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The use of historical nomenclature for pelvic venous disorders fails to recognize the complex and interrelated pelvic venous circulation, contributes to misdiagnosis and poor treatment outcomes and hinders clinical research. The SVP (symptoms-varices-pathophysiology) instrument is designed to clarify the classification of pelvic venous disorders by defining homogenous patient populations. The SVP instrument will facilitate clinical communication, allow treatment to be more precisely directed, and facilitate the development of patient-reported outcome measures and clinical trials. [ABSTRACT FROM AUTHOR]

Pelvic congestion syndrome (PCS) is a pain syndrome characterized by positional pelvic pain and is associated with pelvic and vulvar varicosities as well as symptoms of dyspareunia and postcoital pain. Since the etiology of PCS is complex, the treatment should be individualized. Despite both pharmacological and interventional methods being used, there is significant predominance of minimally invasive therapies e.g. embolization. The study considers the answer to the question of whether pharmacological therapy is altogether effective. Using a combination of keywords, a PubMed search was performed for the years 1987-2022. The relevant articles were appointed and included in this narrative review. Despite the multitude of alternatives for pharmacological treatment, the systemic side effects of the medications used, as well as the interactions between drugs, affect patients' compliance and persistence. Furthermore, the quality of the currently existing evidence, considering the efficacy of the given substances, is low. Because of the adverse effects and thus the limited drug administration period, there is currently insufficient research on long-term effectiveness of the PCS pharmacological treatment. Therefore, prospective, comparative studies with larger patient population sizes are necessary to provide the possibility of efficient pharmacological therapy. [ABSTRACT FROM AUTHOR]

Abstract Background Pelvic congestion syndrome (PCS) represents a diagnostic challenge due to its variable clinical presentation, complex anatomy, and pathophysiology. Accurate delineation of the venous anatomy, detection of venous reflux or obstruction, its extent will enable interventional radiologists to successfully treat such patients and to avoid recurrence. Magnetic resonance imaging (MRI) allows a noninvasive examination of the anatomy and flow inside the pelvic veins in addition to its excellent soft-tissue contrast allowing evaluation of the pelvic organs. Our study is aiming to investigate the role and accuracy of MR venography with time-resolved imaging (TR-MRV) as a diagnostic tool for pretreatment planning of PCS. Results Our study included 25 female patients with mean age 48 ± 12.34, who were referred to the radiology department in the period from April/2019 to April/2020 with clinical and ultrasound features suggesting PCS. TR-MRV was performed and interpreted in a blind fashion evaluating the vascular anatomy, venous dilatation, and reflux. The results were compared to conventional venography as a reference. The sensitivity, specificity, and accuracy of TR-MRV in the detection of ovarian vein reflux were 87%, 80%, and 84%, respectively, versus 75%, 53%, and 72% in internal iliac vein reflux and 92%, 69%, and 64% for pelvic venous plexus reflux. Demonstration of the venous anatomy was excellent in 68% of the patients and was sufficient in 32%. Ovarian vein dilatation was detected in 16 patients by venography and in 10 patients by TR-MRV. The weighted k-values (Cohen's Kappa coefficient statistics) indicated excellent agreement between the two observers for identifying all the refluxing veins by TRI in each patient (k = 0.78). Conclusion MRI with TR imaging has shown high diagnostic accuracy when compared to conventional venography in evaluating pelvic congestion syndrome before endovascular treatment and thus facilitating treatment planning.

Objectives: Patients with pelvic congestion syndrome (PCS) often report overlapping somatic symptoms and syndromes. The objective of this study was to explore the prevalence of co-existing symptoms and self-reported syndrome diagnoses among women with PCS and to inform future research hypotheses. Methods: A brief online survey was offered to members of a PCS support group website. Responses were assessed for self-reported co-existing symptoms and formal diagnoses, including: chronic fatigue syndrome, fibromyalgia, postural tachycardia syndrome, irritable bowel syndrome, migraines, interstitial cystitis, and temporomandibular joint dysfunction. Results: Of a total of 6000 members, there were 398 respondents; 232 (59%) had not yet been treated for PCS. Among these, the most prevalent co-existing symptoms were as follows: severe fatigue (72%), dizziness (63%), IBS symptoms (61%), brain fog (33%), migraines (49%), polyuria or dysuria (41%), excessive sweating (31%), TMJ pain (31%), and loose skin or lax joints (18%). These are much higher than reported for the general female population. The most commonly self-reported comorbid syndrome diagnoses for the overall group of 398 were: irritable bowel syndrome (29%), fibromyalgia (13%), spinal nerve problems (18%), interstitial cystitis (10%), postural tachycardia syndrome (9%), hypertension (11%), chronic fatigue syndrome (10%), and Ehlers-Danlos syndrome (6%). Other than with hypertension, these rates are variably higher than in the general population. Conclusion: Several self-reported co-existing symptoms and syndromes are more prevalent in members of a PCS support group relative to the reported prevalence in the general population. More formal investigation is warranted to evaluate this finding and to investigate potential etiologic links. Ehlers-Danlos Syndrome appears to be common in self identifying PCS women. [ABSTRACT FROM AUTHOR]

