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

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.

Choosing the Most Appropriate Treatment Option for Pelvic Venous Disease: Stenting versus Embolization

Pelvic venous disease (PeVD) in women encompasses a wide variety of entities all resulting in pelvic pain and varices. Successful treatment with percutaneous interventions is dependent on identifying underlying factors contributing to the disease and addressing them with either embolization of incompetent veins or stenting for venous stenoses. There are a multitude of embolization methods with marked practice heterogeneity. Moreover, with the ongoing development of dedicated venous stents in the treatment of chronic venous disease, there are more opportunities to consider this modality for the treatment of PeVD, as many patients present with combined vein reflux and central venous stenosis. The necessity to address both and the order of interventions in these patients is still to be elucidated. Here, we describe when to choose stenting or embolization for PeVD, their limitations, and our practice and identify further areas of research in this field.

Preliminary Results of a New Illuminated Radiofrequency Ablation Catheter for the Treatment of Great Saphenous Vein Reflux Disease

Introduction: In the current study, we present single surgeon experience of a new radiofrequency ablation system, the catheter, and the device. Patients and Methods: The new system, which comprises a generator and an intervally illuminated radiofrequency ablation catheter, was used for the treatment of 272 consecutive patients with chronic venous insufficiency of the great saphenous vein between November 2017 and October 2018. Mean age of the patients was 53.40 ± 11.91 years. Mean saphenous vein diameter was 8.51 ± 2.45 mm. Bilateral great saphenous vein reflux disease was present in 19% (51 cases) of the patients. At the end of the procedure, the closure of the great saphenous vein was confirmed with Doppler ultrasonography. Results: Procedures could be successfully performed in all, except 1 obese (BMI> 30 kg/m2) male patient. At the 3rd month, outpatient clinic follow-up control Doppler USG revealed successful ablation of the treated great saphenous vein in 260 patients (96%), whereas in 12 cases (4%), there was continuing reflux. The diameters of the saphenous veins in these patients ranged between 6.9 mm and 19.5 (mean: 10.68 ± 3.41) mm. Ten patients could be treated successfully with ablation with the same device controlled both at the interventional section as well as on the 3rd month outpatient clinic follow-up. The remaining patients underwent high ligation of the great saphenous vein. Paresthesia occurred in 1 patient and had been permanent. Hematoma occurred in a male patient and resolved spontaneously. Conclusion: Preliminary results of our new radiofrequency ablation device with illumination guidance for the treatment of great saphenous vein reflux disease indicated successful results with enhanced physician utilization, comfort, and reliability.

Long-term results of endovenous laser ablation of saphenous vein reflux: Up to nine years of follow-up

Introduction Endovenous laser ablation (EVLA) has become the gold standard for the treatment of saphenous vein reflux. We report the long-term clinical and ultrasound results of EVLA. Methods This study is a retrospective review of patients who underwent EVLA of saphenous vein over four years. Clinical results were assessed using venous clinical severity score (VCSS), and ultrasound results were classified according to Bush classification. Results Over a median follow-up time of 4.4 years, 168 EVLA-treated patients showed a drop in VCSS from 4.38 to 1.39. Ultrasound results of 140 treated great saphenous veins showed that 64% had one or more cause of recurrence. The presence of neovascularization correlated well with the lack of improvement of VCSS. Conclusion EVLA resulted in drop in VCSS from 4.38 to 1.39. Among 140 treated great saphenous veins, reflux in the anterior accessory saphenous vein was the primary cause (23.5%) of recurrence.