Pelvic Venous Disorders: An Update in Terminology, Diagnosis, and Treatment

Clark, Meghan R.; Taylor, Amy C.

doi:10.1055/s-0043-1771041

Cited by 7 publications

(3 citation statements)

References 47 publications

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“…Not surprisingly, those with PVO had a 1.5 times greater chance of having a lower extremity DVT and were more likely to undergo venous stenting, a clinical decision made by the interventional cardiologist with vascular medicine expertise, based on the presence of post-thrombotic syndrome in the affected lower extremity. The utility of and threshold for iliac vein stenting remains an important ongoing clinical area of research in pelvic venous disorder management [ 7 , 8 , 9 ]. The presence of PVO was not associated with a difference in hemodynamic severity of the PH, proximal or distal nature of CTEPH, or candidacy for PTE vs. BPA.…”

Section: Discussionmentioning

confidence: 99%

Pelvic Vein Obstruction in Chronic Thromboembolic Pulmonary Hypertension: A Novel Association

Vaidya,

Vaidy,

Al-Otaibi

et al. 2024

JCM

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Background: Pelvic venous obstruction (PVO), defined as greater than 50% stenosis or occlusion of pelvic veins, is a known risk factor for deep vein thrombosis (DVT). DVT is a known risk factor for chronic thromboembolic pulmonary hypertension (CTEPH), but the prevalence of PVO in CTEPH is unknown. Methods: This cross-sectional study at Temple University’s tertiary referral center for Pulmonary Hypertension, Right Heart Failure, and CTEPH sought to identify the presence of PVO in patients with CTEPH who underwent cardiac catheterization, pulmonary angiography, and venography. Results: A total of 193 CTEPH patients were referred for pulmonary angiography, and among these, 148 underwent venography. PVO was identified in 65 (44%) patients. Lower extremity (LE) DVT was associated with PVO (p = 0.004). The severity of pulmonary hypertension was similar with and without PVO (mean pulmonary artery pressure 43.0 ± 10.3 mm Hg vs. 43.8 ± 12.4 mm Hg, p = 0.70), as was the need for pulmonary thromboendarterectomy (69.2% vs. 61.4%, p = 0.32). Conclusions: Pelvic vein obstruction is common and a novel clinical association in patients with CTEPH, particularly in patients with a history of LE DVT. PVO and its role in CTEPH warrants further study, including the potential role of revascularization to mitigate further risk.

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Section: Discussionmentioning

confidence: 99%

Pelvic Vein Obstruction in Chronic Thromboembolic Pulmonary Hypertension: A Novel Association

Vaidya,

Vaidy,

Al-Otaibi

et al. 2024

JCM

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“…Ultrasound (US), both transabdominal and transvaginal, with color Doppler imaging and Doppler spectral analysis, should be used in PCS diagnosis. A dilated and tortuous pelvic vein (diameter > 6 mm), a slow blood flow (<3 cm/s) or reversal caudal flow, a dilated arcuate veins and polycystic changes in the ovaries are the ultrasound diagnostic criteria for PCS diagnosis [ 20 ]. MRI represents the first line of investigation, providing better imaging of the many causes of CPP and, due to the patients’ young ages, should be preferred to Computed Tomography (CT) given the absence of ionizing radiation.…”

Section: Discussionmentioning

confidence: 99%

Chronic Pelvic Pain in Congestion Pelvic Syndrome: Clinical Impact and Electromyography Pelvic Floor Activity Prior to and after Endovascular Treatment

Corvino,

Giurazza,

Coppola

et al. 2024

JPM

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Background: This study aims to characterize the clinical impact of endovascular treatment in Chronic Pelvic Pain (CPP) patients due to Pelvic Congestion Syndrome (PCS) and to assess the diagnostic value of surface electromyography (sEMG) studies of pelvic floor musculature (PFM) in PCS patients pre- and post-endovascular treatment. Between January 2019 and July 2023, we studied consecutive patients who were referred for interventional radiology assessment and treatment to a tertiary trauma care hospital, had evidence of non-obstructive PCS from Magnetic Resonance Imaging (MRI), had sEMG of PFM and who had undergone endovascular treatment. The primary outcome was clinical, defined as a change in symptom severity after endovascular treatment. The secondary outcome was a difference in the sEMG values pre- and post-endovascular therapy. Results: We included 32 women (mean age 38 years). CPP was the leading symptom in 100% patients, followed by dysmenorrhea (75%) and post-coital pain (68.7%). Endovascular therapy included ovarian vein embolization in 28 patients (87.5%) and internal iliac vein embolization in only 2 patients (6.2%). After a median of 8 (range 6–10) months from endovascular treatment, 29 (90%) of patients reported an improvement of the main symptoms, and 15 (46%) were symptom-free. The sEMG values did not show a statistical difference pre- and post-PCS endovascular treatment. Conclusions: Endovascular treatment appeared to be highly effective in CPP due to PCS and was associated with a low rate of complication. sEMG study could be useful in revealing alterations of PFM electrophysiology, but a difference pre- and post-embolization in PCS patients was not demonstrated.

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“…PVD enclose a group of disease entities whose common feature is the occurrence of the listed above symptoms of CPP, and varices localized in the pelvis and abdomen. The nomenclature update has changed historically used terms such as pelvic congestion syndrome, nutcracker syndrome and May-Thurner syndrome, resulting in a more precise diagnosis that is based on anatomy and underlying pathophysiology [4,12,13]. Venography is an invasive method requiring the administration of contrast.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive diagnostic imaging of pelvic venous disorders

Szkodziak,

Wozniak,

Szkodziak

et al. 2024

Ultraschall Med

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It is estimated that the problem of Chronic Pelvic Pain (CPP) may concern up to 24% of women. Unfortunately, very often, despite extensive diagnostics, the cause of CPP remains unknown. The pathophysiology of CPP could be explained to a large extent by the occurrence of Pelvic Venous Disorders (PVD). Although pelvic venography is still considered the gold standard for the diagnosis of PVD, non-invasive diagnostic imaging techniques seem to be instrumental in the initial identification of patients with PVD. This literature review aimed to analyse and evaluate the usefulness of non-invasive diagnostic imaging techniques like Transvaginal Ultrasonography, Transabdominal Ultrasonography, Magnetic Resonance and Computed Tomography in the diagnosis and identification of patients with PVD. Forty-one articles published between 1984 and 2023 were included in this literature review. Based on this literature review, we conclude that the clinical application of non-invasive diagnostic techniques in the diagnosis of PVD seems to be very promising. Future studies investigating the role of non-invasive diagnostic imaging techniques in the diagnosis of PVD are required.

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Pelvic Venous Disorders: An Update in Terminology, Diagnosis, and Treatment

Cited by 7 publications

References 47 publications

Pelvic Vein Obstruction in Chronic Thromboembolic Pulmonary Hypertension: A Novel Association

Pelvic Vein Obstruction in Chronic Thromboembolic Pulmonary Hypertension: A Novel Association

Chronic Pelvic Pain in Congestion Pelvic Syndrome: Clinical Impact and Electromyography Pelvic Floor Activity Prior to and after Endovascular Treatment

Noninvasive diagnostic imaging of pelvic venous disorders

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