Transcatheter Foam Sclerotherapy of Symptomatic Female Varicocele with Sodium-Tetradecyl-Sulfate Foam

Gandini, Roberto; Chiocchi, Marcello; Konda, Daniel; Pampana, Enrico; Fabiano, Sebastiano; Simonetti, Giovanni

doi:10.1007/s00270-007-9264-6

Cited by 72 publications

(51 citation statements)

References 15 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%

“…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%

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

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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: Studies Reviewedmentioning

confidence: 99%

Section: Pain Symptomsmentioning

confidence: 99%

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

“…The optimal diagnostic approach for PCS-related pelvic pain remains unclear, and controlled trials comparing medical and interventional treatments are urgently needed. Diagnosis of PCS can be made by pelvic and transvaginal color Doppler ultrasound examination to demonstrate ovarian or pelvic varices with a diameter more than 5 mm denoting presence of a venous reflux [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

The Biology of Combined Colon Clear and Blood-Let Out Cupping Therapy in Female Health

Nasrat¹,

Nasrat²,

Nasrat³

2015

Gen Med (Los Angel)

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The study aimed to predict an etiologic pathology leading to some disease spread in females.Pelvic congestion syndrome (PCS) in females is a condition that is difficult to diagnose; a specific diagnosis for the condition is often difficult, no diagnosis is made in 60% of patients. Chronic pelvic pain (CPP) is a common and disabling condition affecting women of childbearing age; PCS is a recognized cause of CPP. Pelvic congestion and pelvic inflammatory conditions constitute the underlying etiology in a significant proportion of patients with CPP. Treatment of PCS is above all medical, based upon decongestive and anti-inflammatory agents. Abnormal colonic Helicobacter pylori strains have been shown to be responsible for the worst case of pelvic congestion due to accumulation of profuse toxic amounts of ammonia in the colon. Both colon clear and cupping were considered to have an effective therapeutic role in female PCS due to elimination of the underlying etiologic pathological elements (congestive and inflammatory) from the pelvis. The impact on life and the spread beyond traditional medical rules during last three decades of endometriosis, ovarian cystic disease and endometriotic ovarian cysts were considerable and obvious. 50 sexually active female patients with different forms of pelvic clinical presentations had been included in this study. They were 10 patients with pelvic pain, 10 patients with scanty menstruation, 10 patients with primary infertility, 10 patients with endometriosis and 10 patients with ovarian cystic disease. Pelvic and trans-vaginal Doppler ultrasound examinations were done routinely for all patients to assess any local pelvic pathology. All patients had undergone colon clear followed by a blood-let out therapy from the upper and lower back. Revision therapy was decided according to response of patients. All patients with pelvic pain and scanty menstruation were cured after a primary session or revision of therapy with colon clear and cupping therapy. 7 patients with primary infertility got pregnant after 3 sessions of combined colon clear and cupping therapy. All patients with endometriosis and ovarian cystic disease were relieved from their symptoms while most of them (9 with endometriosis and 7 with ovarian cystic disease) have reported after 3 consecutive sessions of colon clear and cupping therapy that their gynecology physicians have confirmed that they demonstrated stop of their disease progress.On conclusion, pelvic disease spread in females beyond traditional scientific rules could indicate the possibility of an existing missed underlying pathology. Screening of females with frank history of H. pylori dyspepsia may become a mandatory new health care requirement for early detection of female pelvic pathology.

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“…Most authors prefer the femoral approach, although transjugular and brachial approaches have been described (2,16). A common technique of ovarian varicose vein occlusion includes embolization with steel coils (1,7,15).…”

Section: B Amentioning

confidence: 99%

“…This technique is simple, effective, and inexpensive. Other methods include embolization with coils and gelfoam (sandwich technique), occlusion with glue, and the use of sclerosing agents (2,4,16). We commonly use femoral approach and embolization with coils (5).…”

Section: B Amentioning

confidence: 99%

Pregnancy after embolization of ovarian varicocele: report of two cases

Таразов

Prozorovskij²,

Rumiantseva³

2009

Diagn Interv Radiol

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Ovarian varicocele is a well-known cause of pelvic pain in women (1-3). Surgical or laparoscopic ligation, or retrograde transcatheter embolization is successfully used for treatment of symptomatic cases (l-6).In 1991, Galkin et al. (7) hypothesized that long-lasting ovarian varicocele might cause hypofunction of the ovaries and, similar to testicular varicocele, could be a cause of infertility. This hypothesis is not yet proven in the medical literature. We report two cases of pregnancy in women with infertility after successful transcatheter embolization of ovarian varices. Case reports Case 1A 43-year-old woman presented with chronic pelvic pain of three years duration. Her pain increased after physical activity and during menses. She had given birth to a full-term baby 20 years prior to presentation. She has not become pregnant since that time, despite a lack of contraception during the last 7 years. Repeated gynecologic examinations including hysterosalpingography did not reveal any source of pelvic pain. No disorder of hormonal milieu was noted on endocrine evaluation.Abdominal ultrasound did not reveal any gynecologic pathology such as leiomyoma, adenomyosis, or endometriosis, but it showed marked dilatation of veins around the left ovary. The diameter of the left ovarian vein trunk was 12 mm.The presence of left ovarian varicocele was confirmed by selective retrograde venography. The right transjugular approach was used, because the patient had several large moles on both groins. A Headhunter 1 catheter (Cordis, Bridgewater, New Jersey, USA) was placed in the left renal vein, and then in the left ovarian vein. Embolization of the dilated left ovarian vein was performed with three long and four short homemade steel coils 10-12 mm in diameter (Fig. 1). The right ovarian vein was not dilated.During the next month, the patient had significant reduction of pelvic pain, which eventually disappeared completely. Ultrasound (US) examination showed occlusion and fibrosis of the left ovarian vein, and disappearance of pelvic varices. Three months after the procedure, the patient became pregnant. The pregnancy was normal, and resulted in an easy delivery. Case 2A 25-year-old woman was referred to our hospital with a 4-year history of infertility. She had never been pregnant. She complained of periodic mild pelvic pain and dysmenorrhea. Her symptoms were aggravated by standing for a long time, and they increased during sexual activity. No pathological changes were observed on gynecologic examination or en- ABSTRACT We describe two cases of left-sided ovarian varicocele in patients with infertility. Pregnancy occurred in both women after successful retrograde venous embolization. Ovarian varicocele may be associated with infertility in some patients. INTERVENTIONAL RADIOLOGY

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Transcatheter Foam Sclerotherapy of Symptomatic Female Varicocele with Sodium-Tetradecyl-Sulfate Foam

Cited by 72 publications

References 15 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

The Biology of Combined Colon Clear and Blood-Let Out Cupping Therapy in Female Health

Pregnancy after embolization of ovarian varicocele: report of two cases

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