Síndrome de congestión venosa pélvica: Diagnóstico y manejo endovascular
Pelvic venous congestion syndrome: Diagnosis and endovascular management
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Mercado, J. L., Ceballos Burbano, O., Márquez, J. A., & Mora Posada, R. (2014). Síndrome de congestión venosa pélvica: Diagnóstico y manejo endovascular. Revista Repertorio De Medicina Y Cirugía, 23(2), 96–101. https://doi.org/10.31260/RepertMedCir.v23.n2.2014.723
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Consiste en la dilatación de las estructuras venosas intrapélvicas que genera su aumento en número y calibre. El principal síntoma es el dolor pélvico crónico y puede asociarse con dispareunia, dismenorrea, dolor postcoital y pesadez perineal; se manifiesta por várices genitales y atípicas en los miembros inferiores. Las diferentes estrategias médicas y quirúrgicas son poco efectivas y/o seguras. La terapia endovascular ofrece un abordaje mínimamente invasivo que permite el diagnóstico y el tratamiento definitivo. Se realizó una búsqueda de los estudios publicados en la literatura mundial sobre los diferentes métodos diagnósticos y terapéuticos, incluyendo series de casos y controles en los cuales se evaluaron los resultados de la terapia endovascular. Abreviaturas: SCVP, síndrome de congestión venosa pélvica.
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3. Cid J. Dolor pélvico crónico. Rev. Soc. Esp. Dolor. 2006; 13(1): 29-39.
4. Kamm MA. Chronic pelvic pain in women--gastroenterological, gynaecological or psychological?. Int J Colorectal Dis. 1997;12(2):57-62.
5. Walker EA, Gelfand AN, Gelfand MD, Green C, Katon WJ. Chronic pelvic pain and gynecological symptoms in women with irritable bowel syndrome. J Psychosom Obstet Gynaecol. 1996 Mar; 17(1):39-46.
6. Cheong Y, William Stones R. Chronic pelvic pain: aetiology and therapy. Best Pract Res Clin Obstet Gynaecol. 2006;20(5):695-711.
7. Richet A. Traite practique d ́anatomie medico-chirurgicale. Paris: E. Chamerot, Libraire Editeur; 1857.
8. Taylor HC. Vascular congestion and hyperemia; their effect on structure and function in the female reproductive system. Am J Obstet Gynecol. 1949;57(2):211-30.
9. Lefévre H. Broad ligament varicocele. Acta Obstet Gynecol Scand. 1965; 43 (suppl. 7): 122-23.
10. Ahlberg NE, Bartley O, Chidekel N, Edlundh KO. Roentgenological diagnosis of pelvic varicosities in women. Acta Obstet Gynecol Scand. 1965;43 (Suppl 7):120-1.
11. Hobbs JT. The pelvic congestion syndrome. Practitioner. 1976; 216 (1295): 529-40.
12. Lechter A, Alvarez A, Lopez G. Pelvic varices and gonadal veins. Phlebologie 1987;2:181-8.
13. Edwards RD, Robertson IR, MacLean AB, Hemingway AP. Case report: pelvic pain syndrome--successful treatment of a case by ovarian vein embolization. Clin Radiol. 1993;47(6):429-31.
14. Latarjet M, Ruíz Liard A, Pro E. Anatomía Humana. Buenos Aires: Medica Panamericana; 2004.
15. Capasso P. Ovarian vein embolization for the treatment of the pelvic congestion syndrome. Part I: Background, anatomy and etiology. Intervention. 2000; 4: 67-71.
16. Leal Monedero J. Indicaciones y tratamiento del síndrome de congestión pélvica. Flebología y linfología, lecturas vasculres. 2010; 5(14): 841-7.
17. Belenky A, Bartal G, Atar E, Cohen M, Bachar GN. Ovarian varices in healthy female kidney donors: incidence, morbidity, and clinical outcome. AJR Am J Roentgenol. 2002;179(3):625-7.
