The new patient-oriented tools for clinical assessment of pelvic varicose disease

Rustem VILEVICH AKHMETZIANOV, MD, PhD Doctor of Medical Sciences, Cardiovascular Surgeon of the Department of Vascular Surgery, Inter-regional Clinical Diagnostic Center of the Ministry of Health of Russia, Assistant of the Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University of the Ministry of Health of Russia, Kazan, Russia Abstract This article presents a review of patient-oriented diagnostic tools currently used in patients with pelvic varicose veins (pelvic congestion syndrome, PCS), and provides rationale for using disease-specific tools, as highlighted in the international consensus documents on the diagnosis and treatment of PCS. The authors present two original diagnostic tools…

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Combination of May-Thurner syndrome and pelvic congestion syndrome: terra incognita

Sergey Gennadievich GAVRILOV, MD, PhD Professor of Surgery, Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Russia Abstract This review presents up-to-date data on the pathophysiology, epidemiology, classification, diagnosis, and treatment of the combination of May-Thurner syndrome (MTS) and pelvic congestion syndrome (PCS). It includes hypotheses to explain the predominant lesion of the pelvic veins in these patients and describes in detail the clinical symptoms of combined lesions of the iliac and pelvic veins. The article discusses modern methods of diagnosis of MTS and PCS, as well as advantages and disadvantages of ultrasound and radiological methods of investigation….

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Phlebolymphedema: an up-to-date review

Jorge H. ULLOA,1 MD, FACS; Sebastian CIFUENTES,2 MD; Valentin FIGUEROA,2 MD; Emelyn Van UDEN,2 MD; Javier A. BRAVO,2 MD; Miguel AMORE,3 MD; Jairo RAMÍREZ,1 MD, FACS 1Vascular Surgery Department, Fundación Santa Fe de Bogotá University Hospital; Universidad de los Andes Medical School. Bogotá, Colombia; 2Universidad de los Andes Medical School, Fundación Santa Fe de Bogotá University Hospital. Bogotá, Colombia; 3Vascular Surgery Department, Fundación Favaloro, Buenos Aires, Argentina Abstract Phlebolymphedema is a vascular condition in which there is damage of the venous and lymphatic systems in the lower limbs. It is secondary to chronic venous insufficiency, which results in venous hypertension…

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Duplex ultrasound as first-line imaging for morphology and hemodynamics in the upper limb venous system

Niels BÆKGAARD,1 MD; Charlotte STRANDBERG,2 MD 1Vascular Department, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark; 2Department of Radiology, Gentofte and Herlev Hospital, Copenhagen, Denmark Abstract This review describes venous anatomy and hemodynamic characteristics for venous return in the upper limb, including main differences in comparison with venous drainage in the lower limb. Duplex ultrasound (DUS) is the first-line imaging modality even it seems less standardized than other investigation approaches for veins in the lower limb. This article presents useful instructions to assess veins from the peripheral to the thoracic outlet via the costoscalene hiatus. Without basic understanding, it is…

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Phlebolymphedema: is it a new concept?

Byung-Boong LEE, MD, PhD, FACS Professor of Surgery and Director, Center for the Lymphedema and Vascular Malformations, George Washington University, Washington DC, USA Abstract Venous and lymphatic systems are inseparable “dual” outflow systems with mutually complimentary function so that such mutual interdependence between these two systems causes a new condition to affect both systems simultaneously when one of the two systems should fail to provide sufficient compensation to the other system, known as “phlebolymphedema” (PLE): combined condition of chronic venous insufficiency (CVI)/chronic venous hypertension and chronic lymphatic insufficiency (CLI)/chronic lymphedema. PLE is, therefore, an unavoidable outcome of the joint failure…

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Modeling and 3D printing of veins from CT venograms

Jean-Francois UHL, MD, FacPh of the UNESCO Chair of Digital Anatomy, Paris University Abstract Digital anatomy has more and more applications in medicine and surgery, thanks to the progress in imaging and power of computer software. To evaluate patients with chronic venous disorders, in the case of complex anatomy or recurrent varices after surgery (REVAS), three-dimensional (3D) modeling of the venous system is often a great support. A global 3D depiction of the whole venous morphology will help the hemodynamical mapping achieved by color Duplex ultrasound. In addition to anatomical information, color Duplex ultrasound also provides essential hemodynamic data for…

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What is the best method of imaging in iliofemoral venous obstruction?

Gerard J. O’SULLIVAN MB, BCh, BAO, FRCR National University of Ireland, Galway, Ireland Abstract Iliofemoral venous obstruction is increasingly recognized as a major cause of post-thrombotic syndrome. Patients can be left with significant symptoms after just one episode of iliofemoral deep-vein thrombosis; ranging from milder problems, such as varicose veins, to itching, leg swelling, and even venous ulceration. With the advent of endovascular techniques to reconstruct the iliofemoral segment has come an understanding that accurate recognition and diagnosis form a central part of the puzzle. Clinical evaluation is limited, and imaging has assumed a central role. This article looks at…

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Use of air plethysmography and ambulatory venous pressure measurement in chronic venous disease

Seshadri RAJU, MD, FACS The RANE Center, St Dominic’s Memorial Hospital, Jackson, Mississippi, USA. Abstract Air plethysmography (APG) and ambulatory venous pressure (AMVP) measurement are functional tests used in chronic venous disease (CVD). We review our experience with these tests in 8456 CVD limbs seen over a 20-year period. The venous filling index (VFI90) parameter in the APG test shows progressive significant worsening as reflux and disease severity increase. Venous volume (VV) also increases—a sign of venous pooling—with reflux and disease progression. This is compensated to a large extent by a parallel increase in ejection volume to as much as…

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New diagnostic modalities in lymphedema

Sarah THOMIS University Hospitals Leuven, Belgium Abstract Introduction: Lymphedema is a chronic, progressive, and debilitating disease. An early and accurate diagnosis and treatment is very important to alter the normal progression of the disease. When lymphedema is diagnosed late, the options for treatment are diminished as fibrous tissue is formed. Until recently, lymphoscintigraphy was considered the gold-standard diagnostic technique; however, other new and renewed diagnostic tools have emerged. This article provides an overview of the available diagnostic tools based on the findings from a literature search. Methods: A literature search for each of the diagnostic tools was performed. Results: Diagnostic…

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Instrumental diagnosis of pelvic congestion syndrome

Santiago ZUBICOA EZPELETA1; Javier LEAL MONEDERO1; Assila T. ELKASHISHI2 1 Ruber Internacional Hospital, Angiology and Vascular Surgery Unit, Madrid, Spain 2 Al Salam Hospital, Cairo, Egypt Abstract Pelvic congestion syndrome (PCS) is a multifactorial medical condition that is characterized by the absence of specific symptoms, and therefore, it needs very precise imaging for an accurate diagnosis. Diagnostic techniques can be noninvasive (duplex ultrasound) or minimally invasive (magnetic resonance, CT, and phlebography). Duplex ultrasound is regarded as a first-line investigation for PCS because it is noninvasive, easily accessible, and inexpensive. This procedure provides essential hemodynamic information, and when combining transvaginal and…

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