Venous angioplasty and stenting improve pelvic congestion syndrome caused by venous outflow obstruction

Daugherty, Stephen F.; Gillespie, David L.

doi:10.1016/j.jvsv.2015.01.003

Cited by 54 publications

(19 citation statements)

References 22 publications

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“…[13] noted that MTS is more prevalent among women . Despite the fact that the overwhelming number of researchers consider MTS as a factor in the development of venous thrombosis, as well as symptoms and signs of CVD, a number of researchers indicate that MTS is the cause of such an often unidentifiable condition as PCS [3,4,14,15] . Endovascular inter-vention in such cases is considered as one of the steps in PCS treatment, leading to pelvic pain decrease .…”

Section: Discussionmentioning

confidence: 99%

First Experience in Endovascular Stenting in Patients with Both May-Thurner and Pelvic Congestion Syndromes

Sg¹,

Maslennikov²,

Москаленко³

et al. 2019

Flebol.

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Objective-to assess endovascular stenting (ES) of the iliac veins in the treatment of the May-Thurner syndrome (MTS) in patients with pelvic congestion syndrome (PCS) and varicocele. Material and methods. Endovascular stenting of the iliac veins was performed in 7 female patients PCS and 1 male patient with varicocele. All patients underwent duplex ultrasound and computed tomography of the pelvic veins, as well as pelvic phlebography. Self-expanding stents were inserted in all cases. Pelvic pain was assessed by visual-analogue scale before and 4 to 7 days after procedure. Results. Technical success, i.e. restoration of normal patency of the left common iliac vein, was achieved in 8 patients. In 2 patients, stent was displaced towards the inferior vena cava (IVC), which required implantation of a second stent using the stentin-stent technique. Dislocation of the stent into the IVC at 6 months after the intervention was found in 1 patient, but did not result in any complications during further follow-up. All the patients reported reduction of pelvic pain within 4 to 7 days after procedure. The PCS severity score was decreased from 7.2±1.3 to 6.2±0.4 at 1 month after the procedure. However, no further decrease was observed in female patients. At 1 month after ES, the male patient noted a complete disappearance of discomfort in the left inguinal region and left testicle during and after intercourse. Conclusion. Stenting of common iliac vein in patients with MTS leads to decrease of pelvic pain in patients with PCS.

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Section: Discussionmentioning

confidence: 99%

First Experience in Endovascular Stenting in Patients with Both May-Thurner and Pelvic Congestion Syndromes

Sg¹,

Maslennikov²,

Москаленко³

et al. 2019

Flebol.

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show abstract

“…Daugherty and Gillespie demonstrated successful clinical outcomes in patients with PeVD and iliac vein stenting alone, while Gavrilov et al found that stent alone was not sufficient to completely improve symptoms in a patient population with predominant CPP and C1 venous disease and additional interventions were needed. 16,17…”

Section: Venous Compressionmentioning

confidence: 99%

“…Initial data based on 19 patients suggested that in patients with both common iliac vein stenosis and left ovarian vein reflux just addressing the venous stenosis with a stent placement was effective in symptom improvement in the majority of patients. 16 However, a more recent study including 12 patients suggested that symptomatic relief of patients with pelvic venous disease was only 16.6% when only stenting was performed, and suggested that ovarian vein embolization should be performed 6 months after stenting. 17 These findings supported the data from a previous study involving a larger number of patients (n ¼ 277) published in 2018 which found that 80% of patients had both gonadal vein insufficiency and iliac vein compression, and advocated for the treatment of venous stenosis first followed by ovarian vein embolization subsequently if symptoms persist, but suggested that patients with large pelvic reservoirs receive simultaneous treatment.…”

Section: Treatment Selectionmentioning

confidence: 99%

Choosing the Most Appropriate Treatment Option for Pelvic Venous Disease: Stenting versus Embolization

Tanaka

Kutsenko

Salazar

2021

Semin intervent Radiol

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Pelvic venous disease (PeVD) in women encompasses a wide variety of entities all resulting in pelvic pain and varices. Successful treatment with percutaneous interventions is dependent on identifying underlying factors contributing to the disease and addressing them with either embolization of incompetent veins or stenting for venous stenoses. There are a multitude of embolization methods with marked practice heterogeneity. Moreover, with the ongoing development of dedicated venous stents in the treatment of chronic venous disease, there are more opportunities to consider this modality for the treatment of PeVD, as many patients present with combined vein reflux and central venous stenosis. The necessity to address both and the order of interventions in these patients is still to be elucidated. Here, we describe when to choose stenting or embolization for PeVD, their limitations, and our practice and identify further areas of research in this field.

