1. PELVIC CONGESTION SYNDROME - WHEN TO TREAT CONSERVATIVELY AND WHEN INVASIVELY?
- Author
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Nikolov, N. and Stoyanova, B.
- Subjects
DUPLEX ultrasonography ,DELAYED diagnosis ,SYMPTOMS ,VENOGRAPHY ,RADIONUCLIDE imaging ,PELVIC pain - Abstract
Definition. Pelvic congestion syndrome (or more precisely - pelvic venous disorders) is a collective concept of diseases with different pathophysiology, with the main symptom chronic pain in the pelvis. It is most often caused by increase in the pressure, number and caliber of the intrapelvic venous structures. Usually, this syndrome is either neglected or not well known, leading to delays in diagnosis and treatment. Diagnostic approach. In addition to the typical clinical presentation, pelvic venous disorders are most often detected by color duplex sonography (transvaginal), but for the preparation of a therapeutic algorithm, computer tomography venography and, to a lesser extent, invasive venography play a key role. The tomographic study gives valuable information about the compression, the affected structures and their sizes. Among the additional tests, we should mention the dynamic renal scintigraphy with which we evaluate the renal function. Therapeutic algorithm. Pathophysiological mechanisms mainly involve reflux and/or obstruction. Finding the exact mechanism of venous system involvement in any of the four areas (renal, gonad/iliac, pelvic, or lower extremity) is critical to successful treatment. In certain cases, the treatment of reflux may not lead to the desired results and, on the contrary, may even harm. In cases of pure reflux to the gonadal veins, the main method of treatment is endovascular - embolization; in cases of compression also - venous stenting. Combined pathologies are a challenge, in which an individual approach and additional exams are essential for their correct treatment. Conclusion. Pelvic venous disorders are a real challenge to the vascular specialist. A good knowledge of venous anatomy and pathophysiology is a cornerstone in the adequate and thorough treatment of this pathology. [ABSTRACT FROM AUTHOR]
- Published
- 2024