scholarly journals Minimally-invasive procedure for pelvic leak points in women

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Roberto Delfrate ◽  
Massimo Bricchi ◽  
Claude Franceschi
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Lower Limb ◽  
Varicose Veins ◽  
Absorbable Suture ◽  
Pelvic Congestion Syndrome ◽  
Minimally Invasive Surgical ◽  
Hemodynamic Assessment ◽  
Pelvic Congestion

Pelvic leak points (PLP) may be responsible for vulvar, perineal and lower limb varicose veins, in women during and/or after pregnancy. The accurate anatomical and hemodynamic assessment of these points, the perineal (PP), inguinal (IP) and clitoral points (CP) and their surgical treatment under local anesthetics as defined by Claude Franceschi is a new therapeutic option. The aim of this study was to assess the reliability and durability of the PLP reflux ablation using a minimally-invasive surgical disconnection at the PLP level in women with varicose veins of the lower limbs fed by the PLP. In this open-label trial 273 pelvic leak points free of pelvic congestion syndrome, with at least a 12-month follow- up, were assessed. 273 PLP treated: PP (n=177), IP (n =91) and CP (n=5). Followup: Period =12 to 92 months (mean =30.51 months). Age from 29 to 77 years (mean=45). The only 3 patients over 70 years (71, 74, 77) showed a high-speed reflux from a I point that fed symptomatic varicose veins of the lower limb. Exclusion criteria: pelvic congestion syndrome, BMI>24, venous malformations, a post thrombotic varicose vein. Diagnosis was performed using echo duplex and PLPs selected for treatment when refluxing at Valsalva + Paraná + squeezing maneuvers. A surgical skin marking of the PLP had been performed using echo duplex before surgery. Surgery consisted of minimally invasive dissection and selective division and ligation with non-absorbable suture of the refluxing veins and fascias at the PP, IP and CP pelvic escape points, under local anesthesia in a single center. The follow-up consisted of an echo duplex ultrasound, searching for reflux at the PLP treated thanks to the Valsalva maneuver, within 2 weeks, after 6 and 12 months and then yearly. The main endpoint of the study was the immediate elimination of the reflux at the PLP treated. The second endpoint was the long-term durability of the reflux ablation at the PLP treated. 267 (97.8%) without PLP reflux redo. 6 (2.2%) PLP reflux recurrences (PP=4, IP=1, CP 1). 3 patients with PLP reflux recurrence undergo a redo surgery (1.1%) where PP=2 (0.7%) and IP=1 (0.3%). This study shows the feasibility and durability of reflux ablation at the PLP level thanks to a minimally-invasive surgical treatment of the PLP and it demonstrates that there is no need for pelvic varicose embolization in patients without clinical signs of pelvic congestion syndrome. The accurate ultrasound assessment of each specific pelvic leak as well as a special surgical technique (vein division, non-absorbable suture of veins and fascias) seems to be the key for satisfactory outcomes.

The Outcome of Treatment for Pelvic Congestion Syndrome

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 74-77 ◽  
Author(s):  
P Coleridge Smith
Keyword(s):  
Lower Limb ◽  
Varicose Veins ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Vein ◽  
Computed Tomographic ◽  
Computed Tomographic Venography ◽  
Clinical Series ◽  
Pelvic Varices ◽  
Pelvic Congestion

Pelvic congestion syndrome is one of many causes of chronic pelvic pain. It is generally accepted that this is attributable to ovarian and pelvic vein incompetence which may result in varices in the lower limb leading to presentation in varicose vein clinics. However, far more patients have pelvic varices associated with varicose veins in the lower limb than have pelvic congestion syndrome. Magnetic resonance imaging and computed tomographic venography are usually used in the diagnosis of this condition and criteria have been established to identify pelvic varices. Many different treatments have been used to manage the symptoms of pelvic congestion. Hysterectomy combined with oophrectomy open surgical ligation of ovarian veins and laparoscopic vein ligation have been used in the past. The most common treatments used currently involve embolization of pelvic and ovarian veins. The results of this treatment have been published in a limited number of clinical series, usually with fairly short follow-up periods. These treatments may be complicated by migration of embolization of coils used to occlude veins. The longest duration of follow-up currently reported is five years. Limited clinical evidence supports the use of embolotherapy in the management of pelvic congestion syndrome.