18. Scultetus AH, Villavicencio JL, Gillespie DL. The nutcracker syndrome: its role in the pelvic venous disorders. J Vasc Surg. 2001;34(5):812-9.
19. Koc Z, Ulusan S, Tokmak N, Oguzkurt L, Yildirim T. Double retroaortic left renal veins as a possible cause of pelvic congestion syndrome: imaging findings in two patients. Br J Radiol. 2006;79(946):e152-5.
20. Koc Z, Ulusan S, Oguzkurt L. Association of left renal vein variations and pelvic varices in abdominal MDCT. Eur Radiol. 2007;17(5):1267-74.
21. O’Sullivan GJ, Semba CP, Bittner CA, Kee ST, Razavi MK, Sze DY, et al. Endovascular management of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 2000;11(7):823-36.
22. Chang CT, Hung CC, Ng KK, Yen TH. Nutcracker syndrome and left unilateral haematuria. Nephrol Dial Transplant. 2005;20(2):460-1.
23. Perrin MR, Labropoulos N, Leon LR. Presentation of the patient with recurrent varices after surgery (REVAS). J Vasc Surg. 2006;43(2):327-34.
24. Creton D, Hennequin L, Kohler F, Allaert FA. Embolisation of symptomatic pelvic veins in women presenting with non-saphenous varicose veins of pelvic origin - three-year follow-up. Eur J Vasc Endovasc Surg. 2007;34(1):112-7.
25. Moore J, Kennedy S. Causes of chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;14(3):389-402.
26. Nader A, Candido KD. Pelvic pain. Pain Pract. 2001;1(2):187-96.
27. Jung SC, Lee W, Chung JW, Jae HJ, Park EA, Jin KN, et al. Unusual causes of varicose veins in the lower extremities: CT venographic and Doppler US findings. Radiographics. 2009;29(2):525-36.
28. Beard RW, Reginald PW, Wadsworth J. Clinical features of women with chronic lower abdominal pain and pelvic congestion. Br J Obstet Gynaecol. 1988;95(2):153-61.
29. Cicchiello LA, Hamper UM, Scoutt LM. Ultrasound evaluation of gynecologic causes of pelvic pain. Obstet Gynecol Clin North Am. 2011 Mar; 38(1):85-114.
30. Kennedy A, Hemingway A. Radiology of ovarian varices. Br J Hosp Med. 1990;44(1):38-43.
31. Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES. Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. AJR Am J Roentgenol. 2001;176(1):119-22.
32. Capasso P, Simons C, Trotteur G, Dondelinger RF, Henroteaux D, Gaspard U. Treatment of symptomatic pelvic varices by ovarian vein embolization. Cardiovasc Intervent Radiol. 1997;20(2):107-11.
33. Soysal ME, Soysal S, Vicdan K, Ozer S. A randomized controlled trial of goserelin and medroxyprogesterone acetate in the treatment of pelvic congestion. Hum Reprod. 2001;16(5):931-9.
34. Beard RW, Kennedy RG, Gangar KF, Stones RW, Rogers V, Reginald PW, et al. Bilateral oophorectomy and hysterectomy in the treatment of intractable pelvic pain associated with pelvic congestion. Br J Obstet Gynaecol. 1991;98(10):988-92.
35. Mathis BV, Miller JS, Lukens ML, Paluzzi MW. Pelvic congestion syndrome: a new approach to an unusual problem. Am Surg. 1995;61(11):1016-8.
36. Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, et al. 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.
37. Nicolaides AN, Trust CDEaR, Surgery ESoV, TIASACO, Angiology IUo, Cernay UIdPatAdVd. Investigation of chronic venous insufficiency: A consensus statement (France, March 5-9, 1997). Circulation. 2000;102(20):E126-63.
38. Edwards RD, Robertson IR, MacLean AB, Hemingway AP. Case report: pelvic pain syndrome--successful treatment of a case by ovarian vein embolization. Clin Radiol. 1993 Jun;47(6):429-31.
