Management of Patients when Superficial Venous Disease Arises from Pelvic Escape Points

2021 ◽  
Vol 38 (02) ◽  
pp. 226-232
Author(s):  
Rakesh S. Ahuja ◽  
Tushar Garg ◽  
Deepak Sudheendra
Keyword(s):  
Venous Insufficiency ◽  
Clinical Presentation ◽  
Uterine Fibroids ◽  
Interventional Treatment ◽  
Venous Disease ◽  
Flow Through ◽  
Pelvic Venous Insufficiency ◽  
Current Terminology ◽  
Pelvic Varices ◽  
Pelvic Congestion

AbstractChronic pelvic pain (CPP) is a common condition in women that carries with it significant morbidity. It is commonly seen in patients presenting to obstetrics and gynecology outpatient clinic visits. CPP is a presenting symptom of various pathologies including pelvic varicocele, pelvic adhesions, spastic colon syndrome, uterine fibroids, endometriosis, and psychosomatic disorders. Pelvic congestion syndrome has more recently been termed “pelvic venous insufficiency (PVI)” due to the underlying retrograde flow through incompetent ovarian and pelvic veins that are thought to cause the symptoms of CPP. Pelvic varices can commonly present alongside vulvar, perineal, and lower extremity varices. There are some predictable “escape pathways” for these varices that may present for interventional treatment. This article introduces the reader to current terminology, clinical presentation, diagnosis, and treatment of patients with pelvic varices due to PVI.

Tratamento Endovascular da Síndrome de Congestão Pélvica: Série de Casos/Endovascular Treatment of Pelvic Congestion Syndrome: Case Series

1970 ◽  
Vol 5 (2) ◽  
pp. 148-157
Author(s):  
Melissa Andreia de Moraes Silva ◽  
Danielle Ribeiro Pereira ◽  
Érica Ribeiro Cruz ◽  
Seleno Glauber de Jesus Silva ◽  
Rodolfo Souza Cardoso
Keyword(s):  
Pelvic Pain ◽  
Varicose Veins ◽  
Delayed Diagnosis ◽  
Case Series ◽  
Reproductive Age ◽  
Venous Disease ◽  
Percutaneous Embolization ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Varices ◽  
Pelvic Congestion

RESUMO                           Introdução: As varizes pélvicas fazem parte de uma entidade clínica, a síndrome da congestão pélvica (SCP), que acomete mulheres em idade reprodutiva, geralmente multíparas, e cursa com como dor e sensação de peso crônico na região pélvica, dispareunia, dismenorreia, congestão vulvar e disúria. A síndrome é  decorrente do refluxo de veias ovarianas incompetentes e dilatadas. O refluxo pélvico também apresenta-se como um fator causal importante no que diz respeito ao surgimento e recidiva da doença venosa nos membros inferiores. Casuística: Foram descritos três casos de pacientes portadoras de SCP com sintomas clássicos, com diagnóstico tardio. Todas foram submetidas à embolização percutânea das varizes através do implante de molas fibradas de liberação livre através do aceso femoral, e obtiveram resultado satisfatório, semelhantes aos citados na literatura. Discussão: O diagnóstico da SCP é difícil e o tratamento envolve terapia medicamentosa para melhora dos sintomas e, em casos refratários, o uso de técnicas minimamente invasivas como a embolização das veias gonadais. Trata-se de uma condição comum e subdiagnosticada, sendo muitas das vezes um achado de exclusão de outras patologias. Conclusão: A embolização percutânea das veias ovarianas é um método simples, eficaz, com baixos índices de complicações e com resultado satisfatório a curto e médio prazo. A recidiva é frequente no longo prazo, e pode estar relacionada à progressão da doença varicosa ao longo do tempo e suas diferentes manifestações clínicas.Palavras-chave: Varizes, Dor pélvica, Embolização terapêutica. ABSTRACTIntroduction: Pelvic varices are part of a clinical entity, Pelvic Congestion Syndrome. This disease affects women at reproductive age, multiparous and presents symptoms such as chronic pelvic pain, feeling of heaviness in the pelvic region, dyspareunia, dysmenorrhea, vulvar congestion and urinary symptoms such as dysuria. Case Report: The aim of this study is to report a small case series of treatment of pelvic varices by embolization. We described three cases of patients suffering from pelvic varices with classic symptoms, which showed a delayed diagnosis, that caused emotional, aesthetic and marital problems. All of them underwent percutaneous embolization of varices, achieved satisfactory results and have been in clinical monitoring. Discussion: The cause of the disturb is the reflux of incompetent and dilated ovarian veins. Pelvic reflux also presents itself as an important causative factor concerning the appearance and recurrence of venous disease in lower members. Diagnosis is difficult. It is a common and underdiagnosed condition, often being a finding that excludes other pathologies. The results found after treatment were similar to stated in literature. Conclusion: The embolization of pelvic varices has been shown simpler and effective, with lowest rates of complications and with satisfactory results at short and long term. However, more studies regarding the outcome of different treatment methods are needed.Keywords: Varicose veins, Pelvic pain, Therapeutic embolization.

