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Title: Pelvic Vein Embolisation in the Management of Varicose Veins

Abstract

Pelvic vein incompetence is common in patients with atypical varicose veins, contributing to their recurrence after surgery. Therefore, refluxing pelvic veins should be identified and treated. We present our experience with pelvic vein embolisation in patients presenting with varicose veins. Patients presenting with varicose veins with a duplex-proven contribution from perivulval veins undergo transvaginal duplex sonography (TVUS) to identify refluxing pelvic veins. Those with positive scans undergo embolisation before surgical treatment of their lower limb varicose veins. A total of 218 women (mean age of 46.3 years) were treated. Parity was documented in the first 60 patients, of whom 47 (78.3%) were multiparous, 11 (18.3%) had had one previous pregnancy, and 2 (3.3%) were nulliparous. The left ovarian vein was embolised in 78%, the right internal iliac in 64.7%, the left internal iliac in 56.4%, and the right ovarian vein in 42.2% of patients. At follow-up TVUS, mild reflux only was seen in 16, marked persistent reflux in 6, and new reflux in 3 patients. These 9 women underwent successful repeat embolisation. Two patients experienced pulmonary embolisation of the coils, of whom 1 was asymptomatic and 1 was successfully retrieved; 1 patient had a misplaced coil protruding into the commonmore » femoral vein; and 1 patient had perineal thrombophlebitis. The results of our study showed that pelvic venous embolisation by way of a transjugular approach is a safe and effective technique in the treatment of pelvic vein reflux.« less

Authors:
 [1]; ; ;  [2];  [3];  [2];  [3]
  1. St. George's Hospital, Department of Radiology (United Kingdom)
  2. Stirling House, Whiteley Clinic (United Kingdom)
  3. Royal Surrey County Hospital, Department of Radiology (United Kingdom)
Publication Date:
OSTI Identifier:
21450314
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 31; Journal Issue: 6; Other Information: DOI: 10.1007/s00270-008-9402-9; Copyright (c) 2008 Springer Science+Business Media, LLC
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; PELVIS; VEINS; WOMEN; ANIMALS; BLOOD VESSELS; BODY; CARDIOVASCULAR SYSTEM; FEMALES; MAMMALS; MAN; ORGANS; PRIMATES; VERTEBRATES

