Venous Anatomy and Collateral Pathways of the Pelvis: An Angiographic                     Review

Zurcher, Kenneth S.; Staack, Sasha O.; Spencer, E. Brooke; Liska, Addison; Alzubaidi, Sadeer; Patel, Indravadan; Naidu, Sailendra; Öklü, Rahmi; Dymek, Ryanne A.; Knuttinen, M. Grace

doi:10.1148/rg.220012

Cited by 3 publications

(2 citation statements)

References 45 publications

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“…Наличие варикозного расширения вен на лобке и передней брюшной стенке (надлобковый шунт) традиционно рассматривается в качестве признака тромботической или нетромботической обструкции подвздошных вен [1][2][3][4]. Последняя может лежать в основе варикозной болезни таза с явлениями тазовой венозной недостаточности и (или) пельвиоперинеального рефлюкса [5].…”

Section: Introductionunclassified

Dilatation of suprapubic veins as a manifestation of pelvic varicose veins: description of a clinical case

Akulova,

Soroka,

Bondarchuk

et al. 2023

Ambulatornaya khirurgiya

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The presence of dilated suprapubic veins (suprapubic shunt) is considered to be a classic symptom of post-thrombotic and non-thrombotic venous outflow obstruction. Meanwhile, the descriptions of isolated cases of the creation of a suprapubic shunt during pregnancy in women with pelvic varicose disease are presented in the literature. We present a clinical case report of successful treatment of pelvic varicose disease with the presence of dilated veins in the suprapubic region. A 33-year-old patient complained of the presence of varicose veins in the lower extremities, in the perineum and suprapubic region, heaviness and pain in the lower extremities, a periodic heavy feeling and burning in the varicose vein area, painful menstruation and pain during intercourse. The symptoms appeared and progressed during four pregnancies, after the last one the patient noted the appearance of dilated veins in the suprapubic region. The ultrasound angiography of the lower extremity veins revealed valvular incompetence of the saphenofemoral junction and the trunks of the great saphenous vein bilaterally, the left anterior accessory saphenous vein, signs of pelvioperineal reflux, dilated veins of the perineum and round ligament of the uterus. The first stage surgery involved phlebography and embolization of the ovarian veins bilaterally. The patient showed positive response to treatment, which resulted in relief of dyspareunia and reduction of algodismenorrhea. The second stage surgery involved endovenous laser coagulation of the trunks of the great saphenous vein bilaterally and the left anterior accessory saphenous vein. Varicose vein tributaries on the lower extremities were removed by means of miniphlebectomy, while varicose veins of the perineum and suprapubic region were obliterated by foam sclerotherapy. Three months after the intervention, the patient had a stable obliteration of all target veins, clinical improvement, disappearance of dilated veins in the suprapubic region, regression of pain in the lower extremities and complete relief of dyspareunia and algodismenorrhea. Thus, the presence of varicose veins in the suprapubic region can be not only a consequence of venous obstruction, but also a symptom of pelvic varicose disease. If a suprapubic shunt is identified, a detailed examination of the patient, including imaging methods for evaluating abdominal or pelvic veins is required. The results of the tests will help develop an individual treatment plan.

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Section: Introductionunclassified

Dilatation of suprapubic veins as a manifestation of pelvic varicose veins: description of a clinical case

Akulova,

Soroka,

Bondarchuk

et al. 2023

Ambulatornaya khirurgiya

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“…The epigastric vessels and iliofemoral vessels can form collaterals more superficially. 3 There is evidence that a patient with venous injury may benefit from primary repair. In a retrospective review, ligation of an isolated iliac venous was associated with increased mortality in comparison to primary repair when technically achievable.…”

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Anterior Abdominal Varicosities Due to Unilateral Common and External Iliac Vein Occlusion Five Decades Post-Injury

Nemeh

Kunac

et al. 2023

The American Surgeon™

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Abdominopelvic varicosities are a rare occurrence after traumatic venous injuries. Several disorders exist that present with abdominopelvic varicosities such as May-Thurner syndrome, pelvic congestion syndrome, and nutcracker syndrome; however, it has rarely been described after trauma. 1 We present a case in 70-year-old male, who in 1974 sustained a penetrating injury from fragments secondary to mortar explosion, requiring exploratory laparotomy. He presented to the hospital with abdominopelvic varicosities that began 20 years after the incident and was asymptomatic at initial presentation. While there is a known case report of congenital absence of a common iliac vein in a young, healthy, athletic man who developed abdominopelvic varicosities, this is the first case report, to our knowledge, of evolution of a traumatic injury of this nature over a lifetime. Pathophysiology, diagnostics, risks of ligation, and management of chronic abdominopelvic varicosities in this patient are discussed.

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Pelvic venous congestion syndrome: female venous congestive syndromes and endovascular treatment options

et al. 2023

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Pelvic venous congestion syndrome (PVCS) is a common, but underdiagnosed, cause of chronic pelvic pain (CPP) in women.PVCS occurs usually, but not exclusively, in multiparous women. It is characterized by chronic pelvic pain of more than six months duration with no evidence of inflammatory disease.The patients present to general practitioners, gynaecologists, vascular specialists, pain specialists, gastroenterologists and psychiatrists. Pain of variable intensity occurs at any time but is worse in the pre-menstrual period, and is exacerbated by walking, standing, and fatigue. Post coital ache, dysmenorrhea, dyspareunia, bladder irritability and rectal discomfort are also common. Under-diagnosis of this condition can lead to anxiety and depression.A multidisciplinary approach in the investigation and management of these women is vital.Non-invasive imaging (US, CT, MRI) are essential in the diagnosis and exclusion of other conditions that cause CPP as well in the definitive diagnosis of PVCS. Trans-catheter venography remains the gold standard modality for the definitive diagnosis and is undertaken as an immediate precursor to ovarian vein embolization (OVE). Conservative, medical and surgical management strategies have been reported but have been superseded by OVE, which has a reported technical success rates of 96–100%, low complication rates and long-term symptomatic relief in between 70–90% of cases.The condition, described in this paper as PVCS, is referred to by a wide variety of other terms in the literature, a cause of confusion.There is a significant body of literature describing the syndrome and the excellent outcomes following OVE however the lack of prospective, multicentre randomized controlled trials for both investigation and management of PVCS is a significant barrier to the complete acceptance of both the existence, investigation and management of the condition.

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Venous Anatomy and Collateral Pathways of the Pelvis: An Angiographic Review

Cited by 3 publications

References 45 publications

Dilatation of suprapubic veins as a manifestation of pelvic varicose veins: description of a clinical case

Dilatation of suprapubic veins as a manifestation of pelvic varicose veins: description of a clinical case

Anterior Abdominal Varicosities Due to Unilateral Common and External Iliac Vein Occlusion Five Decades Post-Injury

Pelvic venous congestion syndrome: female venous congestive syndromes and endovascular treatment options

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