Pelvic congestion syndrome is an interdisciplinary issue
DOI: 10.32364/2618-8430-2021-4-4-346-350
E.Yu. Antropova1, B.M. Sharafutdinov1,2, M.I. Mazitova1, E.A. Gaziev2,
G.A. Khisamieva1, V.V. Shtern1
1Kazan State Medical Academy — Branch of the Russian Medical Academy
of Continuous Professional Education, Kazan, Russian Federation
2Kazan (Volga Region) Federal University, Kazan, Russian Federation
This paper discusses an essential interdisciplinary issue, pelvic congestion syndrome (PGS). PGS is a venous disorder with gonadal vein and/or pelvic venous plexus dilation that results in pelvic venous plethora. The authors address PGS prevalence, causes, underlying pathophysiological mechanisms, major clinical manifestations, diagnostic tools, and treatment approaches. Pharmacotherapy (gonadotropin-releasing hormone agonists, danazol, combined oral contraceptives, progestins, phlebotonics, etc.) is the first-line treatment that provides only a temporary effect. Image-guided vascular surgery (embolization, stenting) is of particular importance among surgical interventions. Surgical technique and critical results of the studies on the efficacy of gonadal vein embolization (from 47% to 100%) are described. The paper details major complications of surgical interventions and highlights issues requiring further researches, i.e., the effects on female fertility, predicted f ull recovery considering compromised somatic and/or gynecological anamnesis. Finally, the importance of timely diagnosis, greater awareness of primary care physicians on the signs and symptoms of this disorder, and a need to refer these women to vascular surgeons are addressed.
Keywords: pelvic congestion syndrome, gonadal vein embolization, pelvic pain, May–Thurner syndrome, nutcracker syndrome.
For citation: Antropova E.Yu., Sharafutdinov B.M., Mazitova M.I. et al. Pelvic congestion syndrome is an interdisciplinary issue. Russian Journal of Woman and Child Health. 2021;4(4):346–350 (in Russ.). DOI: 10.32364/2618-8430-2021-4-4-346-350.
About the authors:
Elena Yu. Antropova — C. Sc. (Med.), associate professor of the Department of Obstetrics and Gynecology, Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education; 11, Mushtari str., Kazan, 420012, Russian Federation; ORCID iD 0000-0002-5991-5163.
Bulat M. Sharafutdinov — C. Sc. (Med.), assistant of the Department of Cardiology, Endovascular, and Cardiovascular Surgery, Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education; 11, Mushtari str., Kazan, 420012, Russian Federation; Head of the Department of Angiography and Interventional Radiology, Medical Wing of the Kazan (Volga Region) Federal University; 1а, Chekhova str., Kazan, 420043, Russian Federation; ORCID iD 0000-0002-4149-118X.
Madina I. Mazitova — Dr. Sc. (Med.), professor of the Department of Obstetrics and Gynecology, Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education; 11, Mushtari str., Kazan, 420012, Russian Federation; ORCID iD 0000-0002-9608-2076.
Edgar A. Gaziev — physician of the Department of Angiography and Interventional Radiology, Medical Wing of the Kazan (Volga Region) Federal University; 1а, Chekhova str., Kazan, 420043, Russian Federation.
Guzel A. Khisamieva — clinical resident of the Department of Obstetrics and Gynecology, Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education; 11, Mushtari str., Kazan, 420012, Russian Federation; ORCID iD 0000-0002-2277-1290.
Vyacheslav V. Shtern — clinical resident of the Department of Obstetrics and Gynecology, Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education; 11, Mushtari str., Kazan, 420012, Russian Federation; ORCID iD 0000-0002-0444-5088.
Contact information: Elena Yu. Antropova, e-mail: antropoval@mail.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 18.05.2021.
Revised 10.06.2021.
Accepted 06.07.2021.
2. Raffetto J.D., Qiao X., Beauregard K.G., Khalil R.A. Estrogen receptor-mediated enhancement of venous relaxation in female rat: implications in sex-related differences in varicose veins. J Vasc Surg. 2010;51(4):972–981.
