Incompetent and Dilated Ovarian Veins

Rozenblit, Alla M.; Ricci, Zina J.; Tuvia, Joseph; Amis, Edward S.

doi:10.2214/ajr.176.1.1760119

Cited by 141 publications

(19 citation statements)

References 10 publications

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“…Prevalence of PVI in the left OV was variously reported at 10%, 17%, 18%, 38% and 47%. 70,[82][83][84]87 The varying thresholds for defining OV dilatation may give rise to these differences, as might the imaging systems deployed, although no apparent association can be deduced here. CT may overmagnify vessel diameters by 20% yet be unable to detect small veins, and some distention of the OV may occur as a result of the increased intra-abdominal pressure caused by breath holding.…”

Section: A Review Of the Association Between Pelvic Vein Incompetencementioning

confidence: 84%

“…A retrospective study of the preoperative helical CT scans of female kidney donors provides data on the incidence of OV varices and incompetence in an asymptomatic population. 82 An OV diameter of > 7 mm was considered to be dilated, whilst reflux was complete opacification during the arterial phase of CT angiography; this latter observation defined incompetence. Medical note review implied that no women reported pelvic or abdominal pain, although 4 out of 34 had small fibroids.…”

Section: Prevalence Of Pelvic Vein Incompetence In Asymptomatic Populmentioning

confidence: 99%

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The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

Champaneria

Shah

Moss³

et al. 2016

Health Technol Assess

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BackgroundPelvic congestion syndrome (PCS) is described as chronic pelvic pain (CPP) arising from dilated and refluxing pelvic veins, although the causal relationship between pelvic vein incompetence (PVI) and CPP is not established. Non-invasive screening methods such as Doppler ultrasound and magnetic resonance venography are used before confirmation by venography. Percutaneous embolisation has become the principal treatment for PCS, with high success rates often cited.ObjectivesOur proposal aimed to systematically and critically review the definitions and diagnostic criteria of PCS, the association between PVI and CPP, the accuracy of various non-invasive imaging techniques and the effectiveness of embolisation for PVI; and to identify factors associated with successful outcome. We also wished to survey clinicians and patients to assess awareness and management of PCS and gauge the enthusiasm for further research.Data sourcesA comprehensive search strategy encompassing various terms for pelvic congestion, pain, imaging techniques and embolisation was deployed in 17 bibliographic databases, including MEDLINE, EMBASE and Web of Science. There was no restriction on study design.MethodsMethodological quality was assessed using appropriate tools. Online surveys were sent to clinicians and patients. The quality and heterogeneity generally precluded meta-analysis and so results were tabulated and described narratively.ResultsWe identified six association studies, 10 studies involving ultrasound, two studies involving magnetic resonance venography, 21 case series and one poor-quality randomised trial of embolisation. There were no consistent diagnostic criteria for PCS. We found that the associations between CPP and PVI were generally fairly similar, with three of five studies with sufficient data showing statistically significant associations (odds ratios of between 31 and 117). The prevalence of PVI ranged widely, although the majority of women with PVI had CPP. Transvaginal ultrasound with Doppler and magnetic resonance venography are both useful screening methods, although the data on accuracy are limited. Early substantial relief from pain symptoms was observed in approximately 75% of women undergoing embolisation, a figure which generally increased over time and was sustained. Reintervention rates were generally low. Transient pain was a common occurrence following foam embolisation, while there was a < 2% risk of coil migration. Confidence in the embolisation technique is reasonably high, although there is a desire to strengthen the evidence base. Even among women with CPP, fewer than half had any knowledge about PCS.ConclusionsThe data supporting the diagnosis and treatment of PCS are limited and of variable methodological quality. There is some evidence to tentatively support a causative association, but it cannot be categorically stated that PVI is the cause of CPP in women with no other pathology, as the six most pertinent drew on clinically disparate populations and defined PVI inconsistently. Embolisation appears to provide symptomatic relief in the majority of women and is safe. However, the majority of included studies of embolism were relatively small case series and only the randomised controlled trial was considered at risk of potential biases. There is scope and demand for considerable further research. The question of the association of PVI and CPP requires a well-designed and well-powered case–control study, which will also provide data to derive a diagnostic standard. An adequately powered randomised trial is essential to provide evidence on the effectiveness of embolisation, but this faces methodological challenges.Study registrationThis study is registered as PROSPERO CRD42012002237 and CRD42012002238.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: A Review Of the Association Between Pelvic Vein Incompetencementioning

confidence: 84%

Section: Prevalence Of Pelvic Vein Incompetence In Asymptomatic Populmentioning

confidence: 99%

The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

Champaneria

Shah

Moss³

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

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“…Selective venography has been considered the gold standard for demonstrating pelvic incompetence as it can potentially show communication between incompetent pelvic veins (ovarian and/or internal iliac) and lower limb varicosities, but a recent study cautions reliance on this modality [ 71 ]. However, as dilated and presumed incompetent veins have been described in asymptomatic parous women [ 2 ], a more functional assessment of pelvic venous incompetence may be required and transvaginal, transperineal or transrectal duplex sonography have been suggested to be such an investigation [ 5 , 6 ]. Pre-operative assessment with functional imaging techniques not involving ionizing radiation such as ultrasound or MR venography in an ‘upright scanner’, is desirable and such techniques may be reproducible with appropriate training.…”