Nutcracker syndrome (NCS) is a rare cause of pelvic venous congestion syndrome and is secondary to either compression of the left renal vein in its normal anatomic position by the superior mesenteric artery and aorta or less commonly when the left renal vein is in a retroaortic position, compressed between the aorta and the spine. We herein present a unique case of NCS in a female patient with a history of chronic pelvic pain and venous congestion. We also review the literature and discuss the diagnostic modalities, differential diagnosis, and various open surgical and endovascular options for NCS.

Abstract Background Due to the scarcity of adequately powered, randomized controlled trials and internationally standardized diagnostic criteria, evidence on the diagnosis and treatment of pelvic congestion syndrome (PCS) is limited. Earlier epidemiologic observations led to the attribution of PCS to the premenopausal state, and a remission of symptoms after menopause is frequently described a hallmark of the pathology. This concept has currently been challenged by radiological studies reporting a notable prevalence of ovarian venous congestion in adult female patients of advanced age. PCS as a pathology of postmenopausal women, however, has not been acknowledged by systematic research to date, impeding appropriate diagnostics and therapy for affected patients. Case presentation A 69-year-old postmenopausal patient presented with newly diagnosed dilated and insufficient pelvic veins in combination with characteristic pain anamnesis, thereby fulfilling the diagnostic criteria of PCS. Interventional coil embolization of both ovarian veins as a standard treatment previously described for premenopausal patients was successfully performed, resulting in prompt alleviation of symptoms. The patient remained symptom-free at the 18-month follow-up visit. Conclusions Given this first systematically documented case of a patient with postmenopausal symptomatic PCS in the light of recently published data on the prevalence of ovarian venous congestion in patients of advanced age, it may be assumed that PCS is not to be considered a pathology strictly limited to premenopausal state. Further clinical studies expanding the diagnostic scope beyond menopause may help to substantiate evidence and subsequently define standardized therapeutic approaches for affected postmenopausal patients.

Background: Pelvic congestion syndrome (PCS) represents a diagnostic challenge due to its variable clinical presentation, complex anatomy, and pathophysiology. Accurate delineation of the venous anatomy, detection of venous reflux or obstruction, its extent will enable interventional radiologists to successfully treat such patients and to avoid recurrence. Magnetic resonance imaging (MRI) allows a noninvasive examination of the anatomy and flow inside the pelvic veins in addition to its excellent soft-tissue contrast allowing evaluation of the pelvic organs. Our study is aiming to investigate the role and accuracy of MR venography with time-resolved imaging (TR-MRV) as a diagnostic tool for pretreatment planning of PCS. Results: Our study included 25 female patients with mean age 48 ± 12.34, who were referred to the radiology department in the period from April/2019 to April/2020 with clinical and ultrasound features suggesting PCS. TR-MRV was performed and interpreted in a blind fashion evaluating the vascular anatomy, venous dilatation, and reflux. The results were compared to conventional venography as a reference. The sensitivity, specificity, and accuracy of TR-MRV in the detection of ovarian vein reflux were 87%, 80%, and 84%, respectively, versus 75%, 53%, and 72% in internal iliac vein reflux and 92%, 69%, and 64% for pelvic venous plexus reflux. Demonstration of the venous anatomy was excellent in 68% of the patients and was sufficient in 32%. Ovarian vein dilatation was detected in 16 patients by venography and in 10 patients by TR-MRV. The weighted k-values (Cohen's Kappa coefficient statistics) indicated excellent agreement between the two observers for identifying all the refluxing veins by TRI in each patient (k = 0.78). Conclusion: MRI with TR imaging has shown high diagnostic accuracy when compared to conventional venography in evaluating pelvic congestion syndrome before endovascular treatment and thus facilitating treatment planning. [ABSTRACT FROM AUTHOR]