Embolization is essential in the treatment of leg varicosities due to pelvic venous insufficiency

2015 ◽  
Vol 30 (1_suppl) ◽  
pp. 81-85 ◽  
Author(s):  
O Hartung
Keyword(s):  
Local Anesthesia ◽  
Lower Limb ◽  
Varicose Veins ◽  
Iliac Vein ◽  
Additional Treatment ◽  
Venous Disease ◽  
Secondary Patency ◽  
Pelvic Venous Insufficiency ◽  
Pelvic Congestion

Purpose Pelvic venous insuffiency (PVI) can be responsible for pelvic congestion syndrome (PCS) and also lower limb varicose veins. Material and methods Charts of all women who had pelvic venography for PVI from September 2013 to August 2014 were reviewed. The procedure was performed under local anesthesia through left femoral approach. In case of reflux without associated obstructive lesions, embolization with coils and polidocanol foam was performed during the same procedure. Results 119 women, with median age 39 years were explored (86 with PCS and 102 with lower limb venous disease). Of these, 78 had an isolated reflux and were embolized and 41 had an obstructive disease (29 iliocaval obstructive lesions (ICOL), 4 nutcracker syndrome (NCS), and 8 with an association of both). Median follow-up was 4 months. Of the 12 NCS, 5 had surgical treatment and 7 had stenting of the left iliac vein without embolization. All patients with ICOL without NCS were treated by stenting in 28 and by a Palma procedure in 1 (failure to recanalize). Primary and secondary patency rates were 97% at 12 months. Embolization led to improvement of PCS in 91% (60% without any pain) and of lower limb varicose veins in 51% by itself. If 82% need an additional treatment of lower limb varicose veins, embolization allowed a switch of strategy from surgery to sclerosis. Conclusion PVI can cause lower limb symptoms. In most cases, it is due to reflux and can be treated under local anesthesia by embolization. This technique is safe and efficient. Obstructive lesions must be recognized and treated.

Correlation Between Various Definition of Superficial Venous Reflux and Clinical Presentation of Venous Disease

2018 ◽  
Vol 42 (4) ◽  
pp. 189-192
Author(s):  
Mehrdad Mac Farid ◽  
Bernardo Fernandez ◽  
Szilvia Udvari-Nagi ◽  
Suresh Kacham ◽  
Tracey Mountjoy Cross ◽  
...  
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Clinical Presentation ◽  
Primary Objective ◽  
Venous Disease ◽  
Venous Reflux ◽  
Saphenous Veins ◽  
Anatomic Distribution ◽  
Definition Of ◽  
Saphenofemoral Junction

There have been various ways of reporting venous reflux in chronic venous insufficiency (CVI). Some vascular laboratories tend to describe venous reflux with categorical presence of reflux and some use grading method by measuring duration of venous reflux in seconds. The primary objective of study is to find out which method of describing venous incompetency in superficial venous system at great saphenous veins (GSV) and saphenofemoral junction (SFJ) would best correlate with clinical presentation of venous disease using CEAP (clinical manifestation, etiologic factors, anatomic distribution, pathophysiologic dysfunction) classification.