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“…10 Historically, PVI was thought to be caused by ovarian vein reflux alone, with ovarian vein embolization (OVE) utilized as the primary treatment modality, regardless of whether or not an iliac vein stenosis was present. 11–13 Although still a matter of some controversy, avoidance of iliac stenting has been proposed by at least some investigators to be preferred given the uncertainty of long-term stent patency. 14 Therefore, the purpose of this investigation is to determine presentation patterns and treatment outcomes of women with PeVD, based on age.…”

Section: Introductionmentioning

confidence: 99%

Presentation patterns in women with pelvic venous disorders differ based on age of presentation

et al. 2020

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Background The prevalence and presentation patterns in women with pelvic venous disorders (PeVD) secondary to pelvic venous insufficiency (PVI) at various ages are ill-defined. The purpose of this investigation was to determine if the types of symptoms, interventions, and treatment outcomes of women with PeVD varied with age progression. Methods From January 2015 to December 2019, we retrospectively reviewed prospectively collected data on 1,280 women with PeVD from our electronic medical record at the Center for Vascular Medicine (CVM). Medical and surgical comorbidities, past medical history, presenting pelvic and lower extremity symptoms, Clinical, Etiology, Anatomy, Pathophysiology (CEAP) class, revised Venous Clinical Severity Score (rVCSS), visual analog pain score (VAS) and types of interventions were assessed. Patients were grouped into five categories based on age of initial presentation: 20–29, 30–39, 40–49, 50–59, and greater than or equal to 60. Patients were also subcategorized according to their course of treatment: Iliac venous stenting alone, ovarian vein embolization (OVE) alone, simultaneous iliac vein stenting and ovarian vein embolization, and staged iliac vein stenting and ovarian vein embolization. Differences in groups were analyzed utilizing chi square, analysis of variance and regression analysis with Graphpad Prism 8 (San Diego, CA) and SAS Studio 3.8 (Cary, NC) statistical software. Results From January 2015 through December 2019, 1,280 women were treated for PeVD. The average ages in each group were the following: 26.53 ± 2.90 (n = 57), 35.80 ± 2.84 (n = 238), 44.98 ± 2.78 (n = 345), 54.67 ± 2.90 (n = 324) and 68.39 ± 8.44 (n = 316) respectively. The prevalence of PVI by age group was 4.45%,18.59%, 26.95%, 25.31% and 24.70% respectively (p < 0.05). The prevalence of diabetes, hypertension, coronary artery disease (CAD) and hypercholesterolemia differed between age groups (p < 0.05). Significant differences in the prevalence of pelvic pain, dyspareunia, dysmenorrhea, vulvar varices, leg pain, leg edema, leg heaviness, restless legs, varicose veins, and leg ulcers were observed across treatment groups (p < 0.05). CEAP distribution differed by age with CEAP 0–2 decreasing with age, CEAP 3 progressively increasing with age and CEAP 4–6 predominantly observed in patients older than 50. Analysis of variance indicated that with each decile increase in age, the prevalence of leg symptoms increased (p < 0.05) with a reciprocal decrease in pelvic symptoms (p < 0.05). All intervention types were infrequent in twenty year old’s. There was a linear increase in stenting with each decile increase in age. The prevalence of OVE was similar across all age groups. There was an overall improvement in VAS scores for all treatment and age groups. For patients in their 20 s, an initial improvement in VAS scores was observed with moderate recurrence of pain observed after three months. Conclusion PeVD presents as a spectrum of signs and symptoms, with pelvic and leg symptoms being inversely related according to age. The prevalence of PeVD is lowest in patients in their twenties with differences in presentation observed with increasing age. Venous stenting progressively increases with each decile of age whereas the prevalence of OVE is similar regardless of age. There is overall improvement in symptoms post intervention, although women in their 20 s do not respond as well to intervention as women in other age groups. Future investigations will focus on determining which pelvic venous lesion is the predominant factor that needs correction to achieve maximal pain reduction.

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Venous angioplasty and stenting improve pelvic congestion syndrome caused by venous outflow obstruction

Cited by 54 publications

References 22 publications

First Experience in Endovascular Stenting in Patients with Both May-Thurner and Pelvic Congestion Syndromes

First Experience in Endovascular Stenting in Patients with Both May-Thurner and Pelvic Congestion Syndromes

Choosing the Most Appropriate Treatment Option for Pelvic Venous Disease: Stenting versus Embolization

Presentation patterns in women with pelvic venous disorders differ based on age of presentation

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