Pelvic veins ultrasound changes after surgical correction in patients with pelvic congestion syndrome
DOI:
https://doi.org/10.14739/2310-1237.2023.2.276782Keywords:
pelvic congestion syndrome, pelvic venosus disorders, ultrasonography, chronic pelvic pain, gonadal veins, ovarian veins, Nutcracker syndrome, May–Thurner syndromeAbstract
Pelvic congestion syndrome is a form of varicose disease, which is considered to be one of the main causes of chronic pelvic pain in women, which is associated with a violation of pelvic veins hemodynamics.
Pelvic venous disorders are invisible to clinicians due to the lack of pathognomonic symptoms and manual disease criteria, but it has significant consequences.
Today, one of the main diagnostic methods of pelvic venous disorders is a transvaginal US of pelvic veins, including gonadal veins (ovarian veins in women). Thanks to this non-invasive and simple diagnostic method that does not require specific preparation and has no contraindications, we have significant opportunities in diagnosis, as well as in the further evaluation of the postoperative results of surgical correction of pelvic congestion syndrome.
The aim of the study was to analyze changes of pelvic veins in patients with pelvic congestion syndrome before and after surgical intervention using the transvaginal US method.
Materials and methods. The study included 35 patients which underwent surgical treatment using open surgery and endovascular procedure between April 2019 and February 2022 with pelvic congestion syndrome. All patients underwent transvaginal ultrasound of the pelvic veins before surgery. A control examination was performed after surgical treatment in 4–6 months. The examination was performed on an expert-class ultrasound system “Toshiba Aplio 500” using all international standards for transvaginal examination of pelvic veins to evaluate the changes of illiac, paraovarian, parametrial and ovarian veins from the left side and from the right side in patients with pelvic venous disorders.
Conclusions. Transvaginal ultrasound of the pelvic veins can be considered one of the key diagnostic methods, with the help of which it is possible to investigate and evaluate hemodynamic disorders in the veins of the pelvis and pelvic organs in real time. Also, this method can be considered optimal for the control examination of patients who underwent surgical correction of pelvic congestion syndrome.
References
Taylor H. C., Jr (1949). Vascular congestion and hyperemia; their effect on structure and function in the female reproductive system. American journal of obstetrics and gynecology, 57(2), 211-230. https://doi.org/10.1016/0002-9378(49)90422-6
Beard, R. W., Highman, J. H., Pearce, S., & Reginald, P. W. (1984). Diagnosis of pelvic varicosities in women with chronic pelvic pain. Lancet, 2(8409), 946-949. https://doi.org/10.1016/s0140-6736(84)91165-6
Park, S. J., Lim, J. W., Ko, Y. T., Lee, D. H., Yoon, Y., Oh, J. H., Lee, H. K., & Huh, C. Y. (2004). Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. AJR. American journal of roentgenology, 182(3), 683-688. https://doi.org/10.2214/ajr.182.3.1820683
Meissner, M. H., Khilnani, N. M., Labropoulos, N., Gasparis, A. P., Gibson, K., Greiner, M., Learman, L. A., Atashroo, D., Lurie, F., Passman, M. A., Basile, A., Lazarshvilli, Z., Lohr, J., Kim, M. D., Nicolini, P. H., Pabon-Ramos, W. M., & Rosenblatt, M. (2021). The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. Phlebology, 36(5), 342-360. https://doi.org/10.1177/0268355521999559
Whiteley, M. S., DosSantos, S. J., Harrison, C. C., Holdstock, J. M., & Lopez, A. J. (2015). Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women. Phlebology, 30(10), 706-713. https://doi.org/10.1177/0268355514554638
Valero, I., Garcia-Jimenez, R., Valdevieso, P., Garcia-Mejido, J. A., Gonzalez-Herráez, J. V., Pelayo-Delgado, I., Fernandez-Palacin, A., & Sainz-Bueno, J. A. (2022). Identification of Pelvic Congestion Syndrome Using Transvaginal Ultrasonography. A Useful Tool. Tomography, 8(1), 89-99. https://doi.org/10.3390/tomography8010008
Hodgkinson, C. P. (1953). Physiology of the ovarian veins during pregnancy. Obstetrics and gynecology, 1(1), 26-37.
Maleux, G., Stockx, L., Wilms, G., & Marchal, G. (2000). Ovarian vein embolization for the treatment of pelvic congestion syndrome: long-term technical and clinical results. Journal of vascular and interventional radiology : JVIR, 11(7), 859-864. https://doi.org/10.1016/s1051-0443(07)61801-6
Capasso, P., Simons, C., Trotteur, G., Dondelinger, R. F., Henroteaux, D., & Gaspard, U. (1997). Treatment of symptomatic pelvic varices by ovarian vein embolization. Cardiovascular and interventional radiology, 20(2), 107-111. https://doi.org/10.1007/s002709900116
Dorobisz, T. A., Garcarek, J. S., Kurcz, J., Korta, K., Dorobisz, A. T., Podgórski, P., Skóra, J., & Szyber, P. (2017). Diagnosis and treatment of pelvic congestion syndrome: Single-centre experiences. Advances in clinical and experimental medicine, 26(2), 269-276. https://doi.org/10.17219/acem/68158
Labropoulos, N., Jasinski, P. T., Adrahtas, D., Gasparis, A. P., & Meissner, M. H. (2017). A standardized ultrasound approach to pelvic congestion syndrome. Phlebology, 32(9), 608-619. https://doi.org/10.1177/0268355516677135
Whiteley, M. S., Dos Santos, S. J., Harrison, C. C., Holdstock, J. M., & Lopez, A. J. (2015). Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women. Phlebology, 30(10), 706-713. https://doi.org/10.1177/0268355514554638
Holdstock, J. M., Dos Santos, S. J., Harrison, C. C., Price, B. A., & Whiteley, M. S. (2015). Haemorrhoids are associated with internal iliac vein reflux in up to one-third of women presenting with varicose veins associated with pelvic vein reflux. Phlebology, 30(2), 133-139. https://doi.org/10.1177/0268355514531952
Hansrani, V., Dhorat, Z., & McCollum, C. N. (2017). Diagnosing of pelvic vein incompetence using minimally invasive ultrasound techniques. Vascular, 25(3), 253-259. https://doi.org/10.1177/1708538116670499
Bookwalter, C. A., VanBuren, W. M., Neisen, M. J., & Bjarnason, H. (2019). Imaging Appearance and Nonsurgical Management of Pelvic Venous Congestion Syndrome. Radiographics, 39(2), 596-608. https://doi.org/10.1148/rg.2019180159
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