Definition. Pelvic congestion syndrome (or more precisely - pelvic venous disorders) is a collective concept of diseases with different pathophysiology, with the main symptom chronic pain in the pelvis. It is most often caused by increase in the pressure, number and caliber of the intrapelvic venous structures. Usually, this syndrome is either neglected or not well known, leading to delays in diagnosis and treatment. Diagnostic approach. In addition to the typical clinical presentation, pelvic venous disorders are most often detected by color duplex sonography (transvaginal), but for the preparation of a therapeutic algorithm, computer tomography venography and, to a lesser extent, invasive venography play a key role. The tomographic study gives valuable information about the compression, the affected structures and their sizes. Among the additional tests, we should mention the dynamic renal scintigraphy with which we evaluate the renal function. Therapeutic algorithm. Pathophysiological mechanisms mainly involve reflux and/or obstruction. Finding the exact mechanism of venous system involvement in any of the four areas (renal, gonad/iliac, pelvic, or lower extremity) is critical to successful treatment. In certain cases, the treatment of reflux may not lead to the desired results and, on the contrary, may even harm. In cases of pure reflux to the gonadal veins, the main method of treatment is endovascular - embolization; in cases of compression also - venous stenting. Combined pathologies are a challenge, in which an individual approach and additional exams are essential for their correct treatment. Conclusion. Pelvic venous disorders are a real challenge to the vascular specialist. A good knowledge of venous anatomy and pathophysiology is a cornerstone in the adequate and thorough treatment of this pathology. [ABSTRACT FROM AUTHOR]

Pelvic 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. [ABSTRACT FROM AUTHOR]

Background: Due to the scarcity of adequately powered, randomized controlled trials and internationally standardized diagnostic criteria, evidence on the diagnosis and treatment of pelvic congestion syndrome (PCS) is limited. Earlier epidemiologic observations led to the attribution of PCS to the premenopausal state, and a remission of symptoms after menopause is frequently described a hallmark of the pathology. This concept has currently been challenged by radiological studies reporting a notable prevalence of ovarian venous congestion in adult female patients of advanced age. PCS as a pathology of postmenopausal women, however, has not been acknowledged by systematic research to date, impeding appropriate diagnostics and therapy for affected patients.Case Presentation: A 69-year-old postmenopausal patient presented with newly diagnosed dilated and insufficient pelvic veins in combination with characteristic pain anamnesis, thereby fulfilling the diagnostic criteria of PCS. Interventional coil embolization of both ovarian veins as a standard treatment previously described for premenopausal patients was successfully performed, resulting in prompt alleviation of symptoms. The patient remained symptom-free at the 18-month follow-up visit.Conclusions: Given this first systematically documented case of a patient with postmenopausal symptomatic PCS in the light of recently published data on the prevalence of ovarian venous congestion in patients of advanced age, it may be assumed that PCS is not to be considered a pathology strictly limited to premenopausal state. Further clinical studies expanding the diagnostic scope beyond menopause may help to substantiate evidence and subsequently define standardized therapeutic approaches for affected postmenopausal patients. [ABSTRACT FROM AUTHOR]

Objectives: To examine whether electrical stimulation of the perineum inhibited urinary frequency in rats with pelvic venous congestion, and whether electrical stimulation influences spinal glycinergic/gamma‐aminobutyric acid‐ergic neurons. Methods: Bilateral common iliac veins and bilateral uterine veins were ligated to create pelvic venous congestion rats. At 4 weeks after ligation, cystometry was carried out before and after electrical stimulation with/without intrathecal injection of strychnine (a glycine receptor antagonist) and/or bicuculline (a gamma‐aminobutyric acid type A receptor antagonist). In addition, measurement of amino acid levels in the lumbosacral cord was carried out with/without electrical stimulation, and cystometry was carried out after oral administration of glycine. Results: Continuous cystometry showed that the interval between bladder contractions was shorter in pelvic venous congestion rats than in sham rats. Electrical stimulation did not change cystometric parameters in sham rats, but the interval between bladder contractions was increased by electrical stimulation in pelvic venous congestion rats. Electrical stimulation increased the levels of glutamic acid, glycine, gamma‐aminobutyric acid, and taurine in the lumbosacral cord of pelvic venous congestion rats. Intrathecal strychnine abolished the effects of electrical stimulation in pelvic venous congestion rats, and intrathecal administration of both strychnine and bicuculline shortened the interval between bladder contractions more than before electrical stimulation. Oral administration of glycine (3%) to pelvic venous congestion rats increased bladder capacity. Conclusions: Electrical stimulation of the perineum inhibits urinary frequency mainly through activation of spinal glycinergic neurons, and partly through activation of gamma‐aminobutyric acid‐ergic neurons in a rat model of pelvic venous congestion. [ABSTRACT FROM AUTHOR]