Incidence and distribution of lower extremity reflux in patients with pelvic venous insufficiency

2019 ◽  
Vol 35 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Nicholas Scotti ◽  
Karl Pappas ◽  
Sanjiv Lakhanpal ◽  
Candace Gunnarsson ◽  
Peter J Pappas
Keyword(s):  
Lower Extremity ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Clinical Severity ◽  
Venous Disease ◽  
Entire Cohort ◽  
Venous Clinical Severity Score ◽  
Venous Disorders ◽  
Pelvic Venous Insufficiency ◽  
Extremity Veins

Introduction Women with pelvic venous insufficiency often present with lower extremity symptoms and manifestations of chronic venous disorders. The purpose of this investigation was to determine the incidence of lower extremity chronic venous disorders and the types and distribution of lower extremity veins involved in patients with a known diagnosis of pelvic venous insufficiency. Methods Between January 2012 and December 2015, we retrospectively reviewed the charts of 227 women with pelvic venous insufficiency as well as their lower extremity venous duplex investigations. Presenting symptoms, Clinical, Etiology, Anatomy, Pathophysiology (CEAP) class, initial revised Venous Clinical Severity Score (rVCSS) and the types of lower extremity veins with reflux and their locations were noted. Patients were also subcategorized according to their primary pelvic disorder as follows: Entire cohort (PVI), Ovarian vein reflux (OVR), Iliac vein stenosis (IVS) or both (OVR + IVS). Results The study group consisted of 227 women (454 limbs) with documented pelvic venous insufficiency. The average age was 44.71 ± 10.2 years. In decreasing order, patients presented with the following lower extremity symptoms: pain (66%), swelling (32%), heaviness (26%), limb fatigue (13%), itching (13%), leg cramps (10%), skin changes or Superficial Venous Thrombosis (SVT) (2%) and ulceration or bleeding (0.08%). Table 1 outlines the CEAP class for 215 of the 227 patients. For the entire cohort, 48% of right and 50% of left limbs demonstrated C0 or C1 disease. The incidence and type of symptomatic lower extremity veins were as follows: any axial vein, 32%; great saphenous vein (GSV), 21%; small saphenous vein (SSV), 11%; GSV and SSV, 5%; non-saphenous tributaries, 15%; saphenous tributaries, 12%; posterior or postero-lateral thigh distribution, 5%; vulvar distribution, 4%; perforators, 4%; deep veins, 2%; and anterior accessory saphenous veins, 1%. For the GSV and SSV, the following patterns of reflux were observed: entire GSV, 4%; entire above knee GSV, 2%; entire below knee GSV, 2%; above knee segmental GSV, 20%; below knee segmental GSV, 21%; above and below knee GSV segmental disease, 1%; entire SSV, 4%; and SSV segmental disease, 12%. The incidence of reflux in any axial vein, the GSV and anterior accessory GSV was greater in the OVR group compared to IVS or OVR + IVS (p ≤ 0.03). In addition, 64 of 227 (28%) patients had a history of prior lower extremity venous ablations: OVR (10/39, 26%), IVS (15/50, 30%) and OVR + IVS (39/127, 9%). The number of ablations per patient was as follows—OVR: 1.48 ± 0.5, IVS: 1.7 ± 0.7 and OVR + IVS: 1.65 ± 0.7. Conclusion At least 50% of patients with pelvic venous insufficiency present with lower extremity venous disease. The incidence of reflux in any axial vein is greatest in the OVR group suggesting a correlation with hormonal fluctuations and pregnancy. The majority of symptomatic patients present with segmental axial GSV or SSV disease. Although vulvar and gluteal escape veins are highly associated with pelvic venous insufficiency, they are infrequently observed. In patients who experience residual or persistent symptoms after treatment for chronic venous disorders, a pelvic venous ultrasound should be performed to assess the presence of pelvic venous insufficiency.

