Embolization of Incompetent Pelvic Veins for the Treatment of Recurrent Varicose Veins in Lower Limbs and Pelvic Congestion Syndrome

Meneses, Luis; Fava, Mario; Diaz, Pamela; Andía, Marcelo E.; Tejos, Cristián; Irarrázaval, Pablo; Uribe, Sergio

doi:10.1007/s00270-012-0389-x

Cited by 39 publications

(68 citation statements)

References 17 publications

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“…Eleven were included from the review of the diagnostic accuracy of non-invasive technique 23,[36][37][38][39][40][41][42][43][44][45] and 21 were included from the review of embolisation; 15,31,[46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] one study was included in both reviews. 65 A summary of the inclusion criteria from the selected studies is given in Table 1.…”

Section: Studies Reviewedmentioning

confidence: 99%

“…40,44,50 Six studies did describe particular pain symptoms; 38,39,[50][51][52]65 one study from 1999 selected for the diagnostic review and the remainder describing the effectiveness of embolisation, all subsequent to 2007. Of the studies that defined symptoms, six described dyspareunia or post-coital ache as a required symptom, 38,39,[49][50][51]66 and four listed dysmenorrhoea or pain specifically just before or during menstruation. [49][50][51]65 Of the other symptoms occasionally highlighted, only two 50,52 mentioned the exacerbation of pain after prolonged periods of standing as a defining symptom and only Carrion Otero et al 39 included a feeling of heaviness in the pelvis or legs in the symptomology.…”

Section: Pain Symptomsmentioning

confidence: 99%

“…Of the studies that defined symptoms, six described dyspareunia or post-coital ache as a required symptom, 38,39,[49][50][51]66 and four listed dysmenorrhoea or pain specifically just before or during menstruation. [49][50][51]65 Of the other symptoms occasionally highlighted, only two 50,52 mentioned the exacerbation of pain after prolonged periods of standing as a defining symptom and only Carrion Otero et al 39 included a feeling of heaviness in the pelvis or legs in the symptomology. Pain that tracked along the site of varicose veins, particularly during menstruation, was reported as defining symptoms in two studies, 51,65 but was not reported in the presenting characteristics in any other studies.…”

Section: Pain Symptomsmentioning

confidence: 99%

“…[49][50][51]65 Of the other symptoms occasionally highlighted, only two 50,52 mentioned the exacerbation of pain after prolonged periods of standing as a defining symptom and only Carrion Otero et al 39 included a feeling of heaviness in the pelvis or legs in the symptomology. Pain that tracked along the site of varicose veins, particularly during menstruation, was reported as defining symptoms in two studies, 51,65 but was not reported in the presenting characteristics in any other studies. Only two studies required their study population to have tried, and been unresponsive to, medical treatment and to have persistent severe symptoms following laparoscopy.…”

Section: Pain Symptomsmentioning

confidence: 99%

“…Descriptions of venous reflux were marginally better, with bidirectional or retrograde flow being indicative of reflux. The location of the reflux was precisely specified in some studies 38,51,65 or else related reflux to changes in the Doppler signal observed during a Valsalva manoeuvre. 37,47,53 Filling of contralateral veins or filling described as 'across the midline' were indicative of pelvic vein insufficiency in nine studies, 31,40,43,44,49,51,58,60,61 while six referred to filling of vulvar or thigh varices as a sign of PVI.…”

Section: 54mentioning

confidence: 99%

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The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

Champaneria

Shah

Moss³

et al. 2016

Health Technol Assess

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BackgroundPelvic congestion syndrome (PCS) is described as chronic pelvic pain (CPP) arising from dilated and refluxing pelvic veins, although the causal relationship between pelvic vein incompetence (PVI) and CPP is not established. Non-invasive screening methods such as Doppler ultrasound and magnetic resonance venography are used before confirmation by venography. Percutaneous embolisation has become the principal treatment for PCS, with high success rates often cited.ObjectivesOur proposal aimed to systematically and critically review the definitions and diagnostic criteria of PCS, the association between PVI and CPP, the accuracy of various non-invasive imaging techniques and the effectiveness of embolisation for PVI; and to identify factors associated with successful outcome. We also wished to survey clinicians and patients to assess awareness and management of PCS and gauge the enthusiasm for further research.Data sourcesA comprehensive search strategy encompassing various terms for pelvic congestion, pain, imaging techniques and embolisation was deployed in 17 bibliographic databases, including MEDLINE, EMBASE and Web of Science. There was no restriction on study design.MethodsMethodological quality was assessed using appropriate tools. Online surveys were sent to clinicians and patients. The quality and heterogeneity generally precluded meta-analysis and so results were tabulated and described narratively.ResultsWe identified six association studies, 10 studies involving ultrasound, two studies involving magnetic resonance venography, 21 case series and one poor-quality randomised trial of embolisation. There were no consistent diagnostic criteria for PCS. We found that the associations between CPP and PVI were generally fairly similar, with three of five studies with sufficient data showing statistically significant associations (odds ratios of between 31 and 117). The prevalence of PVI ranged widely, although the majority of women with PVI had CPP. Transvaginal ultrasound with Doppler and magnetic resonance venography are both useful screening methods, although the data on accuracy are limited. Early substantial relief from pain symptoms was observed in approximately 75% of women undergoing embolisation, a figure which generally increased over time and was sustained. Reintervention rates were generally low. Transient pain was a common occurrence following foam embolisation, while there was a < 2% risk of coil migration. Confidence in the embolisation technique is reasonably high, although there is a desire to strengthen the evidence base. Even among women with CPP, fewer than half had any knowledge about PCS.ConclusionsThe data supporting the diagnosis and treatment of PCS are limited and of variable methodological quality. There is some evidence to tentatively support a causative association, but it cannot be categorically stated that PVI is the cause of CPP in women with no other pathology, as the six most pertinent drew on clinically disparate populations and defined PVI inconsistently. Embolisation appears to provide symptomatic relief in the majority of women and is safe. However, the majority of included studies of embolism were relatively small case series and only the randomised controlled trial was considered at risk of potential biases. There is scope and demand for considerable further research. The question of the association of PVI and CPP requires a well-designed and well-powered case–control study, which will also provide data to derive a diagnostic standard. An adequately powered randomised trial is essential to provide evidence on the effectiveness of embolisation, but this faces methodological challenges.Study registrationThis study is registered as PROSPERO CRD42012002237 and CRD42012002238.FundingThe National Institute for Health Research Health Technology Assessment programme.

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