39. Scultetus AH, Villavicencio JL, Gillespie DL, Kao TC, Rich NM. The pelvic venous syndromes: analysis of our experience with 57 patients. J Vasc Surg. 2002;36(5):881-8.
40. Kostas T, Ioannou CV, Touloupakis E, Daskalaki E, Giannoukas AD, Tsetis D, et al. Recurrent varicose veins after surgery: a new appraisal of a common and complex problem in vascular surgery. Eur J Vasc Endovasc Surg. 2004;27(3):275-82.
41. Leal Monedero J, Perrin M, Langeron P. La pathologie veineuse pelvienne. Traitement embolisant. Phlébologie. 1999; 52(3): 299-310.
42. Leal Monedero J, Zubicoa Ezpeleta S, Grimberg M, VergaraCorrea L, Jimenez Gutiérrez J. Subdiaphragmatic venous insufficiency: Embolization treatment using mixed technique (coils and foam). Phlebolymphology. 2004; 44: 269-75.
43. Maleux G, Stockx L, Wilms G, Marchal G. Ovarian vein embolization for the treatment of pelvic congestion syndrome: long-term technical and clinical results. J Vasc Interv Radiol. 2000;11(7):859-64.
44. Edo Prades MA, Ferrer Puchol MD, Esteban Hernández E, Ferrero Asensi M. Pelvic congestion syndrome: outcome after embolization with coils. Radiologia. 2012 May 24.
45. Kim HS, Malhotra AD, Rowe PC, Lee JM, Venbrux AC. Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol. 2006;17(2 Pt 1): 289-97.
46. Freedman J, Ganeshan A, Crowe PM. Pelvic congestion syndrome: the role of interventional radiology in the treatment of chronic pelvic pain. Postgrad Med J. 2010; 86 (1022):704-10.
47. Ganeshan A, Upponi S, Hon LQ, Uthappa MC, Warakaulle DR, Uberoi R. Chronic pelvic pain due to pelvic congestion syndrome: the role of diagnostic and interventional radiology. Cardiovasc Intervent Radiol. 2007; 30(6):1105-11.
48. Tu FF, Hahn D, Steege JF. Pelvic congestion syndrome-associated pelvic pain: a systematic review of diagnosis and management. Obstet Gynecol Surv. 2010;65(5):332-40.
49. J LM. Embolization treatment of recurrent varices of pelvic origin. In: S ZE, J CC, M CO, G SF, editors. Phlebology. 2006; 21(1): 74-7.
50. Smith PC. The outcome of treatment for pelvic congestion syndrome. Phlebology. 2012;27 Suppl 1:74-7.
2. Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996;87(3):321-7.
3. Cid J. Dolor pélvico crónico. Rev. Soc. Esp. Dolor. 2006; 13(1): 29-39.
4. Kamm MA. Chronic pelvic pain in women--gastroenterological, gynaecological or psychological?. Int J Colorectal Dis. 1997;12(2):57-62.
5. Walker EA, Gelfand AN, Gelfand MD, Green C, Katon WJ. Chronic pelvic pain and gynecological symptoms in women with irritable bowel syndrome. J Psychosom Obstet Gynaecol. 1996 Mar; 17(1):39-46.
6. Cheong Y, William Stones R. Chronic pelvic pain: aetiology and therapy. Best Pract Res Clin Obstet Gynaecol. 2006;20(5):695-711.
7. Richet A. Traite practique d ́anatomie medico-chirurgicale. Paris: E. Chamerot, Libraire Editeur; 1857.
8. Taylor HC. Vascular congestion and hyperemia; their effect on structure and function in the female reproductive system. Am J Obstet Gynecol. 1949;57(2):211-30.
9. Lefévre H. Broad ligament varicocele. Acta Obstet Gynecol Scand. 1965; 43 (suppl. 7): 122-23.
10. Ahlberg NE, Bartley O, Chidekel N, Edlundh KO. Roentgenological diagnosis of pelvic varicosities in women. Acta Obstet Gynecol Scand. 1965;43 (Suppl 7):120-1.
