Semin intervent Radiol 2021; 38(02): 182-188
DOI: 10.1055/s-0041-1727104
Review Article

Choosing the Most Appropriate Treatment Option for Pelvic Venous Disease: Stenting versus Embolization

Mari E. Tanaka
1   Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
,
Oleksandra Kutsenko
2   Department of Radiology, SUNY Upstate University Hospital, Syracuse, New York
,
Gloria Salazar
3   Division of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts
› Author Affiliations

Abstract

Pelvic venous disease (PeVD) in women encompasses a wide variety of entities all resulting in pelvic pain and varices. Successful treatment with percutaneous interventions is dependent on identifying underlying factors contributing to the disease and addressing them with either embolization of incompetent veins or stenting for venous stenoses. There are a multitude of embolization methods with marked practice heterogeneity. Moreover, with the ongoing development of dedicated venous stents in the treatment of chronic venous disease, there are more opportunities to consider this modality for the treatment of PeVD, as many patients present with combined vein reflux and central venous stenosis. The necessity to address both and the order of interventions in these patients is still to be elucidated. Here, we describe when to choose stenting or embolization for PeVD, their limitations, and our practice and identify further areas of research in this field.



Publication History

Article published online:
03 June 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Farquhar CM, Rogers V, Franks S. et al. A randomized controlled trial of medroxyprogesterone acetate and psychotherapy for the treatment of pelvic congestion. BJOG An Int J Obstet Gynaecol 1989; 96 (10) 1153-1162
  • 2 Beard RW, Kennedy RG, Gangar KF. et al. Bilateral oophorectomy and hysterectomy in the treatment of intractable pelvic pain associated with pelvic congestion. BJOG An Int J Obstet Gynaecol 1991; 98 (10) 988-992
  • 3 Behera M, Vilos GA, Hollett-Caines J, Abu-Rafea B, Ahmad R. Laparoscopic findings, histopathologic evaluation, and clinical outcomes in women with chronic pelvic pain after hysterectomy and bilateral salpingo-oophorectomy. J Minim Invasive Gynecol 2006; 13 (05) 431-435
  • 4 Cheong YC, Smotra G, Williams ACDC. Non-surgical interventions for the management of chronic pelvic pain. Cochrane Database Syst Rev 2014; 2014 (03) CD008797
  • 5 Harnod T, Chen W, Wang JH, Lin SZ, Ding DC. Clinical medicine hysterectomies are associated with an increased risk of depression: a population-based cohort study. J Clin Med 2018; 7 (10) 366
  • 6 Kutsenko O, Salazar G. Treatment strategies for varying patterns and presentations of pelvic venous disorder. There is not a one-size-fits-all solution! Endovascular Today 2020;19(04):
  • 7 Kaufman JA. Inferior vena cava and tributaries. In: The Requisites: Vascular and Interventional Radiology. Philadelphia: Elsevier-Mosby; 2014: 304-306
  • 8 Asciutto G, Asciutto KC, Mumme A, Geier B. Pelvic venous incompetence: reflux patterns and treatment results. Eur J Vasc Endovasc Surg 2009; 38 (03) 381-386
  • 9 May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology 1957; 8 (05) 419-427
  • 10 Kibbe MR, Ujiki M, Goodwin AL, Eskandari M, Yao J, Matsumura J. Iliac vein compression in an asymptomatic patient population. J Vasc Surg 2004; 39 (05) 937-943
  • 11 Lourenço De Macedo G, Alves M, Santos D, Sarris AB, Gomes RZ. Diagnosis and treatment of the Nutcracker syndrome: a review of the last 10 years. Jul-Set 2018; 17 (03) 220-228
  • 12 Hung JB, Hsu CW, Tsai SH. Prostatism and May-Thurner syndrome. Am J Emerg Med 2013; 31 (02) 445.e1-445.e2
  • 13 Crowner J, Marston W, Almeida J, McLafferty R, Passman M. Classification of anatomic involvement of the iliocaval venous outflow tract and its relationship to outcomes after iliocaval venous stenting. J Vasc Surg Venous Lymphat Disord 2014; 2 (03) 241-245
  • 14 Elsharawy MA, Moghazy KM, Alsaif HS, Al-Asiri MM. Unusual case of left iliac vein compression secondary to May-Thurner syndrome and crossed fused renal ectopia. Saudi Med J 2008; 29 (04) 603-605
  • 15 Mahnken AH, Thomson K, de Haan M, O'Sullivan GJ. CIRSE standards of practice guidelines on iliocaval stenting. Cardiovasc Intervent Radiol 2014; 37 (04) 889-897
  • 16 Daugherty SF, Gillespie DL. Venous angioplasty and stenting improve pelvic congestion syndrome caused by venous outflow obstruction. J Vasc Surg Venous Lymphat Disord 2015; 3 (03) 283-289
  • 17 Gavrilov SG, Vasilyev AV, Krasavin GV, Moskalenko YP, Mishakina NY. Endovascular interventions in the treatment of pelvic congestion syndrome caused by May-Thurner syndrome. J Vasc Surg Venous Lymphat Disord 2020; 8 (06) 1049-1057
  • 18 Greiner M, Dadon M, Lemasle P, Cluzel P. How does the patho-physiology influence the treatment of pelvic congestion syndrome and is the result long-lasting?. Phlebology 2012; 27 (Suppl. 01) 58-64