Pelvic Congestion Syndrome: Surgical Treatment

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Zekilah SR ◽  
◽  
Sallam EM ◽  
Mashaal AB ◽  
Ageez MN ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pelvic Pain ◽  
Varicose Veins ◽  
University Hospital ◽  
Pelvic Congestion Syndrome ◽  
Pain Scores ◽  
Internal Iliac ◽  
Work Up ◽  
Pelvic Congestion

Aims: To evaluate the mid and long term efficacy of surgical interruption of the refluxing ovarian veins as a treatment modality for pelvic congestion syndrome. Study Design: A prospective non comparative interventional study. Place and Duration of Study: This study was conducted between February 2015 and October 2019 in Alexandria Medical Centre and Tanta Main University Hospital. Methodology: The study included a 27 patient’s undergone surgical interruption of refluxing ovarian veins with or without sclerotherapy of vulval, perineal or thigh varices, and data were collected prospectively. Detailed history was taken and clinical examination was done for every patient along with routine laboratory investigations and radiological work up was transvaginal and abdominal venous duplex. Follow up was done considering the change in pelvic venous images and pelvic pain scores in comparison to the pre-operative state. Results: Twenty seven female patients were treated for pelvic congestion syndrome using single session surgical intervention with or without sclerotherapy to pudendal varices. The patients age ranged from 21 to 43 (mean 33.1). All patients presented with chronic continuous pelvic pain. Other associated symptoms as dyspareunia, dysmenorrhea and pudendal varices were found in some cases. Surgical ligation of the ovarian veins were done to all cases, sclerotherapy/ligation of internal iliac varices was done for 6 cases and scerotherapy or surgical interruption of pudendal or thigh varicose veins was done in 21 cases. Technical success was achieved in all patients. Mean pelvic pain score was improved from 7.33 preoperatively to 1.33 and 0.89 in 6 and 12 months of the post-operative recordings. On sonographic basis pelvic reflux disappeared in 26 patients by the end of the follow up. Out of 27 patients treated there were 24 patients satisfied of the procedures at the end of the follow up. Conclusion: Surgical treatment for pelvic congestion syndrome combined with sclerotherapy to the associated varices was found to be effective, safe and affordable modality of treatment.

Embolization is essential in the treatment of leg varicosities due to pelvic venous insufficiency

2015 ◽  
Vol 30 (1_suppl) ◽  
pp. 81-85 ◽  
Author(s):  
O Hartung
Keyword(s):  
Local Anesthesia ◽  
Lower Limb ◽  
Varicose Veins ◽  
Iliac Vein ◽  
Additional Treatment ◽  
Venous Disease ◽  
Secondary Patency ◽  
Pelvic Venous Insufficiency ◽  
Pelvic Congestion

Purpose Pelvic venous insuffiency (PVI) can be responsible for pelvic congestion syndrome (PCS) and also lower limb varicose veins. Material and methods Charts of all women who had pelvic venography for PVI from September 2013 to August 2014 were reviewed. The procedure was performed under local anesthesia through left femoral approach. In case of reflux without associated obstructive lesions, embolization with coils and polidocanol foam was performed during the same procedure. Results 119 women, with median age 39 years were explored (86 with PCS and 102 with lower limb venous disease). Of these, 78 had an isolated reflux and were embolized and 41 had an obstructive disease (29 iliocaval obstructive lesions (ICOL), 4 nutcracker syndrome (NCS), and 8 with an association of both). Median follow-up was 4 months. Of the 12 NCS, 5 had surgical treatment and 7 had stenting of the left iliac vein without embolization. All patients with ICOL without NCS were treated by stenting in 28 and by a Palma procedure in 1 (failure to recanalize). Primary and secondary patency rates were 97% at 12 months. Embolization led to improvement of PCS in 91% (60% without any pain) and of lower limb varicose veins in 51% by itself. If 82% need an additional treatment of lower limb varicose veins, embolization allowed a switch of strategy from surgery to sclerosis. Conclusion PVI can cause lower limb symptoms. In most cases, it is due to reflux and can be treated under local anesthesia by embolization. This technique is safe and efficient. Obstructive lesions must be recognized and treated.

scholarly journals Minimally invasive high-definition microscope assisted small channel treatment of lumbar disc herniation in children: a case report