11. Hobbs JT. The pelvic congestion syndrome. Practitioner. 1976; 216 (1295): 529-40.
12. Lechter A, Alvarez A, Lopez G. Pelvic varices and gonadal veins. Phlebologie 1987;2:181-8.
13. Edwards RD, Robertson IR, MacLean AB, Hemingway AP. Case report: pelvic pain syndrome--successful treatment of a case by ovarian vein embolization. Clin Radiol. 1993;47(6):429-31.
14. Latarjet M, Ruíz Liard A, Pro E. Anatomía Humana. Buenos Aires: Medica Panamericana; 2004.
15. Capasso P. Ovarian vein embolization for the treatment of the pelvic congestion syndrome. Part I: Background, anatomy and etiology. Intervention. 2000; 4: 67-71.
16. Leal Monedero J. Indicaciones y tratamiento del síndrome de congestión pélvica. Flebología y linfología, lecturas vasculres. 2010; 5(14): 841-7.
17. Belenky A, Bartal G, Atar E, Cohen M, Bachar GN. Ovarian varices in healthy female kidney donors: incidence, morbidity, and clinical outcome. AJR Am J Roentgenol. 2002;179(3):625-7.
18. Scultetus AH, Villavicencio JL, Gillespie DL. The nutcracker syndrome: its role in the pelvic venous disorders. J Vasc Surg. 2001;34(5):812-9.
19. Koc Z, Ulusan S, Tokmak N, Oguzkurt L, Yildirim T. Double retroaortic left renal veins as a possible cause of pelvic congestion syndrome: imaging findings in two patients. Br J Radiol. 2006;79(946):e152-5.
20. Koc Z, Ulusan S, Oguzkurt L. Association of left renal vein variations and pelvic varices in abdominal MDCT. Eur Radiol. 2007;17(5):1267-74.
21. O’Sullivan GJ, Semba CP, Bittner CA, Kee ST, Razavi MK, Sze DY, et al. Endovascular management of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 2000;11(7):823-36.
22. Chang CT, Hung CC, Ng KK, Yen TH. Nutcracker syndrome and left unilateral haematuria. Nephrol Dial Transplant. 2005;20(2):460-1.
23. Perrin MR, Labropoulos N, Leon LR. Presentation of the patient with recurrent varices after surgery (REVAS). J Vasc Surg. 2006;43(2):327-34.
24. Creton D, Hennequin L, Kohler F, Allaert FA. Embolisation of symptomatic pelvic veins in women presenting with non-saphenous varicose veins of pelvic origin - three-year follow-up. Eur J Vasc Endovasc Surg. 2007;34(1):112-7.
25. Moore J, Kennedy S. Causes of chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;14(3):389-402.
26. Nader A, Candido KD. Pelvic pain. Pain Pract. 2001;1(2):187-96.
27. Jung SC, Lee W, Chung JW, Jae HJ, Park EA, Jin KN, et al. Unusual causes of varicose veins in the lower extremities: CT venographic and Doppler US findings. Radiographics. 2009;29(2):525-36.
28. Beard RW, Reginald PW, Wadsworth J. Clinical features of women with chronic lower abdominal pain and pelvic congestion. Br J Obstet Gynaecol. 1988;95(2):153-61.
29. Cicchiello LA, Hamper UM, Scoutt LM. Ultrasound evaluation of gynecologic causes of pelvic pain. Obstet Gynecol Clin North Am. 2011 Mar; 38(1):85-114.
30. Kennedy A, Hemingway A. Radiology of ovarian varices. Br J Hosp Med. 1990;44(1):38-43.
31. Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES. Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. AJR Am J Roentgenol. 2001;176(1):119-22.
32. Capasso P, Simons C, Trotteur G, Dondelinger RF, Henroteaux D, Gaspard U. Treatment of symptomatic pelvic varices by ovarian vein embolization. Cardiovasc Intervent Radiol. 1997;20(2):107-11.