  • 19 Sürücü HS, Erbil KM, Tastan C, Yener N. Anomalous veins of the retroperitoneum: clinical considerations. Surg Radiol Anat 2001; 23 (06) 443-445
  • 20 DePietro DM, Carlon T, Trerotola SO, Sudheendra D. Endovascular treatment of an anatomically complex iliac lesion and a review of variant iliac venous anatomy. J Vasc Interv Radiol 2020; 31 (02) 260-264
  • 21 Moreland AJ, Holly BP, AAssar OS, Lessne ML. Variant drainage of left internal iliac vein to right common iliac vein potentiating pelvic congestion syndrome. J Vasc Interv Radiol 2019; 30 (04) 622-625
  • 22 Santoshi RKN, Lakhanpal S, Satwah V, Lakhanpal G, Malone M, Pappas PJ. Iliac vein stenosis is an underdiagnosed cause of pelvic venous insufficiency. J Vasc Surg Venous Lymphat Disord 2018; 6 (02) 202-211
  • 23 Arnoldussen CWKP, de Wolf MAF, Wittens CHA. Diagnostic imaging of pelvic congestive syndrome. Phlebology 2015; 30 (1, Suppl): 67-72
  • 24 Gloviczki P, Comerota AJ, Dalsing MC. et al; Society for Vascular Surgery, American Venous Forum. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53 (5, Suppl): 2S-48S
  • 25 De Gregorio MA, Guirola JA, Alvarez-Arranz E, Anchez-Ballestin MS, Urbano J, Sierre S. Pelvic venous disorders in women due to pelvic varices: treatment by embolization: experience in 520 patients. J Vasc Interv Radiol 2020; 31 (10) 1560-1569
  • 26 Guerrero A, Theophanous RG. A case report of a migrated pelvic coil causing pulmonary infarct in an adult female. Clin Pract Cases Emerg Med 2020; 4 (03) 436-439
  • 27 Liu J, Han L, Han X. The effect of a subsequent pregnancy after ovarian vein embolization in patients with infertility caused by pelvic congestion syndrome. Acad Radiol 2019; 26 (10) 1373-1377
  • 28 Kies DD, Lee JM, Venbrux AC, Kim HS. Management of female venous congestion syndrome. In: Image-Guided Interventions. Philadelphia: Elsevier - Saunders; 2014: 563-568
  • 29 Daniels JP, Champaneria R, Shah L, Gupta JK, Birch J, Moss JG. Effectiveness of embolization or sclerotherapy of pelvic veins for reducing chronic pelvic pain: a systematic review. J Vasc Interv Radiol 2016; 27 (10) 1478-1486.e8
  • 30 Mahmoud O, Vikatmaa P, Aho P. et al. Efficacy of endovascular treatment for pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord 2016; 4 (03) 355-370
  • 31 Marcelin C, Izaaryene J, Castelli M. et al. Embolization of ovarian vein for pelvic congestion syndrome with ethylene vinyl alcohol copolymer (Onyx®). Diagn Interv Imaging 2017; 98 (12) 843-848
  • 32 Esposito A, Charisis N, Kantarovsky A, Uhl JF, Labropoulos N. A comprehensive review of the pathophysiology and clinical importance of iliac vein obstruction. Eur J Vasc Endovasc Surg 2020; 60 (01) 118-125
  • 33 Gagne PJ, Gasparis A, Black S. et al. Analysis of threshold stenosis by multiplanar venogram and intravascular ultrasound examination for predicting clinical improvement after iliofemoral vein stenting in the VIDIO trial. J Vasc Surg Venous Lymphat Disord 2018; 6 (01) 48-56.e1
  • 34 Neglén P, Raju S. Intravascular ultrasound scan evaluation of the obstructed vein. J Vasc Surg 2002; 35 (04) 694-700
  • 35 Thorpe PE. Identification and treatment of restenosis in failing venous stents: the role of intravascular ultrasound. J Vasc Surg Venous Lymphat Disord 2014; 2 (01) 109-110
  • 36 Murphy E. Surveying the 2019 venous stent landscape. Endovasc Today 2019; 18 (07) 53-64
  • 37 Razavi MK, Jaff MR, Miller LE. Safety and effectiveness of stent placement for iliofemoral venous outflow obstruction: systematic review and meta-analysis. Circ Cardiovasc Interv 2015; 8 (10) e002772
  • 38 Hartung O, Barthelemy P, Arnoux D, Boufi M, Alimi YS. Management of pregnancy in women with previous left ilio-caval stenting. J Vasc Surg 2009; 50 (02) 355-359
  • 39 Milinis K, Thapar A, Shalhoub J, Davies AH. Antithrombotic therapy following venous stenting: International Delphi Consensus. Eur J Vasc Endovasc Surg 2018; 55 (04) 537-544
  • 40 Radaideh Q, Patel NM, Shammas NW. Iliac vein compression: epidemiology, diagnosis and treatment. Vasc Health Risk Manag 2019; 15: 115-122
  • 41 Lichtenberg MKW, de Graaf R, Stahlhoff WF, Özkapi A, Rassaf T, Breuckmann F. Venovo venous stent in the treatment of non-thrombotic or post-thrombotic iliac vein lesions - short-term results from the Arnsberg venous registry. Vasa 2019; 48 (02) 175-180
  • 42 Lichtenberg M, Breuckmann F, Stahlhoff WF, Neglén P, Rick G. Placement of closed-cell designed venous stents in a mixed cohort of patients with chronic venous outflow obstructions - short-term safety, patency, and clinical outcomes. Vasa 2018; 47 (06) 475-481
  • 43 Khilnani NM, Meissner MH, Learman LA. et al. Research priorities in pelvic venous disorders in women: recommendations from a multidisciplinary research consensus panel. J Vasc Interv Radiol 2019; 30 (06) 781-789