2021 ◽  
Author(s):  
Hao Yuan ◽  
Nan Zhao ◽  
Jun Ao ◽  
Lv Sun ◽  
Chong Wang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Muscle Strength ◽  
Minimally Invasive ◽  
Disc Herniation ◽  
Lower Limb ◽  
Lumbar Disc ◽  
High Definition ◽  
Small Channel ◽  
Left Lower Limb

Abstract Background: Despite lumbar disc herniation (LDH) is common in adults, it is extremely rare in children. The treatment of LDH in children is still a challenge for surgeons. This study aimed to explore the pathogenesis, clinical characteristics and treatment methods of LDH in children for communication and learning.Methods: In October 2017, a child with LDH who failed to receive conservative treatment underwent surgical treatment. The child underwent minimally invasive high-definition microscope-assisted nucleus pulposus resection and nerve root decompression. The soft tissues such as muscles and paravertebral ligaments were separated and removed under microscope, the nucleus pulposus of disc herniation was removed, and the left lumbar 5 nerve root was decompressed. During the short-term and long-term follow-up after operation, the assessment pain was significantly improved, the activity was not limited, and the muscle strength returned to normal.Results: The next day after operation, the child could wear ordinary waist circumference to get out of bed, and the left lower limb muscle strength returned to grade 4-5, and were discharged 5 days after operation. After 3 years of telephone follow-up, the patient complained that the pain was significantly relieved, the left lower limb movement was not limited, and the muscle strength returned to normal. Conclusions: In this case, the minimally invasive high-definition microscope assisted small channel treatment of LDH in children was successful, and the postoperative recovery was good. It can provide reference for LDH in children who need surgical treatment when conservative treatment was ineffective.

scholarly journals Surgical Treatment of Non-Saphenous Varicose Veins of Lower Limbs in Women with Pelvic Congestion Syndrome

2018 ◽  
Vol 26 (6) ◽  
pp. 669-676
Author(s):  
O.I. Nabolotnyi ◽  
◽  
Y. Hupalo ◽  
O. Shved ◽  
V. Gurianov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Varicose Veins ◽  
Lower Limbs ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Congestion

Pelvic congestion syndrome and left renal compression syndrome - clinical features and therapeutic approaches

VASA ◽  
2016 ◽  
Vol 45 (4) ◽  
pp. 275-282 ◽  
Author(s):  
Christina Jeanneret ◽  
Konstantin Beier ◽  
Alexander von Weymarn ◽  
Jürg Traber
Keyword(s):  
Varicose Veins ◽  
Left Renal Vein ◽  
Standing Position ◽  
Ovarian Vein ◽  
Pelvic Congestion Syndrome ◽  
Compression Syndrome ◽  
Abstract Knowledge ◽  
Increased Risk ◽  
Definition Of ◽  
Pelvic Congestion

Abstract. Knowledge of the anatomy of the pelvic, gonadal and renal veins is important to understand pelvic congestion syndrome (PCS) and left renal vein compression syndrome (LRCS), which is also known as the nutcracker syndrome. LRCS is related to PCS and to the presence of vulvar, vaginal and pudendal varicose veins. The diagnosis of the two syndromes is difficult, and usually achieved with CT- or phlebography. The gold standard is the intravenous pressure measurement using conventional phlebography. The definition of PCS is described as pelvic pain, aggravated in the standing position and lasting for more than 6 months. Pain in the left flank and microhaematuria is seen in patients with LRCS. Women with multiple pregnancies are at increased risk of developing varicose vein recurrences with pelvic drainage and ovarian vein reflux after crossectomy and stripping of the great saphenous vein. The therapeutic options are: conservative treatment (medroxyprogesteron) or interventional (coiling of the ovarian vein) or operative treatment (clipping of the ovarian vein). Controlled prospective trials are needed to find the best treatment.

Pelvic congestion syndrome as a predisposing factor of "two-level" varicose veins development

2019 ◽  
Vol 19 (3) ◽  
Author(s):  
Larysa Chernukha ◽  
Alla Guch ◽  
Vadym Kondratyuk ◽  
Olenka Vlasenko ◽  
Alla Bobrova
Keyword(s):  
Varicose Veins ◽  
Predisposing Factor ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Congestion
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