Section: Discussionmentioning

confidence: 99%

“…Ovarian and other pelvic varices (such as in the distribution of the internal iliac veins) are not an infrequent finding in adult women, and particularly those who have previously had at least one pregnancy associated with a vaginal delivery or at least a significant trial of labour [ 1 ]. However, they are also well described in asymptomatic parous women [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Female Pelvic Vein Embolization: Indications, Techniques, and Outcomes

Lopez

2015

Cardiovasc Intervent Radiol

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Until recently, the main indication for pelvic vein embolization (PVE) in women was to treat pelvic venous congestion syndrome (PVC) but increasingly, patients with refluxing pelvic veins associated with leg varicosities are also being treated. A more unusual reason for PVE is to treat pelvic venous malformations, although such lesions may be treated with sclerotherapy alone. Embolotherapy for treating PVC has been performed for many years with several published studies included in this review, whilst an emerging indication for PVE is to treat lower limb varicosities associated with pelvic vein reflux. Neither group, however, has been subjected to an adequate randomized, controlled trial. Consequently, some of the information presented in this review should be considered anecdotal (level III evidence) at this stage, and a satisfactory ‘proof’ of clinical efficacy remains deficient until higher-level evidence is presented. Furthermore, a wide range of techniques not accepted by all are used, and some standardization will be required based on future mandatory prospective studies. Large studies have also clearly shown an unacceptably high recurrence rate of leg varicose veins following venous surgery. Furthermore, minimally or non-invasive imaging is now revealing that there is a refluxing pelvic venous source in a significant percentage of women with de novo leg varicose veins, and many more with recurrent varicosities. Considering that just over half the world’s population is female and a significant number of women not only have pelvic venous reflux, but also have associated leg varicosities, minimally invasive treatment of pelvic venous incompetence will become a common procedure.

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“…Multi-detector computed tomography (MDCT) has been established as a rapid, non-invasive technique for evaluating anatomy and diseases of the pelvic region in women [Bazot et al, 1999; Foshager & Walsh, 1994; Kumar et al, 2002; MacSweeney & King, 1994; Occhipinti et al, 1993; Rigsby & Siegel, 1994; Rozenblit et al, 2001; Saksouk & Johnson, 2004]. Multi-detector CT uses x-rays, an array of multiple detectors, and advanced computer processing to generate high-detail slice images of the body [Horton et al, 2002].…”

Section: Introductionmentioning

confidence: 99%

Validation of multi‐detector computed tomography as a non‐invasive method for measuring ovarian volume in macaques (Macaca fascicularis)

Jones

Appt

Werre

et al. 2010

American J Primatol

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The purpose of this study was to validate low radiation dose, contrast-enhanced, multi-detector computed tomography (MDCT) as a non-invasive method for measuring ovarian volume in macaques. Computed tomography scans of four known-volume phantoms and nine mature female cynomolgus macaques were acquired using a previously described, low radiation dose scanning protocol, intravenous contrast enhancement, and a 32-slice MDCT scanner. Immediately following MDCT, ovaries were surgically removed and the ovarian weights were measured. The ovarian volumes were determined using water displacement. A veterinary radiologist who was unaware of actual volumes measured ovarian CT volumes three times, using a laptop computer, pen display tablet, hand-traced regions of interest, and free image analysis software. A statistician selected and performed all tests comparing the actual and CT data. Ovaries were successfully located in all MDCT scans. The iliac arteries and veins, uterus, fallopian tubes, cervix, ureters, urinary bladder, rectum, and colon were also consistently visualized. Large antral follicles were detected in six ovaries. Phantom mean CT volume was 0.702±SD 0.504 cc and the mean actual volume was 0.743±SD 0.526 cc. Ovary mean CT volume was 0.258±SD 0.159 cc and mean water displacement volume was 0.257±SD 0.145 cc. For phantoms, the mean coefficient of variation for CT volumes was 2.5%. For ovaries, the least squares mean coefficient of variation for CT volumes was 5.4%. The ovarian CT volume was significantly associated with actual ovarian volume (ICC coefficient 0.79, regression coefficient 0.5, P = 0.0006) and the actual ovarian weight (ICC coefficient 0.62, regression coefficient 0.6, P = 0.015). There was no association between the CT volume accuracy and mean ovarian CT density (degree of intravenous contrast enhancement), and there was no proportional or fixed bias in the CT volume measurements. Findings from this study indicate that MDCT is a valid non-invasive technique for measuring the ovarian volume in macaques.

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Incompetent and Dilated Ovarian Veins

Abstract: Incompetent and dilated ovarian veins are frequently seen on CT in asymptomatic parous women. As an isolated finding, it is unlikely to be associated with pelvic congestion syndrome.

Cited by 141 publications

References 10 publications

The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

Female Pelvic Vein Embolization: Indications, Techniques, and Outcomes

Validation of multi‐detector computed tomography as a non‐invasive method for measuring ovarian volume in macaques (Macaca fascicularis)

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