Pub Date : 2021-11-15DOI: 10.9739/tjvs.2021.s56900
R. Loffroy
Patients with pelvic congestion syndrome, which is the part of pelvic venous disorders (PeVDs), present with unexplained chronic pelvic pain greater than six months, and anatomical findings including pelvic venous insufficiency and pelvic varicosities. Venography is usually necessary to confirm ovarian vein reflux and should be the first step of embolization. Endovascular therapy has been validated by several large patient series with long-term follow-up and should be the first-line therapy. Embolization has been shown to be significantly more effective than surgical therapy in improving symptoms in patients who fail hormonal therapy. Briefly, the goal is to eliminate the ovarian vein reflux with direct sclerosis or embolization of enlarged pelvic varicosities. Symptom improvement is seen in 70 to 90% of the treated patients, despite technical variation. Different embolic agents can be used for this purpose. Therefore, in this review, we discuss the different types of treatment available, with focus on embolic materials.
{"title":"Management of pelvic venous disorders","authors":"R. Loffroy","doi":"10.9739/tjvs.2021.s56900","DOIUrl":"https://doi.org/10.9739/tjvs.2021.s56900","url":null,"abstract":"Patients with pelvic congestion syndrome, which is the part of pelvic venous disorders (PeVDs), present with unexplained chronic pelvic pain greater than six months, and anatomical findings including pelvic venous insufficiency and pelvic varicosities. Venography is usually necessary to confirm ovarian vein reflux and should be the first step of embolization. Endovascular therapy has been validated by several large patient series with long-term follow-up and should be the first-line therapy. Embolization has been shown to be significantly more effective than surgical therapy in improving symptoms in patients who fail hormonal therapy. Briefly, the goal is to eliminate the ovarian vein reflux with direct sclerosis or embolization of enlarged pelvic varicosities. Symptom improvement is seen in 70 to 90% of the treated patients, despite technical variation. Different embolic agents can be used for this purpose. Therefore, in this review, we discuss the different types of treatment available, with focus on embolic materials.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83739610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-22DOI: 10.9739/tjvs.2021.s56892
H. Jalaie, M. Barbati, Marald Wikkeling, S. Doganci
The two main mechanisms for pelvic venous disease (PeVD) are reflux of ovarian vein and obstruction of left common iliac or left renal vein. Some patients have a combination of the two. Adequate assessment of the location and degree of stenosis and delineation of venous anatomy are the key elements in the success of interventions to treat chronic obstructions causing PeVD. While venography is more accessible and less expensive to perform than intravascular ultrasound (IVUS), an increasing number of studies have demonstrated that IVUS is significantly more sensitive than venography in identifying stenotic lesions and real-time anatomical alterations of the affected venous segments. In this paper, we discuss the derived information and the clinical applications of IVUS during such interventions. The definitive diagnosis of PeVD can be achieved with venography combined with IVUS to evaluate for obstructive lesions in the iliac veins and compression of the left renal vein. Venography has poor sensitivity and specificity in the detection of venous stenosis. However, IVUS can detect fine intraluminal trabeculae and outside compression that can be missed with standard multiplanar venography. The IVUS can confidently confirm the persistent venous stenosis regardless of the hemodynamical alterations of venous pressure, as well. Moreover, it is possible to precisely measure the diameter of ovarian vein with IVUS. This may be helpful to decide about the diameter of the coils or the plugs needed to avoid migration. In conclusion, IVUS enables us to accurately evaluate the underlying cause of PeVD and apply a patient"s tailored treatment on table.
