was multiparity (56%) followed by the RVF uterus (26%). No significant difference was found between CT, MRI, and venography as regarding the diameter of the ovarian vein, diameter, and the number of the varicose veins. The sensitivity of CT and MRI was 94.8 and 96%. CT and MRI discovered five cases with local pelvic obstructing cause,14 cases with evidence of vascular compression syndrome, and the rest 31 cases diagnosed to have primary non-obstructing PCS which was effective in decision-making with the surgery indicated in the first group while stenting of the vascular obstruction followed by bilateral ovarian veins coiling was the better option for the second group and only bilateral coiling was needed for the last group. Conclusion: CT and MRI play important roles in the diagnosis and even management decision in cases of PCS. Advances in knowledge: : Identification of the importance of diagnostic radiology before management decisions of cases with PCS.

scholarly journals Pelvic congestion syndrome - treatment with pelvic varicose veins embolization

2019 ◽  
Vol 65 (4) ◽  
pp. 518-523
Author(s):  
Glauce Romeiro de Almeida ◽  
Antonio Silvinato ◽  
Ricardo Santos Simões ◽  
Renata Ferreira Buzzini ◽  
Wanderley M Bernardo
Keyword(s):  
Varicose Veins ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Congestion
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