Ovarian Vein Ligation Research Articles

Ovarian vein surgical ablation versus endovascular technique for treatment of pelvic vein incompetence

ObjectiveChronic pelvic pain in women is a disorder brought on by pelvic vein incompetence (PVI). In this prospective, randomized study, the effects of percutaneous coil embolization and surgical ovarian vein ligation and division combined with retrograde sclerotherapy were compared with regard to ovarian vein occlusion, improvement of pelvic congestion symptoms, and their influence on estradiol level after intervention. MethodsA total of 50 patients with PVI were enrolled, with a mean age of 31.9 ± 4.7 years and a pain score of 9 (range, 0-10; from 0 [no pain] to 10 [the highest level of pain]). Both percutaneous coil embolization of ovarian veins (endovascular group) and surgical ovarian vein ablation with retrograde sclerotherapy were offered to the patients at random. ResultsIn the open group, the pain level decreased to 2, whereas in the endovascular group, it decreased to 1 (range, 0-10). Estradiol levels were 224 (range, 9-612) in the open group and 478 (range, 18-613) in the endovascular group before the intervention, with no significant change (P = .1120). After 1 week of intervention, estradiol levels in the open group were 89 (range, 18-243) and 124 (range, 22-298) in the endovascular group, respectively, with statistical insignificance (P = .225). After 1 month of intervention, the endovascular group's estradiol level was 101 (range, 20-196) and the open group's was 89 (range, 15-190) (P = .382). After 3 months of intervention, the open group's estradiol level was 78 (range, 12-132) and the endovascular group's was 65 (range, 18-110) (P = .045). ConclusionsIn addressing PVI, both methods seemed to have promising results. Nevertheless, endovascular management was more effective at decreasing estrogen levels and relieving discomfort. Three months should be the time at which estradiol levels are measured, because this is when they are at their lowest. In both the open and endovascular groups as well as in the pooled data, there was a significant association between estradiol level from before the intervention and improvement in pain scores (P = .005). Because it was linked to a lower pain score, the high preoperative estradiol level can be used to predict postintervention improvement.

A rare indication of robot-assisted uretero-ureterostomy: ovarian vein syndrome

Ovarian vein syndrome is a rare cause of ureteral obstruction. Most of these cases occur during pregnancy likely from the gravid uterus causing ovarian vein dilatation and valvular incompetence. Hormonal changes associated with pregnancy also affect the muscular wall of ureter, causing decrease in tone and may facilitate compression as well. There is a predilection for right side and in thin females. The traditional treatment has been the ligation of ovarian vein and ureterolysis. We report a case of ovarian vein syndrome in a young female which was managed by robot-assisted laparoscopic ovarian vein ligation, resection of stenosed ureteric segment and end-to-end ureterostomy.

Single site robotic-assisted laparoscopic transperitoneal ligation of ovarian veins for treatment of pelvic congestion syndrome, a case report and review of literature

Single site robotic-assisted laparoscopic transperitoneal ligation of ovarian veins for treatment of pelvic congestion syndrome, a case report and review of literature

Laparoscopic Ovarian Vein Ligation for Treatment of Pelvic Congestion Syndrome

Laparoscopic Ovarian Vein Ligation for Treatment of Pelvic Congestion Syndrome

Laparoscopic treatment of ovarian vein syndrome: A case series

Ovarian vein syndrome is a rare entity of ureteral obstruction. Its pathogeny and clinical expression are highly polymorphic. The treatment gainsgreat advances because of the development of laparoscopy. We reported two cases of ovarian vein syndrome occurring in two multiparous women, with unremarkable past medical history. The patients were presented with isolated right flank pain. The diagnosis was confirmed by computed tomography angiography in the two cases. Ovarian vein ligation was successfully performed throughout a retroperitoneoscopic approach with excellent outcomes. The ovarian vein syndrome continues to be a rare diagnosis that should be recognized. The diagnosis is mainly urographic. Owing to its simplicity, low morbidity, and good results attained, the laparoscopic approach will continue to advance the surgical management of ovarian vein syndrome.

The Outcome of Treatment for Pelvic Congestion Syndrome

Pelvic congestion syndrome is one of many causes of chronic pelvic pain. It is generally accepted that this is attributable to ovarian and pelvic vein incompetence which may result in varices in the lower limb leading to presentation in varicose vein clinics. However, far more patients have pelvic varices associated with varicose veins in the lower limb than have pelvic congestion syndrome. Magnetic resonance imaging and computed tomographic venography are usually used in the diagnosis of this condition and criteria have been established to identify pelvic varices. Many different treatments have been used to manage the symptoms of pelvic congestion. Hysterectomy combined with oophrectomy, open surgical ligation of ovarian veins and laparoscopic vein ligation have been used in the past. The most common treatments used currently involve embolization of pelvic and ovarian veins. The results of this treatment have been published in a limited number of clinical series, usually with fairly short follow-up periods. These treatments may be complicated by migration of embolization of coils used to occlude veins. The longest duration of follow-up currently reported is five years. Limited clinical evidence supports the use of embolotherapy in the management of pelvic congestion syndrome.