Purpose: The relationship between blood flow and lower urinary tract disease was explored by measuring blood flow in the common iliac vein to examine the influence of pelvic congestion on lower urinary tract symptoms. Methods: Color Doppler ultrasonography of the right common iliac vein was performed in 113 men and 60 women, who were outpatients of two Japanese hospitals. Average blood flow velocity and cross-sectional area of the vein were measured, and blood flow volume was calculated. The relationship between these parameters and age or urological diseases was then examined. Results: There was no relation between age and average blood flow velocity or blood flow volume of the common iliac vein in either men or women. However, average common iliac vein blood flow velocity was significantly lower in men with chronic prostatitis and in women with overactive bladder than in other male and female patients, respectively. Common iliac vein blood flow volume was also significantly lower in men with chronic prostatitis than in other male patients. Conclusions: Men with chronic prostatitis and women with overactive bladder have low blood flow in the common iliac vein, suggesting that pelvic congestion may be related to these two conditions. [ABSTRACT FROM AUTHOR]

Introduction: Pelvic congestion syndrome (PCS), is a condition associated with ovarian vein (OV) incompetence among other causes. It is manifested by chronic pelvic pain with associated dyspareunia and dysmenorrhea. The diagnosis of PCS is often overlooked and the management can be difficult. Traditional therapy for PCS has included both medical and surgical approaches and more recently endovascular therapy. The aim of this work: The aim of this work was to assess the clinical efficacy of ovarian vein embolization in treatment of PCS associated with OV incompetence and in the management of pelvic varices via catheter directed coil embolization. Conclusion: From our and previous results, we can conclude that catheter directed OV coil embolization is a feasible procedure for treatment of pelvic congestion syndrome associated with OV incompetence. Presence of bilateral OV incompetence should always be investigated prior this therapy. Further prospective trials are required to assess the full benefits and efficacy of this technique, and to assess which may be the best embolic agent.

Objectives To assess the technical success and short term clinical efficacy of trans-catheter ovarian vein coiling in the treatment of symptomatic pelvic congestion syndrome in women. Methods This study included 10 female patients having pelvic venous congestion treated by coiling and were followed up for 3 months between February 2016 and April 2017 at Ain Shams University hospital, Cairo, Egypt. Symptomatology of pelvic congestion syndrome that was documented either by transvaginal Doppler and/or by MRI with no response to conservative treatment. Results Symptoms successfully disappeared in 8 patients out of 10. Partial relief of symptoms in one patient that was then disappeared after another session. Only one patient showed no improvement. Conclusion Our study demonstrates high efficacy of ovarian vein coiling as a new technique in the treatment of symptomatic female patients with pelvic congestion syndrome. [ABSTRACT FROM AUTHOR]

May-Thurner syndrome (MTS), or iliac vein compression syndrome, is a pelvic condition that involves compression of the iliac veins resulting in endothelial damage. This condition is typically asymptomatic and often missed in primary care. As progression occurs over time, symptoms related to venous hypertension may be present including acute extremity pain and swelling, pelvic pain, venous claudication, deep venous thrombosis, or chronic development of venous insufficiency. A case report is provided to enhance primary health care providers' knowledge of MTS and promote early detection and recognition to enhance positive and expedited outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Pelvic congestion syndrome (PCS), is a condition associated with ovarian vein (OV) incompetence among other causes. It is manifested by chronic pelvic pain with associated dyspareunia and dysmenorrhea. The diagnosis of PCS is often overlooked and the management can be difficult. Traditional therapy for PCS has included both medical and surgical approaches and more recently endovascular therapy. The aim of this work: The aim of this work was to assess the clinical efficacy of ovarian vein embolization in treatment of PCS associated with OV incompetence and in the management of pelvic varices via catheter directed coil embolization. Conclusion: From our and previous results, we can conclude that catheter directed OV coil embolization is a feasible procedure for treatment of pelvic congestion syndrome associated with OV incompetence. Presence of bilateral OV incompetence should always be investigated prior this therapy. Further prospective trials are required to assess the full benefits and efficacy of this technique, and to assess which may be the best embolic agent. [ABSTRACT FROM AUTHOR]