3. O’Brien M.T., Gillespie D.L. Diagnosis and treatment of the pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord. 2015;3(1):96–106. DOI: 10.1016/j.jvsv.2014.05.007.
4. Soysal M.E., Soysal S., Vicdan K., Ozer S. A randomized controlled trial of goserelin and medroxyprogesterone acetate in the treatment of pelvic congestion. Hum Reprod. 2001;16(5):931–939. DOI: 10.1093/humrep/16.5.931.
5. Артымук Н.В., Руднева О.Д. Тазовая веноконгестия как одна из ведущих причин хронической тазовой боли. StatusPraesens. Гинекология, акушерство, бесплодный брак. 2015;4(27):42–49. [Artymuk N.V., Rudneva O.D. Pelvic veno-congestion as one of the leading causes of chronic pelvic pain. StatusPraesens. Ginekologiya, akusherstvo, besplodnyy brak. 2015;4(27):42–49 (in Russ.)].
6. Ahlberg N.E., Bartley O., Chidekel N. Circumference of the left gonadal vein. An anatomical and statistical study. Acta Radiol Diagn (Stockh). 1965;3(6):503–512. DOI: 10.1177/028418516500300605.
7. Jung S.C., Lee W., Chung J.W. et al. Unusual causes of varicose veins in the lower extremities: CT venographic and Doppler US findings. Radiographics. 2009;29(2):525–536. DOI: 10.1148/rg.292085154.
8. Gloviczki P., Comerota A.J., Dalsing M.C. et al. Society for Vascular Surgery. American Venous Forum. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 Suppl):2S–48S. DOI: 10.1016/j.jvs.2011.01.079.
9. Whiteley M.S., Dos Santos S.J., Harrison C.C. et al. Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women. Phlebology. 2015;30(10):706–713. DOI: 10.1177/0268355514554638.
10. Cheong Y.C., Smotra G., Williams A.C. Non-surgical interventions for the management of chronic pelvic pain. Cochrane Database Syst Rev. 2014;(3):CD008797. DOI: 10.1002/14651858.CD008797.pub2.
11. Gandini R., Konda D., Abrignani S. et al. Treatment of symptomatic high-flow female varicoceles with stop-flow foam sclerotherapy. Cardiovasc Intervent Radiol. 2014;37(5):1259–1267. DOI: 10.1007/s00270-013-0760-6.
12. Bittles M.A., Hoffer E.K. Gonadal vein embolization: treatment of varicocele and pelvic congestion syndrome. Semin Intervent Radiol. 2008;25(3):261–270. DOI: 10.1055/s-0028-1085927.
13. Edwards R.D., Robertson I.R., MacLean A.B., Hemingway A.P. Case report: pelvic pain syndrome — successful treatment of a case by ovarian vein embolization. Clin Radiol. 1993;47(6):429–431. DOI: 10.1016/S0009-9260(05)81067-0.
14. Галкин Е.В., Гракова Л.С., Наумова Е.Б. Рентгеноэндоваскулярная хирургия гипофункции яичников при варикозном расширении овариальных вен. Вестник рентгенологии и радиологии. 1991;5:51–58. [Galkin E.V., Grakova L.S., Naumova E.B. X-ray endovascular surgery of ovarian hypofunction with varicose ovarian veins. Vestnik rentgenologii i radiologii. 1991;5:51–58 (in Russ.)].
15. Daniels J.P., Champaneria R., Shah L. et al. Effectiveness of embolization or sclerotherapy of pelvic veins for reducing chronic pelvic pain: a systematic review. J Vasc Interv Radiol. 2016;27(10):1478–1486.e8. DOI: 10.1016/j.jvir.2016.04.016.
16. Vleuten C., van Kempen J., Schultze-Kool L. Embolization to treat pelvic congestion syndrome and vulval varicose veins. Int J Gynaecol Obstet. 2012;118(3)227–230. DOI: 10.1016/j.ijgo.2012.04.021.
17. Kim H.S., Malhotra A., Rowe P. Embolotherapy for pelvic congestion syndrome: Long-term results. J Vasc Interv Radiol. 2006:17:289–297.
