The relation between pelvic varicose veins and lower extremity venous insufficiency in women with chronic pelvic pain

Bora, Aydın; Avcu, Serhat; Arslan, Halil; Adalı, Ertan; Bulut,

doi:10.5334/jbr-btr.623

Cited by 11 publications

(14 citation statements)

References 21 publications

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“…6,16,23,40,77,78 A further four studies considered the prevalence of PVI in non-pain populations 68,76,79,80 and three studies investigated the relationship between PVI and venous insufficiency of the lower limbs. 37,77,81 The quality assessment of the case-control studies is summarised in Table 3. Generally, the quality was acceptable, although cases and controls were usually of similar numbers and not determined by an a priori sample size.…”

Section: Resultsmentioning

confidence: 99%

“…In the five case-control studies with appropriate data amongst those assessing the association between pelvic pain and PVI, the associations were generally fairly similar, 6,16,23,40,77 with three studies showing statistically significant associations (odds ratios of between 31 and 117). 6,16,77 The two smallest studies failed to reach statistical significance in the odds of association, perhaps because they were too small for a difference to be detected. The proportion of women found to have PVI who reported CPP ranged considerably, from 39% to 91%.…”

Section: Summary Of Key Findingsmentioning

confidence: 85%

“…77 Using a threshold diameter in the OV of 5 mm, 21 women had dilated veins by ultrasound and 35 had dilated veins by CT. They found a significant relationship with CPP, with 51 of 56 (91%) of those with dilated pelvic veins reporting pain, compared with 8% of the non-dilated group (chi-squared test p < 0.0001).…”

Section: A Review Of the Association Between Pelvic Vein Incompetencementioning

confidence: 99%

“…77 Using a threshold diameter in the OV of 5 mm, 56 women had dilated veins and lower-limb venous insufficiency was found in 44 of these. …”

Section: Relationship With Varicose Veins Of the Lower Limbsmentioning

confidence: 99%

“…Two studies both used CT and a threshold of 5 mm to define dilatation in the pelvic veins and yet prevalence of varices were 9% and 18%, respectively. 77,84 Belenky et al 83 argued that detected of retrograde venous flow by renal artery angiography is preferable as it is physiological, whereas selective venous catheterisation may aggravate reflux. Nascimento et al 70 remarked that the MR angiography technique they used was suboptimal and led to less indeterminate determination of blood flow, in addition to the general issue of undertaking the scans in the supine position and with breath holding.…”

Section: A Review Of the Association Between Pelvic Vein Incompetencementioning

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: Resultsmentioning

confidence: 99%

Section: Summary Of Key Findingsmentioning

confidence: 85%

Section: A Review Of the Association Between Pelvic Vein Incompetencementioning

confidence: 99%

“…77 Using a threshold diameter in the OV of 5 mm, 56 women had dilated veins and lower-limb venous insufficiency was found in 44 of these. …”

Section: Relationship With Varicose Veins Of the Lower Limbsmentioning

confidence: 99%

Section: A Review Of the Association Between Pelvic Vein Incompetencementioning

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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Pelvic pain and venous congestion revisited: examining relationship between chronic pelvic pain and uterine venous size and blood flow

Amin

Wong

Foo

et al. 2023

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?Our study showed that uterine vein diameter and blood-flow pattern or reflux were not independently associated with the occurrence of chronic pelvic pain. However, age, menopausal status, adenomyosis and endometriosis were found to be significantly associated with chronic pelvic pain. What are the clinical implications of this work?Demographic factors and the presence of pelvic pathology should be accounted for as confounders when exploring possible associations between uterine vein features and chronic pelvic pain.

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Embolization in pelvic venous disorders using ethylene vinyl alcohol copolymer (Onyx®) and Aetoxysclerol: a prospective evaluation of safety and long-term efficacy

et al. 2022

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The relation between pelvic varicose veins and lower extremity venous insufficiency in women with chronic pelvic pain

Cited by 11 publications

References 21 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

Pelvic pain and venous congestion revisited: examining relationship between chronic pelvic pain and uterine venous size and blood flow

Embolization in pelvic venous disorders using ethylene vinyl alcohol copolymer (Onyx®) and Aetoxysclerol: a prospective evaluation of safety and long-term efficacy

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