Transvaginal Ultrasound Examination of Women With and Without Pelvic Venous Congestion

Halligan, Steve; Campbell, Deirdre; Bartram, Clive I.; Rogers, V.; El-Haddad, Cadria; Patel, Sujata; Beard, R. W.

doi:10.1053/crad.2000.0602

Cited by 24 publications

(41 citation statements)

References 15 publications

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“…6,16,23,40,77,78 A further four studies considered the prevalence of PVI in non-pain populations 68,76,79,80 and three studies investigated the relationship between PVI and venous insufficiency of the lower limbs. 37,77,81 The quality assessment of the case-control studies is summarised in Table 3.…”

Section: Resultsmentioning

confidence: 99%

“…22 Polycystic ovaries are frequently seen in excess in women with PCS. 23 It has been observed that counteracting this with intravenous synthetic ergotamine reduced pain and improved venous flow in the pelvic veins. 24 Temporary down-regulation of ovarian function by medroxyprogesterone acetate (MPA), progestin or gonadotropin-releasing hormone (GnRH) agonists, 10,25,26 (see Treatment), improves pain, again implicating an endocrine role in PVI.…”

Section: Pathophysiologymentioning

confidence: 99%

“…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%

“…23,36,37,43,[45][46][47][48][53][54][55]61,62 These studies invariably discussed definitions of PCS in the introduction section of the report, but it was not clearly stated which pain symptoms defined eligibility for the study, or else the report described the prevalence of pain symptoms in terms of percentage of patients reporting each symptom but did not indicate whether or not any were essential. In 5 of these 12 studies, 38,39,[46][47][48] the study population were women referred for screening or treatment of varicose veins of the leg.…”

Section: Pain Symptomsmentioning

confidence: 99%

“…A case-control study combined three criteria, each with a scale of severity from 1 to 3, to give a score, but did not compute a threshold on which to define a case of PCS. 23 Chung and Huh 31 deployed a similar scoring system with four criteria, but with a threshold of ≥ 5 out of 12 as indicative of PCS. These scoring systems were similar to that first proposed by Beard et al, 16 which was cited in one other study.…”

Section: Composite Criteriamentioning

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: Resultsmentioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%

Section: Studies Reviewedmentioning

confidence: 99%

Section: Pain Symptomsmentioning

confidence: 99%

Section: Composite Criteriamentioning

confidence: 99%

See 3 more Smart Citations

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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Chronic Pelvic Pain

Stones¹

2012

Dewhurst's Textbook of Obstetrics &Amp; Gynaecology

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Reference ranges for uterine vein dimensions in non‐pregnant women with normal pelvic organs

Amin

Wong

Pointer

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To establish reference ranges for uterine vein (UtV) diameters in non-pregnant women with normal pelvic organs. Methods This was a prospective study of all women attending the general gynecological clinic of a university teaching hospital in the UK, between August 2015 and December 2016. All women aged ≥ 18 years underwent a transvaginal ultrasound examination in accordance with the study protocol. In women with normal pelvic organs, the largest trunk of the uterine venous plexus was identified in the transverse plane on each side. The maximum anteroposterior vessel diameter was measured by placing the calipers on the inner walls of the vein, and the mean of three measurements was used as the representative value. Inter-and intraobserver variability was assessed in a subgroup of 30 women. Maximum UtV diameter was compared between right and left UtVs and between pre-and postmenopausal women. Factors associated with UtV diameter were assessed and reference ranges were constructed. Results Of 1500 women examined, 486 (32%) had normal pelvic organs on ultrasound scan and were included in the final analysis. In all women, the uterine venous trunk was clearly visualized and there was no significant difference between the maximum median left and right UtV diameters (P = 0.37). UtV diameters were generally lower in postmenopausal, compared with premenopausal, women, with the difference being statistically significant for the right UtV and the average of left and right UtVs. There was a gradual increase in UtV diameter with advancing age, with a peak observed in women aged 41-50 years and decreasing values in older age groups. Univariable analysis showed that parity, menopausal status and age were associated significantly with UtV diameters (P < 0.01). On multivariable analysis, only higher parity was significantly associated with increasing venous size in both pre-and postmenopausal

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Transvaginal Ultrasound Examination of Women With and Without Pelvic Venous Congestion

Cited by 24 publications

References 15 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

Chronic Pelvic Pain

Reference ranges for uterine vein dimensions in non‐pregnant women with normal pelvic organs

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