{"title":"The diagnostic role of IVUS in pelvic venous disease","authors":"H. Jalaie, M. Barbati, Marald Wikkeling, S. Doganci","doi":"10.9739/tjvs.2021.s56892","DOIUrl":"https://doi.org/10.9739/tjvs.2021.s56892","url":null,"abstract":"The two main mechanisms for pelvic venous disease (PeVD) are reflux of ovarian vein and obstruction of left common iliac or left renal vein. Some patients have a combination of the two. Adequate assessment of the location and degree of stenosis and delineation of venous anatomy are the key elements in the success of interventions to treat chronic obstructions causing PeVD. While venography is more accessible and less expensive to perform than intravascular ultrasound (IVUS), an increasing number of studies have demonstrated that IVUS is significantly more sensitive than venography in identifying stenotic lesions and real-time anatomical alterations of the affected venous segments. In this paper, we discuss the derived information and the clinical applications of IVUS during such interventions. The definitive diagnosis of PeVD can be achieved with venography combined with IVUS to evaluate for obstructive lesions in the iliac veins and compression of the left renal vein. Venography has poor sensitivity and specificity in the detection of venous stenosis. However, IVUS can detect fine intraluminal trabeculae and outside compression that can be missed with standard multiplanar venography. The IVUS can confidently confirm the persistent venous stenosis regardless of the hemodynamical alterations of venous pressure, as well. Moreover, it is possible to precisely measure the diameter of ovarian vein with IVUS. This may be helpful to decide about the diameter of the coils or the plugs needed to avoid migration. In conclusion, IVUS enables us to accurately evaluate the underlying cause of PeVD and apply a patient\"s tailored treatment on table.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80420720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-22DOI: 10.9739/tjvs.2021.s56893
C. Arnoldussen, Marald Wikkeling, S. Doganci
Pelvic venous disease (PeVD) is an overlooked condition that can affect daily life of patients. Although medical history and physical examination may lead to suspicion of PeVD, accurate imaging is important for establishing the diagnosis with high certainty. Despite the increasing popularity of magnetic resonance imaging and Duplex ultrasound as non-invasive imaging methods, selective venography remains the gold-standard imaging method to establish the diagnosis of PeVD. In addition, venography provides an opportunity for treatment in a single procedure. In this chapter, we define the techniques for selective ovarian venography and discuss its clinical importance in diagnosis of PeVD.
{"title":"Do we still need selective ovarian venography in diagnosis of pelvic venous disease in 2021?","authors":"C. Arnoldussen, Marald Wikkeling, S. Doganci","doi":"10.9739/tjvs.2021.s56893","DOIUrl":"https://doi.org/10.9739/tjvs.2021.s56893","url":null,"abstract":"Pelvic venous disease (PeVD) is an overlooked condition that can affect daily life of patients. Although medical history and physical examination may lead to suspicion of PeVD, accurate imaging is important for establishing the diagnosis with high certainty. Despite the increasing popularity of magnetic resonance imaging and Duplex ultrasound as non-invasive imaging methods, selective venography remains the gold-standard imaging method to establish the diagnosis of PeVD. In addition, venography provides an opportunity for treatment in a single procedure. In this chapter, we define the techniques for selective ovarian venography and discuss its clinical importance in diagnosis of PeVD.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76425682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-22DOI: 10.9739/tjvs.2021.s56899
Zaza Lazarashvili, T. Hirsch
Pelvic venous disease (PeVD) are one of the most important causes of chronic pelvic pain in women resulting from the pathological venous flow in ovarian and pelvic veins. Pelvic vein embolization is the method of choice for treatment of PeVD caused by primary reflux in ovarian and internal iliac veins. In this review, we discuss possible complications and side effects after embolization therapy.
{"title":"Complications and side effects after pelvic vein embolization","authors":"Zaza Lazarashvili, T. Hirsch","doi":"10.9739/tjvs.2021.s56899","DOIUrl":"https://doi.org/10.9739/tjvs.2021.s56899","url":null,"abstract":"Pelvic venous disease (PeVD) are one of the most important causes of chronic pelvic pain in women resulting from the pathological venous flow in ovarian and pelvic veins. Pelvic vein embolization is the method of choice for treatment of PeVD caused by primary reflux in ovarian and internal iliac veins. In this review, we discuss possible complications and side effects after embolization therapy.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88086442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-22DOI: 10.9739/tjvs.2021.s56891
C. Arnoldussen
The purpose of this article is to highlight the advantages and disadvantages of magnetic resonance venography (MRV) and computed tomography venography (CTV) in diagnosing and evaluating pelvic venous disease (PeVD).