Clinical Presentation, Patient Assessment, Anatomy, Pathophysiology, and Imaging of Pelvic Venous Disease

2021 ◽  
Vol 38 (02) ◽  
pp. 233-238
Author(s):  
Sean Maratto ◽  
Neil M. Khilnani ◽  
Ronald S. Winokur
Keyword(s):  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Varicose Veins ◽  
Transvaginal Ultrasound ◽  
Venous Disease ◽  
Imaging Evaluation ◽  
Clinical Communication ◽  
Ultrasound Computed Tomography ◽  
The Impact ◽  
Pelvic Varices

AbstractPelvic venous disorders (PeVDs) can result in several different clinical presentations, but can be challenging to distinguish from other etiologies of chronic pelvic pain (CPP). Clinical evaluation of CPP patients optimally should be performed in a multidisciplinary fashion and patients who may have PeVD should be referred for consultation with a vascular interventionalist whose evaluation would utilize an imaging workup to search for pelvic varices. Additionally, it is critical to quantify the quality-of-life effects of all CPP to determine the impact on the patient's overall health. Diagnostic imaging, including transabdominal and transvaginal ultrasound, computed tomography, magnetic resonance imaging, and venography, can be utilized to identify pelvic varices, as well as venous reflux and obstruction leading to CPP. The use of the SVP tool is important to classify PeVD patients based on their clinical symptoms, varicose veins, and pathophysiology for precise clinical communication and for reporting clinical research. The goal of this publication is to delineate the clinical presentation, anatomy, pathophysiology, and imaging evaluation of patients with CPP suspected of having PeVD.

scholarly journals Physical Examination and Ultrasound Evaluation of Patients with Superficial Venous Disease

2021 ◽  
Vol 38 (02) ◽  
pp. 167-175
Author(s):  
Leigh C. Casadaban ◽  
John M. Moriarty ◽  
Cheryl H. Hoffman
Keyword(s):  
Physical Examination ◽  
Venous Insufficiency ◽  
Duplex Ultrasonography ◽  
Venous Disease ◽  
Venous Anatomy ◽  
Ultrasound Evaluation ◽  
Clinical Presentations ◽  
Ultrasound Assessment ◽  
Anatomic Variants ◽  
Tools And Techniques

AbstractSystematic and standardized evaluation of superficial venous disease, guided by knowledge of the various clinical presentations, venous anatomy, and pathophysiology of reflux, is essential for appropriate diagnosis and optimal treatment. Duplex ultrasonography is the standard for delineating venous anatomy, detecting anatomic variants, and identifying the origin of venous insufficiency. This article reviews tools and techniques essential for physical examination and ultrasound assessment of patients with superficial venous disease.

Characteristics of venous insufficiency in western Turkey: VEYT-I study

2012 ◽  
Vol 27 (7) ◽  
pp. 374-377 ◽  
Author(s):  
B Akbulut ◽  
H İ UÇAr ◽  
M Öç ◽  
M İKizler ◽  
C Yorgancoğlu ◽  
...  
Keyword(s):  
Venous Insufficiency ◽  
Demographic Data ◽  
Adult Population ◽  
Signs And Symptoms ◽  
Turkish Population ◽  
Venous Hypertension ◽  
Venous Disease ◽  
Health Care Centre ◽  
Western Turkey ◽  
Study Population