Purpose: Pelvic congestion syndrome is an uncommon poorly understood and frequently misdiagnosed disorder of the pelvic venous circulation, which causes chronic pelvic pain in women in premenopausal age. This condition has typical features, such as pelvic varicosities, pelvic pain worsened by prolonged standing, coitus, menstruation, and pregnancy.Methods: The precise etiology of this syndrome remains uncertain, and it is probably multifactorial. Valvular insufficiency, venous obstruction, and hormones all may play a role in the development of congestion of the pelvic veins.Results: Pelvic pain and venous varices are often both present in premenopausal women, but not necessarily causally related. Furthermore, incompetent and dilated pelvic veins are a common finding in asymptomatic women. As such, it is challenging but important to determine which patients have chronic pelvic pain specifically related to pelvic congestion syndrome in order to treat them properly.Conclusions: Once the syndrome has been accurately diagnosed, medical, surgical, or minimally invasive endovascular treatments can improve symptoms in a high percentage of cases. This updated nonsystematic review of the literature explores the pathophysiology, clinical features, diagnostic investigations, and treatment option of this complex condition that affects young women with considerable implications for their daily social and psychological condition. [ABSTRACT FROM AUTHOR]

Chronic pelvic pain (CPP) has many potential causes and is often a complex disorder with multiple contributing etiologies. The evaluation and treatment of women with CPP often requires a multidimensional approach. The treatment of CPP consists of two approaches: 1) treatment of pain itself or global treatment, and 2) treatment of disease-specific etiologies. Most often, treatment requires a combination of both approaches. This article reviews recent literature in the global treatment of CPP, including pharmacologic, psychotherapy, and neuroablative, as well as specific interventions for endometriosis, interstitial cystitis, pelvic adhesive disease, adenomyosis, and pelvic venous congestion. [ABSTRACT FROM AUTHOR]

Chronic pelvic pain (CPP) is a common cause of gynecologic referral. Pelvic congestion syndrome, which is said to occurs due to ovarian vein incompetence, is a recognized cause of CPP. The aim of this paper is to briefly describe the clinical manifestations, and to review the role of diagnostic and interventional radiology in the management of this probably under-diagnosed condition. [ABSTRACT FROM AUTHOR]

Chronic pelvic pain is a common and disabling condition affecting women of childbearing age. A specific diagnosis for the condition is often difficult, and referred pain from the abdominal viscera, neurogenic and psychogenic factors have all been implicated, as have pelvic conditions such as endometriosis, pelvic inflammatory disease and ovarian cysts; no diagnosis is made in 60% of patients. Pelvic congestion syndrome (PCS), the presence of varices of the pelvic veins, has been shown to be the underlying aetiology in a significant proportion of patients with chronic pelvic pain; the development of these varices is caused by a combination of endocrine and mechanical factors. Given the positional nature of these varices, they are rarely diagnosed with conventional methods such as B-mode ultrasound and diagnostic laparoscopy. Diagnosis is best made with selective ovarian venography, although newer, non-invasive methods such as magnetic resonance imaging and duplex ultrasound are increasingly gaining favour. Pelvic varices are eminently treatable, either using ovarian suppression or by the ligation or embolization of the pelvic veins. [ABSTRACT FROM AUTHOR]

Absence of isolated infrarenal inferior vena cava (IVC) is a rare condition documented in only a few published cases and typically treated with anticoagulation. We herein describe successful surgical management of the isolated infrarenal IVC absence in a healthy 35-year-old woman who presented with disabling pelvic congestion. An ascending venogram showed the absence of infrarenal IVC with a large left ovarian vein draining pelvic collateral vessels to the normal left renal vein and suprarenal IVC. The patient was successfully treated with a common femoral vein to the suprarenal IVC bypass using a bifurcated polytetrafluoroethylene graft, with rapid symptom resolution, and remained symptom free 6 months later. This is the first reported case describing a surgical strategy for isolated infrarenal IVC absence in a symptomatic patient. [ABSTRACT FROM AUTHOR]

The term pelvic venous disorders (PeVD) describes a group of related clinical entities with overlapping clinical presentations that were previously characterized by separate imprecise syndromic terminology. The clinical manifestations of PeVD may variously include chronic pelvic pain; pelvic origin extrapelvic lower extremity and genital varices; lower extremity pain and swelling; and left flank pain and hematuria. This manuscript focuses on the primary manifestations of PeVD in women - chronic pelvic pain and pelvic origin lower extremity and vulvar varices - and will review the underlying pathophysiology and related complicating factors (such as maladaptive pain responses) to explain the variety of clinical presentations. [ABSTRACT FROM AUTHOR]