{"title":"Magnetic resonance venography and computed tomography venography in pelvic venous disease","authors":"C. Arnoldussen","doi":"10.9739/tjvs.2021.s56891","DOIUrl":"https://doi.org/10.9739/tjvs.2021.s56891","url":null,"abstract":"The purpose of this article is to highlight the advantages and disadvantages of magnetic resonance venography (MRV) and computed tomography venography (CTV) in diagnosing and evaluating pelvic venous disease (PeVD).","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90310762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-22DOI: 10.9739/tjvs.2021.s56895
S. Gianesini, E. Menegatti, Oscar Bottini, S. Doganci, Y. Chi
Pelvic venous disease (PeVD) are a not rare cause of venous insufficiency in the leg that is frequently underestimated and poorly managed. Graduated compression stockings (GCSs) represents a pillar in lower limb chronic venous disease (CVD). Despite these first two considerations, clear GCS indications in PeVD are still missing due to the lack of literature data on this topic. In the present short report, we offer an insight on the topic and the potential rationale for GCS use in PeVD.
{"title":"Graduated compression in pelvic venous disease","authors":"S. Gianesini, E. Menegatti, Oscar Bottini, S. Doganci, Y. Chi","doi":"10.9739/tjvs.2021.s56895","DOIUrl":"https://doi.org/10.9739/tjvs.2021.s56895","url":null,"abstract":"Pelvic venous disease (PeVD) are a not rare cause of venous insufficiency in the leg that is frequently underestimated and poorly managed. Graduated compression stockings (GCSs) represents a pillar in lower limb chronic venous disease (CVD). Despite these first two considerations, clear GCS indications in PeVD are still missing due to the lack of literature data on this topic. In the present short report, we offer an insight on the topic and the potential rationale for GCS use in PeVD.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75000539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-22DOI: 10.9739/tjvs.2021.s56896
Marald Wikkeling, H. Jalaie
Compression syndromes play an important role in pelvic venous disease (PeVD). Although compressive lesions of the common iliac and renal veins are common on non-invasive imaging studies, they are usually asymptomatic and the factors associated with the development of symptoms remain poorly understood. The prevalence of pelvic or lower-extremity symptoms and varicose veins caused by compression of an iliac or left renal vein is unknown. However, a high index of suspicion is needed in the work-up of PeVD, particularly in patients who are refractory to the initial treatment. Once a symptomatic compression syndrome is discovered in a PeVD patient, this should be treated first. After treating compression syndromes, there should be a waiting period to notice if the complaints and symptoms diminish.
{"title":"Endovascular management of compression syndromes associated with pelvic venous disease","authors":"Marald Wikkeling, H. Jalaie","doi":"10.9739/tjvs.2021.s56896","DOIUrl":"https://doi.org/10.9739/tjvs.2021.s56896","url":null,"abstract":"Compression syndromes play an important role in pelvic venous disease (PeVD). Although compressive lesions of the common iliac and renal veins are common on non-invasive imaging studies, they are usually asymptomatic and the factors associated with the development of symptoms remain poorly understood. The prevalence of pelvic or lower-extremity symptoms and varicose veins caused by compression of an iliac or left renal vein is unknown. However, a high index of suspicion is needed in the work-up of PeVD, particularly in patients who are refractory to the initial treatment. Once a symptomatic compression syndrome is discovered in a PeVD patient, this should be treated first. After treating compression syndromes, there should be a waiting period to notice if the complaints and symptoms diminish.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90920934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-22DOI: 10.9739/tjvs.2021.s56894
S. Gianesini, E. Menegatti, Oscar Bottini, Y. Chi
While the thrombotic risk associated with lower limb venous reflux has been clearly reported in the literature, evidence is lacking on the potentially similar procoagulant effect generated by a venous incompetence in the pelvic region. A recent publication identified an incidental periuterine venous plexus thrombosis in 3% of the women undergoing a gynaecological consultation for whatever reason, suggesting a potentially underestimated condition worthy of further investigation. The present paper analyses the available literature on the topic, providing an insight covering both pathophysiological and clinical aspects.