Objectives Syndromes of venous hypertension and reduced venous clearance are important causes of morbidity and disability in patients with varicose venous disease. Published estimates of the prevalence of varicosities range from 7% to 55% in the adult population, with most studies demonstrating clinical varicose reflux in about 40% of the population where the frequency of venous insufficiency is believed to be higher in Westernized and industrialized nations, most likely due to differences in lifestyle and activity. Unfortunately, the prevalence in a Turkish population is not known. The goal of the VEYT-I study was to determine the characteristics of venous insufficiency in a Turkish population. Method Randomized patients who applied to a health-care centre were included in this study. The Tübingen questionnaire was used to evaluate the signs and symptoms of venous insufficiency and their seriousness in a Turkish population. Patients were additionally questioned on demographic data, education, working, living habits, quality of life and actual health status. Results A total of 2167 patients were involved in this study. Four patients with chronic renal failure and 40 patients with congestive heart failure were excluded. In patients with venous insufficiency, 90.1% did not receive any therapy. In all, 51.53% of patients with venous insufficiency were men, and mean age was 56.9 ± 9.4. Conclusion The prevalence of venous insufficiency seems to be somewhat higher when compared with Western populations. One of the most prominent facts is that about 90% of patients with venous insufficiency did not receive any therapy. Therefore, disease-related complications or discomfort might emerge soon, and so more importance should be given to venous insufficiency. The VEYT-I study is a continuing database study and the target is to enlarge the study population.

Transabdominal Pelvic Venous Duplex Examination

2018 ◽  
Vol 42 (3) ◽  
pp. 130-134
Author(s):  
Jill Bearse ◽  
Michelle Delda ◽  
Donna Kelly ◽  
Diana Neuhardt ◽  
Barbara Pohle-Schulze ◽  
...  
Keyword(s):  
Blood Flow ◽  
Venous Insufficiency ◽  
Venous System ◽  
Portal Venous System ◽  
Professional Performance ◽  
Vascular Ultrasound ◽  
Pelvic Venous Insufficiency

The Society for Vascular Ultrasound developed a Professional Performance Guideline for transabdominal pelvic venous duplex evaluation. The purpose of this guideline is to provide a template to aid the vascular technologist/sonographer and other interested parties. Transabdominal pelvic venous duplex examinations are performed to assess abnormal blood flow in the abdominal and pelvic veins (excluding the portal venous system). The evaluation includes the assessment of abdominal and pelvic venous compressions, abdominal and pelvic venous insufficiency, and the presence or absence of pelvic varicosities.

scholarly journals Evaluation of Arterial Stiffness Using Pulse Wave Velocity and Augmentation Index in Patients with Chronic Venous Insufficiency

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Mustafa Dogdus ◽  
Onur Akhan ◽  
Mehmet Ozyasar ◽  
Ahmet Yilmaz ◽  
Mehmet Sait Altintas
Keyword(s):  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
High Morbidity

Background and Objectives. Chronic venous insufficiency (CVI) is a common pathology of the circulatory system and is associated with a high morbidity for the patients and causes high costs for the healthcare systems. Arterial stiffness has been shown to be a predictor of cardiovascular events and mortality. The relationship between CVI and arterial stiffness using pulse wave velocity (PWV) and augmentation index (Aix) was evaluated in this study. Methods. Sixty-two patients with the stage of C3-C5 chronic venous disease (CVD) and 48 healthy subjects were enrolled in the study. To assess arterial stiffness, all cases were evaluated with I.E.M. Mobil-O-Graph brand ambulatory blood pressure monitor device. PWV and Aix were used to assess arterial stiffness in this study. Results. The mean age was 61.9±11.05 years and 54 % of the patient population was females. PWV and Aix were significantly higher in CVI patients than controls (8.92±1.65 vs. 8.03±1.43, p=0.001; 25.51±8.14 vs. 20.15±9.49, p=0.003, respectively) and also positive linear correlation was observed between CVI and all measured arterial stiffness parameters (r=0.675 for CVI and PWV, r=0.659 for CVI and Aix, respectively). A PWV value of > 9.2 has 88.9 % sensitivity and 71.4 % specificity to predict the presence of CVI. Conclusions. PWV and Aix are the most commonly used, easy, reproducible, reliable methods in the clinic to assess arterial stiffness. Logistic regression analysis showed that PWV and Aix were the independent predictors of CVI. PWV has the sensitivity of 88.9 % and specificity of 71.4 % to detect the presence of CVI.

Sign in / Sign up

Export Citation Format

Share Document