Search

Objective: Pelvic vein incompetence (PVI) affects 15-20% of all women, yet we know little about how it affects sufferers. The aim of this prospective pilot study was to explore symptoms experienced by women with PVI, and determine its impact on quality of life and NHS costs., Study Design: Case-control study at a UK University teaching hospital conducted over an eight-month period. Cases were 40 premenopausal women aged 18-49 years with PVI and varicose veins (VV). There were two age-matched controls groups: (i) 40 healthy women with no PVI but with VV, and (ii) 40 healthy women with no PVI and no VV. Subjects were asked to complete a structured questionnaire on disease specific outcomes, health status and use of healthcare resources., Results: Mean age (range) was 39.8 (24-47) years for cases, 39.1 (24-49) for VV controls and 38 (25-49) for healthy controls. Pelvic pain was reported by 38 of 40 (95%) PVI cases, compared with 25 of 40 (62%) VV controls, and 26 of 40 (65%) healthy controls (p=0.001). The median (range) EQ-5D utility score for PVI cases was 0.80 (0.29-1.0) compared with 0.80 (0.09-1.0) for VV controls and 1.0 (0.62-1.0) for healthy controls (p=0.002). Of the 40 PVI cases, 35 (88%) visited a consultant in the previous 12 months compared with 12 of 40 (30%) VV controls, and 14 of 40 (35%) healthy controls (p<0.001)., Conclusions: Women with PVI report a greater frequency of pelvic pain with reduced health status and increased use of healthcare resources compared with matched controls., (Copyright © 2015. Published by Elsevier Ireland Ltd.)

Objective: To investigate the effectiveness of transvenous occlusion of incompetent pelvic veins in women presenting with chronic pelvic pain (CPP) in improving symptoms and quality of life. Design: Patient‐blinded randomised controlled trial with objective outcome measures. Results were analysed on an intention‐to‐treat basis. Setting: Gynaecology and Vascular Surgery Services of two teaching hospitals in northwest England. Population: Sixty women aged 18–54 years presenting with CPP after exclusion of other pathology, and who were found to have pelvic vein incompetence. Methods: Participants were randomised and assigned to contrast venography alone or contrast venography plus transvenous occlusion of the incompetent pelvic veins. Main outcome measure: The primary outcome was change in pain score measured using the short‐form McGill Pain Score (SF‐MPQ) and the Visual Analogue Score (VAS) recorded at 12 months post‐randomisation. Secondary outcomes included quality of life using the EQ‐5D instrument, symptomatic improvement and procedure‐related complications. Results: Sixty participants were randomised to transvenous occlusion of incompetent pelvic veins or venography only. At 12 months, median pain scored 2 (3–10) in the intervention group versus 9 (5–22) in controls (p = 0.016). Pain on the VAS scored 15 (0–3) versus 53 (20–71), respectively (p = 0.002). Median EQ‐5D improved after intervention from 0.79 (0.74–0.84) to 0.84 (0.79–1.00; p = 0.008) over 12 months. No major complications were reported. Conclusion: Transvenous occlusion of pelvic vein incompetence reduced pain scores, improved quality of life and diminished symptom burden with no major reported complications. Trial registration: ISRCTN 15091500. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between chronic pelvic pain (CPP) and pelvic vein incompetence (PVI) or pelvic varices. Design: Case–control study. Setting: Gynaecology and vascular surgery services in two teaching hospitals in north‐west England. Sample: A total of 328 premenopausal women (aged 18–54 years), comprising 164 women with CPP and 164 matched controls with no history of CPP. Methods: Symptom and quality‐of‐life questionnaires and transvaginal duplex ultrasound for PVI and pelvic varices. Main outcome measures: Venous reflux of >0.7 s in the ovarian or internal iliac veins (primary outcome) and presence of pelvic varices (secondary outcome). Statistical analysis compared the prevalence of PVI between women with and without CPP using the two‐sided chi‐square test. Logistic regression was used to compare the odds of having PVI and pelvic varices between women with and without CPP. Results: Pelvic vein incompetence was found on transvaginal duplex ultrasound in 101/162 (62%) women with CPP, compared with 30/164 (19%) asymptomatic controls (OR 6.79, 95% CI 4.11–11.47, p < 0.001). Forty‐three of 164 (27%) women with CPP had pelvic varices compared with three of 164 (2%) asymptomatic women (OR 18.9, 95% CI 5.73–62.7, p < 0.001). Conclusions: There was a significant association between PVI, as detected by transvaginal duplex imaging, and CPP. Pelvic varices were strongly associated with CPP and were infrequently seen in control patients. These results justify further evaluation of PVI and its treatment in well‐designed research. [ABSTRACT FROM AUTHOR]