Ovarian vein incompetence: a potential cause of chronic pelvic pain in women

Tropeano, Giovanna; Stasi, Carmine Di; Amoroso, Sonia; Cina, Alessandro; Scambia, Giovanni

doi:10.1016/j.ejogrb.2007.11.006

Cited by 31 publications

(40 citation statements)

References 22 publications

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“…Ten studies simply stated that their populations had pelvic varices, sometimes described as dilated or voluminous. 38,41,47,50,[52][53][54][55][56]65 More studies reported an OV diameter, above which the vein was considered to be dilated, but this threshold varied considerably, from > 4.5 mm 67 to > 10 mm, 57,58 with > 5 mm being the most frequently cited. 40,42,43,59,60 Halligan et al grouped patients into three ranges of pelvic vein diameter without specifying a threshold.…”

Section: Venous Anatomymentioning

confidence: 99%

“…Only two studies required their study population to have tried, and been unresponsive to, medical treatment and to have persistent severe symptoms following laparoscopy. 30,52 Clinical observations Examination revealing superficial varices in the pelvic region formed part of the definition of PCS in five studies. 38,39,46,53,65 Atypical varices in the thigh, vulval or buttock area were the most frequently described criteria, 46,49,53,65 with no further details given regarding the size or the degree of discomfort.…”

Section: Pain Symptomsmentioning

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.…”

Section: Pain Symptomsmentioning

confidence: 99%

“…There are many ways to describe the observations of the venous blood flow, converging on general terms such as congestion, insufficiency and reflux. A non-descript term of congestion was used in nine studies, 41,47,50,[52][53][54][55][56]65 sometimes with qualifying terms such as stasis or distension, and categories of severe or moderate, but without any thresholds for such grouping. Descriptions of venous reflux were marginally better, with bidirectional or retrograde flow being indicative of reflux.…”

Section: 54mentioning

confidence: 99%

“…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%

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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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Section: Venous Anatomymentioning

confidence: 99%

Section: Pain Symptomsmentioning

confidence: 99%

Section: Pain Symptomsmentioning

confidence: 99%

Section: 54mentioning

confidence: 99%

Section: Studies Reviewedmentioning

confidence: 99%

See 3 more Smart Citations

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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show abstract

Chronic pelvic pain

Uppal

Amarasekara

Kaushik³

2011

Australas J Ultrason Med

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Pelvic congestion syndrome

Robertson

McCuaig

2013

Australas J Ultrason Med

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Background: The precise aetiology of pelvic congestion syndrome (PCS) remains poorly understood but is believed to be multifactorial having mechanical, hormonal and psychological components. Materials and methods: Minimally invasive techniques of embolisation or sclerotherapy of the ovarian veins has become the mainstay of treatment for PCS. Studies report a technical success rates from 89–100% and clinical success rates of 58–100%. Conclusions: Embolisation and sclerotherapy can be done as a day surgery procedure concurrently with diagnostic venography and given current evidence provide better long term pain relief than medical therapy.

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Ovarian vein incompetence: a potential cause of chronic pelvic pain in women

Cited by 31 publications

References 22 publications

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

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

Chronic pelvic pain

Pelvic congestion syndrome

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