nine patients with complete resolution of symptoms and four patients with improvements of symptoms. The most common presenting symptoms were hematuria and flank pain. There was no stent migration and 2-year primary patency was 85%.11
The majority of the
data regarding PeVD and embolization is retrospective in nature. Moving forward, randomized controlled trials are necessary to support existing data and aid in development of diagnostic/treatment algorithms. In summary, CPP secondary to PeVD is a complex process with varying presentations, symptoms and often confusing terminology which results in diagnostic errors. Although we have recently made great strides, continued work on imaging/diagnostic criteria, treatment algorithms and classification of disease is required.
References
1. Latthe P, Latthe M, Say L, et al. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health. 2006;6:177.
2. Khilnani NM, Meissner MH, Learman LA, Gibson KD, Daniels JP, Winokur RS, et al. Research priorities in pelvic venous disorders in women: Recommendations from a multidisciplinary research consensus panel. J Vasc Interv Radiol. 2019;30:781–9.
3. Meissner MH, Khilnani NM, Labropoulos N, Gasparis AP, Gibson K, Greiner M, Learman LA, Atashroo D, Lurie F, Passman MA, Basile A, Lazarshvilli Z, Lohr J, Kim MD, Nicolini PH, Pabon-Ramos WM, Rosenblatt M. The Symptoms-Varices-Pathophysiology classifi cation of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. J Vasc Surg Venous Lymphat Disord. 2021 May;9(3):568–584. doi: 10.1016/j.jvsv.2020.12.084. Epub 2021 Jan 30. PMID: 33529720.
4. Knuttinen MG, Machan L, Khilnani NM, Louie M, Caridi TM, Gupta R, Winokur RS. Diagnosis and management of pelvic venous disorders: AJR Expert Panel Narrative Review. AJR Am J Roentgenol. 2023 Nov;221(5):565–574. doi: 10.2214/AJR.22.28796. Epub 2023 Apr 5. PMID: 37095667.
5. Steege JF, Siedhoff MT. Chronic pelvic pain. Obstet Gynecol 2014; 124:616–629.
6. Steenbeek M, van Der Vleuten CJM, Schultze Kool LJ, et al. Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review. Acta Obstet Gyenecol Scand. 2018;97:776–786.
7. Kachlik D, Pechacek V, Musil V, et al. The venous system of the pelvis: New nomenclature. Phlebology. 2010;25:162–173.
8. Greiner M, Dadon M, Lemasle P, et al. How does the pathophysiology infl uence the treatment of pelvic congestion syndrome and is the result long-lasting? Phlebology 2012;27(Suppl 1):58–64.
9. Brown CL, Rizer M, Alexander R, Sharpe EE 3rd, Rochon PJ. Pelvic congestion syndrome: Systematic review of treatment success. Semin Intervent Radiol. 2018; 35:35–40.
10. Daugherty SF, Gillespie DL. Venous angioplasty and stenting improve pelvic congestion syndrome caused by venous outfl ow obstruction. J Vasc Surg Venous Lymphat Disord. 2015; 3:283–289.
11. Avgerinos ED, Saadeddin Z, Humar R, Salem K, Singh M, Hager E, Makaroun M, Chaer RA. Outcomes of left renal vein stenting in patients with nutcracker syndrome. J Vasc Surg Venous Lymphat Disord. 2019 Nov;7(6):853–859. doi: 10.1016/j.jvsv.2019.06.016. Epub 2019 Aug 27. PMID: 31471277.
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