Transcatheter Ovarian Vein Embolization Using Coils for the Treatment of Pelvic Congestion Syndrome

Kwon, Se Hwan; Oh, Joo Hyeong; Ko, Kyung Ran; Park, Ho‐Chul; Huh, Joo Yup

doi:10.1007/s00270-007-9040-7

Cited by 96 publications

(88 citation statements)

References 13 publications

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“…Eleven were included from the review of the diagnostic accuracy of non-invasive technique 23,[36][37][38][39][40][41][42][43][44][45] and 21 were included from the review of embolisation; 15,31,[46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] one study was included in both reviews. 65 A summary of the inclusion criteria from the selected studies is given in Table 1.…”

Section: Studies Reviewedmentioning

confidence: 99%

“…38,41,47,50,[52][53][54][55][56]65 More studies reported an OV diameter, above which the vein was considered to be dilated, but this threshold varied considerably, from > 4.5 mm 67 to > 10 mm, 57,58 with > 5 mm being the most frequently cited. 40,42,43,59,60 Halligan et al grouped patients into three ranges of pelvic vein diameter without specifying a threshold. Two studies reported an ultrasound protocol that included assessment in both a supine and a tilted or upright position, with a consequent change in the diameter as a defining criterion.…”

Section: Venous Anatomymentioning

confidence: 99%

See 1 more Smart Citation

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: Studies Reviewedmentioning

confidence: 99%

Section: Venous Anatomymentioning

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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“…However, we did not perform selective small collateral vein embolisations along the main ovarian vein. The indications for coil embolisation included dilatation of the ovarian vein (.5 mm), ovarian vein reflux into the pelvic cavity involving an incompetent valve, severe congestion of the pelvic venous plexus, significant stasis of contrast medium in the pelvic veins, abnormal filling of the pelvic veins across the midline and filling of vulvovaginal or thigh varicosities [15,16].…”

Section: Venography and Embolisationmentioning

confidence: 99%

Time-resolved MR angiography for detecting and grading ovarian venous reflux: comparison with conventional venography

Yang¹,

Kim²,

Nam³

et al. 2012

BJR

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Objective: The purpose of this study was to compare the diagnostic accuracy of timeresolved MR angiography (TR-MRA) with that of conventional venography for the detection and grading of ovarian venous reflux, which aid in the diagnosis of pelvic venous congestion. Methods: We performed a retrospective analysis of 19 consecutive patients who underwent TR-MRA and conventional venography. The images were analysed by two radiologists in a randomised ''blinded'' manner. With the use of conventional venography as a gold standard, the images were reviewed to determine if differences in the detection and grading of ovarian venous reflux were seen between TR-MRA and conventional venography; the sensitivity, specificity and accuracy of TR-MRA compared with that of conventional venography were evaluated. The McNemar test was performed to determine the significance of any differences. Interobserver agreement was analysed using generalised k statistics. Results: There was no significant difference between TR-MRA and conventional venography for grading ovarian venous reflux (p.0.05). The sensitivity, specificity and diagnostic accuracy of TR-MRA were found to be 66.7%, 100% and 78.9%, and 75%, 100% and 84.2%, respectively, for the two observers. The weighted k-values indicated excellent agreement between the two observers for grading ovarian venous reflux on TR-MRA (k50.894). Conclusion: TR-MRA is an accurate method for accessing pelvic venous congestion.

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“…Ovarian vein embolization is a safe and effective therapeutic method for treatment of PCS. It is thought that surgical treatment should be considered in cases where embolization proves ineffective [14]. However, the long-term effect of embolization and surgery should be routinely re-assessed because of the plexiform nature of recurrent venous disorders [2].…”

Section: Discussionmentioning

confidence: 99%

The Biology of Combined Colon Clear and Blood-Let Out Cupping Therapy in Female Health

Nasrat¹,

Nasrat²,

Nasrat³

2015

Gen Med (Los Angel)

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The study aimed to predict an etiologic pathology leading to some disease spread in females.Pelvic congestion syndrome (PCS) in females is a condition that is difficult to diagnose; a specific diagnosis for the condition is often difficult, no diagnosis is made in 60% of patients. Chronic pelvic pain (CPP) is a common and disabling condition affecting women of childbearing age; PCS is a recognized cause of CPP. Pelvic congestion and pelvic inflammatory conditions constitute the underlying etiology in a significant proportion of patients with CPP. Treatment of PCS is above all medical, based upon decongestive and anti-inflammatory agents. Abnormal colonic Helicobacter pylori strains have been shown to be responsible for the worst case of pelvic congestion due to accumulation of profuse toxic amounts of ammonia in the colon. Both colon clear and cupping were considered to have an effective therapeutic role in female PCS due to elimination of the underlying etiologic pathological elements (congestive and inflammatory) from the pelvis. The impact on life and the spread beyond traditional medical rules during last three decades of endometriosis, ovarian cystic disease and endometriotic ovarian cysts were considerable and obvious. 50 sexually active female patients with different forms of pelvic clinical presentations had been included in this study. They were 10 patients with pelvic pain, 10 patients with scanty menstruation, 10 patients with primary infertility, 10 patients with endometriosis and 10 patients with ovarian cystic disease. Pelvic and trans-vaginal Doppler ultrasound examinations were done routinely for all patients to assess any local pelvic pathology. All patients had undergone colon clear followed by a blood-let out therapy from the upper and lower back. Revision therapy was decided according to response of patients. All patients with pelvic pain and scanty menstruation were cured after a primary session or revision of therapy with colon clear and cupping therapy. 7 patients with primary infertility got pregnant after 3 sessions of combined colon clear and cupping therapy. All patients with endometriosis and ovarian cystic disease were relieved from their symptoms while most of them (9 with endometriosis and 7 with ovarian cystic disease) have reported after 3 consecutive sessions of colon clear and cupping therapy that their gynecology physicians have confirmed that they demonstrated stop of their disease progress.On conclusion, pelvic disease spread in females beyond traditional scientific rules could indicate the possibility of an existing missed underlying pathology. Screening of females with frank history of H. pylori dyspepsia may become a mandatory new health care requirement for early detection of female pelvic pathology.

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Transcatheter Ovarian Vein Embolization Using Coils for the Treatment of Pelvic Congestion Syndrome

Abstract: Ovarian vein embolization using coils is a safe and effective therapeutic method for treatment of PCS. It is thought that surgical treatment should be considered in cases where embolization proves ineffective.

Cited by 96 publications

References 13 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

Time-resolved MR angiography for detecting and grading ovarian venous reflux: comparison with conventional venography

The Biology of Combined Colon Clear and Blood-Let Out Cupping Therapy in Female Health

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