Pelvic congestion syndrome: Early clinical results after transcatheter ovarian vein embolization

Cordts, Paul R.; Eclavea, Anthony; Buckley, Peter J.; DeMaioribus, Christopher A.; Cockerill, Mark L.; Yeager, Terry

doi:10.1016/s0741-5214(98)70062-x

Cited by 115 publications

(67 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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%

“…A further 12 studies described their populations as women with chronic pelvic or lower abdominal pain with no further elaboration of the nature of the symptoms required for inclusion 15,31,38,[40][41][42][56][57][58][59]63,64 and only three specifying 6 months as the minimum duration of symptoms. 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.…”

Section: Pain Symptomsmentioning

confidence: 99%

“…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%

See 2 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

View full text Add to dashboard Cite

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.

show abstract

Section: Studies Reviewedmentioning

confidence: 99%

Section: Pain Symptomsmentioning

confidence: 99%

Section: Venous Anatomymentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“…Among the current surgical procedures for treatment of PCS, laparoscopy and transcatheter embolotherapy have been used with good symptomatic relief, but with a tendency for later recurrence of pelvic pain in some cases (4 -9). Since anatomical venous variations are common (10,11), it is important to know the anatomy of these vessels for treatment planning (12,4). The diagnosis of PCS has usually been suggested by venography and ultrasound with Doppler (13)(14)(15)(16)(17)(18)(19), but ultrasound does not depict the gonadal veins.…”

mentioning

confidence: 99%

Ovarian veins: Magnetic resonance imaging findings in an asymptomatic population

Nascimento

Mitchell

Holland

2002

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Purpose: To evaluate the magnetic resonance (MR) venographic appearance of the ovarian veins in a healthy population, correlated with surgical findings. Our data can be used as a basis for comparison to patients with suspected pelvic congestion syndrome (PCS). Materials and Methods:We retrospectively reviewed exams of 22 women who had MR angiography for potential renal donation evaluation (age range, 19.3-60.5 years; mean, 38 years). We evaluated the diameter of the ovarian veins on dynamic multiphasic postcontrast coronal images, the phase of contrast appearance in these veins, the apparent direction of flow, and the presence of ovarian or pelvic varices. Surgical correlation was obtained in 12 patients. Clinical charts were reviewed and patients were asked about symptoms of chronic pelvic pain and the number of their children. Results:Of the 22 exams, 21 left gonadal veins were identified. Passive reflux from the left renal vein into the left gonadal vein was suggested in eight exams (38%). These veins had a mean diameter of 6.4 Ϯ 1.6 mm, significantly larger than 4.5 Ϯ 1.3 mm for the other 13 left gonadal veins without reflux (P Ͻ 0.005). The right gonadal vein was identified in 8 of 22 women, with a mean diameter of 4.4 Ϯ 0.5 mm. No patient reported symptoms of chronic pelvic pain. Conclusion:Passive reflux from the left renal vein to the left gonadal vein can occur in asymptomatic women. Diagnosis of PCS depends heavily on appropriate clinical history.

show abstract

“…3,[12][13][14][15][16][17][18] Since in many cases there may be therapeutic success only by eliminating pelvic varices, choice was for angioplasty of the left renal vein associated with embolization of the varicosed venous plexus. Through a puncture of the femoral vein, the left renal vein was catheterized and submitted to angioplasty, and the left ovarian vein was embolized using eight Gianturco coils (Cook, USA), with immediate therapeutic success confirmed by almost absence of venous reflux in the affected territory ( Figure 3).…”

Section: Case Reportmentioning

confidence: 99%

Dor pélvica crônica: o papel da síndrome do quebra-nozes

et al. 2008

View full text Add to dashboard Cite

Chronic pelvic pain is a problem at the same time common and underdiagnosed in women. Some literature reports show an incidence of up to 15% in women aged between 18-50 years, with impact over quality of life and economy. Among the causes of chronic pelvic pain, pelvic congestion syndrome stands out, characterized by pain, dysuria, hematuria, dysmenorrhea, dyspareunia and vulvar congestion, often accompanied by vulvar varices, described in 1949 by Taylor. We herein report a case of a patient with chronic pelvic pain in whom we diagnosed a nutcracker syndrome, characterized by stenosis of the left renal vein between the superior mesenteric artery and the aorta, with consequent status of left gonadal plexus hypertension, pelvic varices and symptoms of pelvic congestion. The treatment was varicose pelvic veins embolization, through a minimally invasive endovascular approach, with immediate technical and clinical success in less than 24 hours.Keywords: Pelvic pain, varicose veins, renal veins, embolization, angioplasty. RESUMOA dor pélvica crônica é um problema subdiagnosticado e relativamente comum nas mulheres. Alguns autores evidenciaram prevalência de até 15% entre mulheres de 18 a 50 anos, com repercussões sobre a qualidade de vida e sobre a economia. Dentre as causas de dor pélvica crônica, destaca-se a síndrome de congestão venosa pélvica, com quadro clínico caracterizado por diversos graus de dor, disúria, hematúria, dismenorréia, dispareunia e congestão vulvar, que pode ser acompanhado de varizes vulvares, descrito em 1949 por Taylor. Relatamos o caso de uma paciente portadora de dor pélvica crônica, na qual se diagnosticou o pinçamento da veia renal esquerda entre a aorta e a artéria mesentérica superior, com conseqüente quadro de hipertensão do plexo gonadal esquerdo, varizes pélvicas e sintomas de congestão pélvica. O tratamento realizado constou de embolização das varizes pélvicas, por método minimamente invasivo endovascular, com sucesso técnico e resolução dos sintomas em menos de 24 h. Palavras-chave: Dor pélvica, varizes, veias renais, embolização, angioplastia.

show abstract

Pelvic congestion syndrome: Early clinical results after transcatheter ovarian vein embolization

Cited by 115 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

Ovarian veins: Magnetic resonance imaging findings in an asymptomatic population

Dor pélvica crônica: o papel da síndrome do quebra-nozes

Contact Info

Product

Resources

About