Research Priorities in Pelvic Venous Disorders in Women: Recommendations from a Multidisciplinary Research Consensus Panel

Khilnani, Neil M.; Meissner, Mark H.; Learman, Lee A.; Gibson, Kathleen; Daniels, Jane; Winokur, Ronald S.; Marvel, Richard P.; Machan, Lindsay; Venbrux, Anthony C.; Tu, Frank F.; Pabon‐Ramos, Waleska M.; Nedza, Susan M.; White, Sarah B.; Rosenblatt, Melvin

doi:10.1016/j.jvir.2018.10.008

Cited by 82 publications

(46 citation statements)

References 98 publications

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“…Longer-term results in homogenous populations and comparative studies with conservative treatments would be desirable as well. More importantly, the definition of proper indications to this radiologic procedure should be addressed; in fact, an invasive treatment could be taken into consideration when relevant chronic pelvic pain (and dyspareunia), possibly with related varices in the lower limbs, is accompanied with pelvic venous hypertension [105][106][107].…”

Section: Pelvic Congestion Syndromementioning

confidence: 99%

Medicine and Phlebolymphology: Time to Change?

Cavezzi

2020

JCM

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Biomedical science is undergoing a reappraisal of its scientific advancement process and of the related healthcare management. Progress in medicine should combine improvements of knowledge, efficacy, and safety of diagnostic/therapeutic procedures, with adequate cost-effectiveness profiles. This narrative review is aimed at assessing in medicine, more specifically in phlebology and lymphology: (a) scientific literature possible biases, (b) the level of evidence, comprehensiveness, and cost-effectiveness of the main therapeutic options, and (c) the possible contribution of integrative and translational medicine. Current medical research may have cognitive biases, or industry-tied influences, which impacts clinical practice. Some reductionism, with an increasing use of drugs and technology, often neglecting the understanding and care of the root causative pathways of the diseases, is affecting biomedical science as well. Aging brings a relevant burden of chronic degenerative diseases and disabilities, with relevant socio-economic repercussions; thus, a major attention to cost-effectiveness and appropriateness of healthcare is warranted. In this scenario, costly and innovative but relatively validated therapies may tend to be adopted in venous and lymphatic diseases, such as varicose veins, leg venous ulcer, post-thrombotic syndrome, pelvic congestion syndrome, and lymphedema. Conversely, a more comprehensive approach to the basic pathophysiology of chronic venous and lymphatic insufficiency and the inclusion of pharmacoeconomics analyses would benefit overall patients’ management. Erroneous lifestyle and nutrition, together with chronic stress-induced syndromes, significantly influence chronic degenerative phlebo-lymphatic diseases. The main active epigenetic socio-biologic factors are obesity, dysfunctions of musculo-respiratory-vascular pumps, pro-inflammatory nutrition, hyperactivation of stress axis, and sedentarism. An overall critical view of the scientific evidence and innovations in phebolymphology could be of help to improve efficacy, safety, and sustainability of current practice. Translational and integrative medicine may contribute to a patient-centered approach. Conversely, reductionism, eminence/reimbursement-based decisional processes, patients’ lack of education, industry-influenced science, and physician’s improvable awareness, may compromise efficacy, safety, appropriateness, and cost-effectiveness of future diagnostic and therapeutic patterns of phlebology and lymphology.

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Section: Pelvic Congestion Syndromementioning

confidence: 99%

Medicine and Phlebolymphology: Time to Change?

Cavezzi

2020

JCM

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“…The first attempts were also made to standardize this type of research and to create the first classifications describing the phenomenon of pelvic venous insufficiency [4,[21][22][23]. In the newest international consensuses [24,25] the authors briefly present 4-grades (GI-GIV) of pelvic venous reflux criteria for cross-sectional imaging diagnosis of PVI.…”

Section: Introductionmentioning

confidence: 99%

“…However, to date, none of the existing classifications has gained universal approval [25]. Taking the above into account, the authors attempted to create a simple hemodynamic -radiological classification that would stratify the grade of ovarian veins system insufficiency.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic and Radiological Classification of Ovarian Veins System Insufficiency

Szary

Wilczko²,

Zawadzki

et al. 2021

JCM

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Ovarian veins system insufficiency is one of the most common reasons for pelvic venous insufficiency (PVI). PVI is a hemodynamic phenomenon responsible for the occurrence of venous insufficiency of the lower extremities and recurrent varicose veins in nulliparous and parous women, as well as for a set of symptoms described as pelvic congestion syndrome (PCS). In the years 2017–2019, 535 patients admitted to our center with symptoms of venous insufficiency of the lower extremities, underwent complete ultrasound diagnostics (color-duplex ultrasound) of the venous system of the abdomen, pelvis and lower limbs, as well as extended imaging diagnostics using computed tomography (CT) or magnetic resonance (MR) venography. On the basis of the obtained results, the authors proposed a 4-grade hemodynamic and radiological classification (grades I-IV) defining the stratification of ovarian veins insufficiency. Using the above mentioned classification approx. 32% patients were identified as Grade I and I/II, approximately 35% revealed morphological and hemodynamic changes corresponding to Grade II and II/III, approximately 25% were classified as Grade III, whereas the remaining 8% were assessed as Grade IV. The described classification allows for the grading of ovarian veins insufficiency based on transparent radiological criteria, making it easy to use in everyday clinical practice. According to the authors, the proposed classification could facilitate communication between diagnostic physicians, specialists dealing with the treatment of venous insufficiency and gynecologists, who admit patients with symptoms suggesting venous insufficiency of the pelvis.

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“…The group explicitly chose not to use CEAP to classify pelvic venous disorders in part because they were aware of an independent multidisciplinary workgroup developing such a classification system. 15 The pelvic venous disorders discriminative instrument is being designed to interface with CEAP when venous disorders affect both the pelvis and lower limb.…”

Section: Items Not Addressed By the 2020 Revisionmentioning

confidence: 99%