Citation Formats

Ratnam, Lakshmi A., Marsh, Petra, Holdstock, Judy M., Harrison, Charmaine S., Hussain, Fuad F., Whiteley, Mark S., and Lopez, Anthony, E-mail: consultant@radiologist.co.u. Pelvic Vein Embolisation in the Management of Varicose Veins. United States: N. p., 2008. Web. doi:10.1007/S00270-008-9402-9.
Ratnam, Lakshmi A., Marsh, Petra, Holdstock, Judy M., Harrison, Charmaine S., Hussain, Fuad F., Whiteley, Mark S., & Lopez, Anthony, E-mail: consultant@radiologist.co.u. Pelvic Vein Embolisation in the Management of Varicose Veins. United States. doi:10.1007/S00270-008-9402-9.
Ratnam, Lakshmi A., Marsh, Petra, Holdstock, Judy M., Harrison, Charmaine S., Hussain, Fuad F., Whiteley, Mark S., and Lopez, Anthony, E-mail: consultant@radiologist.co.u. 2008. "Pelvic Vein Embolisation in the Management of Varicose Veins". United States. doi:10.1007/S00270-008-9402-9.
@article{osti_21450314,
title = {Pelvic Vein Embolisation in the Management of Varicose Veins},
author = {Ratnam, Lakshmi A. and Marsh, Petra and Holdstock, Judy M. and Harrison, Charmaine S. and Hussain, Fuad F. and Whiteley, Mark S. and Lopez, Anthony, E-mail: consultant@radiologist.co.u},
abstractNote = {Pelvic vein incompetence is common in patients with atypical varicose veins, contributing to their recurrence after surgery. Therefore, refluxing pelvic veins should be identified and treated. We present our experience with pelvic vein embolisation in patients presenting with varicose veins. Patients presenting with varicose veins with a duplex-proven contribution from perivulval veins undergo transvaginal duplex sonography (TVUS) to identify refluxing pelvic veins. Those with positive scans undergo embolisation before surgical treatment of their lower limb varicose veins. A total of 218 women (mean age of 46.3 years) were treated. Parity was documented in the first 60 patients, of whom 47 (78.3%) were multiparous, 11 (18.3%) had had one previous pregnancy, and 2 (3.3%) were nulliparous. The left ovarian vein was embolised in 78%, the right internal iliac in 64.7%, the left internal iliac in 56.4%, and the right ovarian vein in 42.2% of patients. At follow-up TVUS, mild reflux only was seen in 16, marked persistent reflux in 6, and new reflux in 3 patients. These 9 women underwent successful repeat embolisation. Two patients experienced pulmonary embolisation of the coils, of whom 1 was asymptomatic and 1 was successfully retrieved; 1 patient had a misplaced coil protruding into the common femoral vein; and 1 patient had perineal thrombophlebitis. The results of our study showed that pelvic venous embolisation by way of a transjugular approach is a safe and effective technique in the treatment of pelvic vein reflux.},
doi = {10.1007/S00270-008-9402-9},
journal = {Cardiovascular and Interventional Radiology},
number = 6,
volume = 31,
place = {United States},
year = 2008,
month =
}
  • No abstract prepared.
  • We present our experience with embolization of incompetent pelvic veins (IPV) in women with recurrence of varicose veins (VV) in lower limbs, as well as symptoms of pelvic congestion syndrome (PCS), after first surgery. In addition, we evaluated the effects of embolization in decreasing the symptoms of VV before surgery as well as its effects on PCS symptoms. We included 10 women who had consulted a vascular surgeon because of recurrent VV in lower limbs after surgery. All of these patients were included in the study because they also had symptoms of PCS, probably due to IPV. In patients whomore » had confirmed IPV, we performed embolization before a second surgery. VV and PCS were assessed before and at 3 months after embolization (before the second surgery) using a venous clinical severity score (VCSS) and a visual analog pain scale (VAS), respectively. Patients were controlled between 3 and 6 months after embolization. Paired Student t test analysis was used for comparing data before and after embolization. Fifteen vein segments in 10 women were suitable for embolization. There was a significant (p < 0.001) decrease of VCSS after embolization, and recurrence of VV was not detected within a period of 6 months. There was also significant (p < 0.01) relief of chronic pelvic pain related to PCS evaluated using VAS at 3 months after embolization. Embolization decreases the risk of VV recurrence after surgery and also improves PCS symptoms in women with VV in lower limbs and IPV.« less
  • High-intensity focused ultrasound (HIFU) treatment utilizing microbubbles was investigated in the present study. It is known that microbubbles have the potential to enhance the heating effects of an ultrasound field. In this study, the heat accompanying microbubble oscillation was used to occlude varicose veins. Alteration of veins was observed after ultrasound irradiation. Veins were resected by stripping. In this study, two vein conditions were adopted during HIFU irradiation; non-compressed and compressed. Compressing the vein was expected to improve occlusion by rubbing the altered intima under compressed conditions. The frequency of the ultrasound was 1.7 MHz, the intensity at the focusmore » was 2800 W/cm{sup 2}, and the irradiation time was 20 s. In this study, the contrast agent Levovist registered was chosen as a microbubble source, and the void fraction (ratio of total gas volume to liquid) in the vein was fixed at 10{sup -5}. Under non-compressed conditions, changes were observed only at the adventitia of the vein anterior wall. In contrast, under compressed conditions, changes were observed from the intima to the adventitia of both the anterior and posterior walls, and they were partly stuck together. In addition, more experiments with hematoxylin-eosin staining suggested that the changes in the vein were more substantial under the latter conditions. From these results, it was confirmed that the vein was occluded more easily with vein compression.« less
  • The aim of the study was to assess the suitability of radiofrequency ablation (RFA), endovenous laser ablation (EVLA), and foam sclerotherapy (FS) for patients with symptomatic varicose veins (VVs). The study comprised 403 consecutive patients with symptomatic VVs. Data on 577 legs from 403 consecutive patients with symptomatic VVs were collected for the year 2006. Median patient age was 55 years (interquartile range 45-66), and 62% patients were women. A set of criteria based on duplex ultrasonography was used to select patients for each procedure. Great saphenous vein (GSV) reflux was present in 77% (446 of 577) of legs. Overall,more » 328 (73%) of the legs were suitable for at least one of the endovenous options. Of the 114 legs with recurrent GSV reflux disease, 83 (73%) were suitable to receive endovenous therapy. Patients with increasing age were less likely to be suitable for endovenous therapy (P = 0.03). Seventy-three percent of patients with VVs caused by GSV incompetence are suitable for endovenous therapy.« less
  • This work examines laser radiation absorption in water and blood at the wavelengths that are used in endovenous laser treatment (EVLT): 0.81-1.06, 1.32, 1.47, 1.5 and 1.56 {mu}m. It is shown that the best EVLT conditions are ensured by 1.56-{mu}m radiation. Analysis of published data suggests that even higher EVLT efficacy may be achieved at wavelengths of 1.68 and 1.7 {mu}m. (laser medicine)