18. Nasser F., Cavalcante R.N., Affonso B.B. et al. Safety, efficacy, and prognostic factors in endovascular treatment of pelvic congestion syndrome. Int J Gynaecol Obstet. 2014;125(1):65–68. DOI: 10.1016/j.ijgo.2013.10.008.
19. Гаврилов С.Г., Кириенко А.И., Ревякин В.И. и др. Принципы хирургического лечения варикозной болезни вен таза. Вестник Российского государственного медицинского университета. 2009;(5):11–15. [Gavrilov S.G., Kiriyenko A.I., Revyakin V.I. et al. Principles of surgical treatment of pelvic veins’ varicose disease. Bulletin of RSMU. 2009;(5):11–15 (in Russ.)].
20. Asciutto G., Mumme A., Geier B., Asciutto K. Pelvic venous incompetence: reflux patterns and treatment results. Eur J Vasc Endovasc Surg. 2009:38(3):381–386. DOI: 10.1016/j.ejvs.2009.05.023.
21. Hocquelet A., Le Bras Y., Balian E. Еvaluation of the efficacy of endovascular treatment of pelvic congestion syndrome. Diagn Interv Imaging. 2014:95:301–306. DOI: 10.1016/j.diii.2013.09.011.
22. Castenmiller P.H., Leur K., Jong T. Clinical results after coil embolization of the ovarian vein in patients with primary and recurrent lower-limb varices with respect to vulval varices. Phlebology. 2013;28(5):234–238. DOI: 10.1258/phleb.2012.011117.
23. Laborda A., Medrano J., de Blas I. et al. Endovascular treatment of pelvic congestion syndrome: visual analog scale (VAS) long-term follow-up clinical evaluation in 202 patients. Cardiovasc Intervent Radiol. 2013;36(4):1006–1014. DOI: 10.1007/s00270-013-0586-2.
24. Pyra K., Woźniak S., Drelich-Zbroja A. Evaluation of effectiveness of embolization in pelvic congestion syndrome with the new vascular occlusion device (ArtVentive EOS™): preliminary results. Cardiovasc Intervent Radiol. 2016;39(8):1122–1127. DOI: 10.1007/s00270-016-1380-8.
25. Boersma D., van Eekeren R.R., Werson D.A. et al. Mechanochemical endovenous ablation of small saphenous vein insufficiency using the ClariVein(®) device: one-year results of a prospective series. Eur J Vasc Endovasc Surg. 2013;45(3):299–303. DOI: 10.1016/j.ejvs.2012.12.004.
26. Wang C.L., Cohan R.H., Ellis J.H. et al. Frequency, outcome, and appropriateness of treatment of nonionic iodinated contrast media reactions. AJR Am J Roentgenol. 2008;191(2):409–415. DOI: 10.2214/AJR.07.3421.
27. Marsh P., Holdstock J.M., Bacon J.L. et al. Coil protruding into the common femoral vein following pelvic venous embolization. Cardiovasc Intervent Radiol. 2008;31(2):435–438. DOI: 10.1007/s00270-007-9249-5.
28. Chung M.H., Huh C.Y. Comparison of treatments for pelvic congestion syndrome. Tohoku J Exp Med. 2003;201(3):131–138. DOI: 10.1620/tjem.201.131.
29. Forauer A.R., Gemmete J.J., Dasika N.L. et al. Intravascular ultrasound in the diagnosis and treatment of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 2002;13(5):523–527. DOI: 10.1016/s1051-0443(07)61535-8.
30. Daugherty S.F., Gillespie D.L. Venous angioplasty and stenting improve pelvic congestion syndrome caused by venous outflow obstruction. J Vasc Surg Venous Lymphat Disord. 2015;3(3):283–289. DOI: 10.1016/j.jvsv.2015.01.003.
31. Neglén P., Hollis K.C., Olivier J., Raju S. Stenting of the venous outflow in chronic venous disease: long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg. 2007;46(5):979–990. DOI: 10.1016/j.jvs.2007.06.046.
This work is licensed under a Creative Commons «Attribution» 4.0 License.
Распечатать