{"title":"Pelvic venous thrombosis","authors":"S. Gianesini, E. Menegatti, Oscar Bottini, Y. Chi","doi":"10.9739/tjvs.2021.s56894","DOIUrl":"https://doi.org/10.9739/tjvs.2021.s56894","url":null,"abstract":"While the thrombotic risk associated with lower limb venous reflux has been clearly reported in the literature, evidence is lacking on the potentially similar procoagulant effect generated by a venous incompetence in the pelvic region. A recent publication identified an incidental periuterine venous plexus thrombosis in 3% of the women undergoing a gynaecological consultation for whatever reason, suggesting a potentially underestimated condition worthy of further investigation. The present paper analyses the available literature on the topic, providing an insight covering both pathophysiological and clinical aspects.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89005700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-22DOI: 10.9739/tjvs.2021.s56898
Aleksandra Jaworucka-Kaczorowska
Pelvic venous incompetence (PVI), although usually asymptomatic, may cause pelvic venous disease (PeVD), which may clinically manifest through pelvic symptoms, particularly chronic pelvic pain (CPP). There is no standard approach to manage PeVD and, therefore, the treatment should be individualized based on symptoms and the patient"s needs. To date, many treatment methods have been proposed, including conservative treatment, pelvic vein embolization, and reparative surgery. Medical treatment of CPP due to PVI includes non-steroidal anti-inflammatory drugs (NSAIDs), medical suppression of ovarian function, venoprotective agents, vasoconstrictor drugs, and psychotropic agents. The NSAIDs have a short-term efficacy and, due to side effects after longer use, they should be avoided as a long-term solution. Pharmacological suppression of ovarian function may result in CPP relief and may be achieved using medroxyprogesterone acetate, gonadotropin-releasing hormone (GnRH) agonist, long-acting reversible contraceptives, and danazol. They have been proven to be effective in the treatment of pelvic symptoms of PeVD. Venoactive drugs (VADs), particularly micronized purified flavonoid fraction (MPFF) and psychotropic agents, also provide an improvement in CPP related to PVI. A conservative approach represents the first-line treatment modality. It is reasonable to offer such treatment initially, reserving more invasive approaches for resistant cases and patients who present with side effects to the conservative management.
{"title":"Conservative treatment of pelvic venous disease","authors":"Aleksandra Jaworucka-Kaczorowska","doi":"10.9739/tjvs.2021.s56898","DOIUrl":"https://doi.org/10.9739/tjvs.2021.s56898","url":null,"abstract":"Pelvic venous incompetence (PVI), although usually asymptomatic, may cause pelvic venous disease (PeVD), which may clinically manifest through pelvic symptoms, particularly chronic pelvic pain (CPP). There is no standard approach to manage PeVD and, therefore, the treatment should be individualized based on symptoms and the patient\"s needs. To date, many treatment methods have been proposed, including conservative treatment, pelvic vein embolization, and reparative surgery. Medical treatment of CPP due to PVI includes non-steroidal anti-inflammatory drugs (NSAIDs), medical suppression of ovarian function, venoprotective agents, vasoconstrictor drugs, and psychotropic agents. The NSAIDs have a short-term efficacy and, due to side effects after longer use, they should be avoided as a long-term solution. Pharmacological suppression of ovarian function may result in CPP relief and may be achieved using medroxyprogesterone acetate, gonadotropin-releasing hormone (GnRH) agonist, long-acting reversible contraceptives, and danazol. They have been proven to be effective in the treatment of pelvic symptoms of PeVD. Venoactive drugs (VADs), particularly micronized purified flavonoid fraction (MPFF) and psychotropic agents, also provide an improvement in CPP related to PVI. A conservative approach represents the first-line treatment modality. It is reasonable to offer such treatment initially, reserving more invasive approaches for resistant cases and patients who present with side effects to the conservative management.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82439079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-22DOI: 10.9739/tjvs.2021.s56897
S. Doganci, Zaza Lazarashvilli
Pelvic venous disease (PeVD) as a terminology incorporates many different pathologies in pelvis in both men and women. There are still many question marks in this area that need to be answered. In this article, we attempt to highlight the areas of where we should focus on for future research topics.
{"title":"Future perspective on treatment of pelvic venous disease","authors":"S. Doganci, Zaza Lazarashvilli","doi":"10.9739/tjvs.2021.s56897","DOIUrl":"https://doi.org/10.9739/tjvs.2021.s56897","url":null,"abstract":"Pelvic venous disease (PeVD) as a terminology incorporates many different pathologies in pelvis in both men and women. There are still many question marks in this area that need to be answered. In this article, we attempt to highlight the areas of where we should focus on for future research topics.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80611519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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