33. Soysal ME, Soysal S, Vicdan K, Ozer S. A randomized controlled trial of goserelin and medroxyprogesterone acetate in the treatment of pelvic congestion. Hum Reprod. 2001;16(5):931-9.
34. Beard RW, Kennedy RG, Gangar KF, Stones RW, Rogers V, Reginald PW, et al. Bilateral oophorectomy and hysterectomy in the treatment of intractable pelvic pain associated with pelvic congestion. Br J Obstet Gynaecol. 1991;98(10):988-92.
35. Mathis BV, Miller JS, Lukens ML, Paluzzi MW. Pelvic congestion syndrome: a new approach to an unusual problem. Am Surg. 1995;61(11):1016-8.
36. Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, et al. 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.
37. Nicolaides AN, Trust CDEaR, Surgery ESoV, TIASACO, Angiology IUo, Cernay UIdPatAdVd. Investigation of chronic venous insufficiency: A consensus statement (France, March 5-9, 1997). Circulation. 2000;102(20):E126-63.
38. Edwards RD, Robertson IR, MacLean AB, Hemingway AP. Case report: pelvic pain syndrome--successful treatment of a case by ovarian vein embolization. Clin Radiol. 1993 Jun;47(6):429-31.
39. Scultetus AH, Villavicencio JL, Gillespie DL, Kao TC, Rich NM. The pelvic venous syndromes: analysis of our experience with 57 patients. J Vasc Surg. 2002;36(5):881-8.
40. Kostas T, Ioannou CV, Touloupakis E, Daskalaki E, Giannoukas AD, Tsetis D, et al. Recurrent varicose veins after surgery: a new appraisal of a common and complex problem in vascular surgery. Eur J Vasc Endovasc Surg. 2004;27(3):275-82.
41. Leal Monedero J, Perrin M, Langeron P. La pathologie veineuse pelvienne. Traitement embolisant. Phlébologie. 1999; 52(3): 299-310.
42. Leal Monedero J, Zubicoa Ezpeleta S, Grimberg M, VergaraCorrea L, Jimenez Gutiérrez J. Subdiaphragmatic venous insufficiency: Embolization treatment using mixed technique (coils and foam). Phlebolymphology. 2004; 44: 269-75.
43. Maleux G, Stockx L, Wilms G, Marchal G. Ovarian vein embolization for the treatment of pelvic congestion syndrome: long-term technical and clinical results. J Vasc Interv Radiol. 2000;11(7):859-64.
44. Edo Prades MA, Ferrer Puchol MD, Esteban Hernández E, Ferrero Asensi M. Pelvic congestion syndrome: outcome after embolization with coils. Radiologia. 2012 May 24.
45. Kim HS, Malhotra AD, Rowe PC, Lee JM, Venbrux AC. Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol. 2006;17(2 Pt 1): 289-97.
46. Freedman J, Ganeshan A, Crowe PM. Pelvic congestion syndrome: the role of interventional radiology in the treatment of chronic pelvic pain. Postgrad Med J. 2010; 86 (1022):704-10.
47. Ganeshan A, Upponi S, Hon LQ, Uthappa MC, Warakaulle DR, Uberoi R. Chronic pelvic pain due to pelvic congestion syndrome: the role of diagnostic and interventional radiology. Cardiovasc Intervent Radiol. 2007; 30(6):1105-11.
48. Tu FF, Hahn D, Steege JF. Pelvic congestion syndrome-associated pelvic pain: a systematic review of diagnosis and management. Obstet Gynecol Surv. 2010;65(5):332-40.
49. J LM. Embolization treatment of recurrent varices of pelvic origin. In: S ZE, J CC, M CO, G SF, editors. Phlebology. 2006; 21(1): 74-7.
50. Smith PC. The outcome of treatment for pelvic congestion syndrome. Phlebology. 2012;27 Suppl 1:74-7.
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