Cyanoacrylate ablation for chronic venous disease: a review and future applications

Kathleen Ozsvath, MD, FACS Chief of Surgery, Samaritan Hospital, Troy, New York; Vascular Associates, St Peters Health Partners, Albany, New York; Professor of Surgery, Albany Medical Center, Albany, New York, USA ABSTRACT Many endovenous procedural modalities exist today, including endovenous thermal ablation (laser ablation, [EVLT] and radiofrequency ablation [RFA]), nonthermal nontumescent ablation, and ultrasound-guided sclerotherapy (UGS) and chemical ablation. Recently, cyanoacrylate has been used for the treatment of axial insufficiency. The most studied preparation of N-butyl cyanoacrylate is VenaSeal (Medtronic), which has been compared with the other ablative techniques. These studies have shown excellent results with patient satisfaction, outcomes, and…

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Chronic pelvic pain anpelvic venous disorders: the gynecologist’s point of view

Aleksandra Jaworucka-Kaczorowska, MD, PhD Center of Phlebology and Aesthetic Medicine, Center of General and Vascular Surgery, Gynecology and Obstetrics “Jaworuccy”, Gorzów Wlkp, Poland ABSTRACT Chronic pelvic pain (CPP) is a very common symptom with multiple potential etiologies. Very often, it is the result of an overlap of several pain-generating disorders of the reproductive tract, gastrointestinal system, urological organs, musculoskeletal system, and psychoneurological system. Living with CPP carries a heavy economic and social burden. Due to the complex etiology of CPP, to achieve good treatment results, the approach should be multimodal and requires a cooperative interdisciplinary team of clinicians, including gynecologists,…

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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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Clinical aspects of pelvic congestion syndrome

Pier Luigi ANTIGNANI1; George GEROULAKOS2; Mamuka BOKUCHAVA3 1 Director, Vascular Center, Nuova Villa Claudia, Rome, Italy 2 Consultant Vascular Surgeon, Department of Surgery, Charing Cross Hospital, London, UK 3 Deputy Director of the Center of Vascular and Heart Diseases, Tbilisi, Georgia Abstract The main symptom of pelvic congestion syndrome (PCS) is pelvic pain. Women typically have a dull, throbbing, and achy pain in the vulvar region, which often worsens during or after intercourse, just before the onset of menstruation, and as the day progresses, especially in women who stand or sit for long periods. The cause of PCS is unknown;…

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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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Treatment options for pelvic congestion syndrome

Javier LEAL MONEDERO1; Santiago ZUBICOA EZPELETA1; Neil M. KHILNAN2 1 Ruber Internacional Hospital, Angiology and Vascular Surgery Unit, Madrid, Spain 2 Division of Interventional Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA Abstract Pelvic congestion syndrome (PCS) and its main symptom, chronic pelvic pain, are caused by an increase in pressure, number, and caliber of intrapelvic venous structures. These structures are veins with a varicose morphology (ie, tortuous and ectatic with a very retarded flow) that are typically caused by inverted flow in the valveless and enlarged gonadal axis and, in some cases, the branches…

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Pelvic congestion syndrome: does one name fit all?

Sergio GIANESINI1; Pier Luigi ANTIGNANI2; Lorenzo TESSARI1 1 Glauco Bassi Foundation, Trieste, Italy 2 Director, Vascular center, Nuova Villa Claudia, Rome, Italy Abstract The pelvic congestion syndrome definition includes two not so frequently overlapping scenarios: (i) pelvic venous engorgement with lower abdomen symptomatology; and (ii) lower limb varicose veins fed by pelvic escape points that are generally less prone to develop the abdominal clinical manifestation typical for pelvic congestion syndrome. We retrospectively evaluated 985 female patients (43±11 years old; 23±5kg/m2 BMI) who visited our offices for lower limb varicose veins of pelvic origin. Second-level imaging was needed for 229 patients….

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Pelvic congestion syndrome: prevalence and quality of life

Zaza LAZARASHVILI1; Pier Luigi ANTIGNANI2; Javier LEAL MONEDERO3 1 Chapidze Emergency Cardiovascular Center, Liubljana str.4, 0159 Tbilisi, Georgia 2 Director, Vascular center, Nuova Villa Claudia, Rome, Italy 3 Ruber International Hospital, Angiology and Vascular Surgery Unit, La Masó St. 38, 28034, Madrid, Spain Abstract Pelvic congestion syndrome is an important cause of chronic pelvic pain that develops due to pelvic, but particularly ovarian, vein incompetence. Pelvic pain is one of the frequent reasons for outpatient gynecologic visits. Unfortunately, large and reliable studies on the prevalence of pelvic congestion syndrome do not yet exist; therefore, only indirect data, such as the…

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Treatment of vulvar and perineal varicose veins

Jean-François VAN CLEEF Service de médecine vasculaire, Institut Arthur Vernes, 36 rue d’Assas, 75006 Paris, France. Private practice: 43 rue de la Chaussée d’Antin, 75009, Paris, France SUMMARY Vulvar varicose veins occur in 10% of pregnant women, generally during month 5 of a second pregnancy. Anatomically, the vulvar veins have communicating branches and anastomoses between the pelvic wall and the veins of internal organs, between the internal and external iliac venous system, and with the circulation of the medial aspect of the thigh via the perineal veins. Vulvar varices are not caused by an increase in circulatory volume during pregnancy,…

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