A clinical analysis on laparoscopic surgery for torsion of ovarian cysts with ovarian preservation

Objective To explore the clinical features and efficacy of laparoscopic restoration of torsed varian cysts and then removal of the cysts following ligation of ovarian veins.Methods We analyzed the clinical data on 38 women who had been hospitalized and had received laparoscopic surgery for torsion of ovarian cysts with ovarian preservation during the period of May 2007 to May 2011.Results The time period from the onset of ovarian cyst torsion to the beginning of surgical treament was 4 to 72 hours.After the laparoscopic surgery,the blood supply,shape,and endocrine function of the ovary were rapidly restored.Four of the women were successfully pregnant and finally gave birth.Conclusions Laparoscopic restoration of torsed varian cysts and then removal of the cysts following ligation of ovarian veins is a less invasive,simple,feasible,safe,effective procedure.It is worth trying in clinical practice. Key words: Laparoscopy; Ovary; Torsion

Successful ultrasound-guided foam sclerotherapy for vulval and leg varicosities secondary to ovarian vein reflux: a case study

Pelvic varicose veins secondary to ovarian vein reflux are common and can present with clinical pelvic congestion syndrome (PCS). After assessment with duplex ultrasound and venography, treatment often involves surgical ovarian vein ligation and more recently embolization of the ovarian vein(s) followed by ultrasound-guided foam sclerotherapy (UGFS) of the pelvic tributaries. This paper presents one out of many PCS patients treated with UGFS of the pelvic tributaries alone, with clinically symptomatic improvement.

Bilateral Laparoscopic Transperitoneal Ligation of Ovarian Veins for Treatment of Pelvic Congestion Syndrome

Study Objective To evaluate the efficacy and safety of bilateral laparoscopic transperitoneal ligation of the ovarian veins in women with symptomatic pelvic varices. Design Prospective pilot study performed in a small series (Canadian Task Force classification III). Setting Urban hospital in Turin and University hospital in Cagliari, Italy. Patients Twenty-three women. Intervention Bilateral laparoscopic transperitoneal ligation of the ovarian veins. The right ovarian vein was reached by incising posterior peritoneum below the mesentericoparietal fossa in all women. The left ovarian vein was reached by reflecting medially the left colon in 10 women and by incising the posterior peritoneum covering the aorta 2 cm below the inferior duodenal fold in 13. Measurements and Main Results After the plateau of the learning curve was reached, average operating time was about 60 minutes without complications. Complete remission of pain and absence of pelvic varicosities lasted for 12 months. Conclusion The laparoscopic transperitoneal paraaortic approach to bilateral ligation of ovarian veins near their origin could be a new treatment option for pelvic congestion syndrome.

Ovarian varices in healthy female kidney donors: incidence, morbidity, and clinical outcome.

Kidney donation is associated with ligation of the ovarian vein and is comparable to ovarian vein embolization. We evaluated the incidence, morbidity, and clinical outcome of ovarian varices in healthy female kidney donors before and 6 months after nephrectomy. Between 1994 and 2001, 273 healthy female kidney donors underwent preoperative abdominal aortography. The study group consisted of 27 women (9.9%) in whom retrograde flow in an incompetent left ovarian vein was noted during the venous phase of imaging. All patients underwent left nephrectomy with left ovarian vein ligation. Only women with retrograde flow in the left ovarian vein were asked to complete a questionnaire about the incidence and intensity of pelvic pain before and 6 months after nephrectomy. Twenty-two of the 27 left-kidney donors with retrograde flow in the ovarian vein were available for follow-up. Thirteen (59%) of those 22 reported chronic pelvic pain. After nephrectomy, the pelvic pain completely resolved in seven (54%), improved in three (23%), and persisted in three (23%). Our study found a 9.9% prevalence of ovarian varices in the general population. Our findings suggest that more than half (59%) the patients with ovarian varices have pelvic congestion syndrome and that most (77%) of them might benefit from ovarian vein embolization or ligation.

Massive Pulmonary Embolism Permitting Paradoxical Systemic Arterial Embolism: Successful Surgical Management

The case of a young woman, receiving oral contraceptives, who developed massive pulmonary embolism producing circulatory collapse and paradoxical arterial embolism through a patent foramen ovale is documented. Limb viability was threatened. Emergency management included removal of arterial and pulmonary emboli, surgical closure of the patent foramen ovale, inferior caval partitioning, ovarian vein ligation, and short-term anticoagulation. Recovery was rapid and complete.

Management of septic chemical abortion with renal failure. Report of five consecutive cases with five survivors.

The woman with complications of chemical abortion (often induced by soap or Lysol solution) is a prototype of the critically ill surgical patient. Usual mortality where hysterectomy is delayed or not done is 60%. 5 such patients, all with sepsis and uterine necrosis were treated by hysterectomy. All had renal failure, 4 required dialysis; 1 underwent diuresis after injection of ethacrynic acid. Major complications, in addition to renal failure, were pulmonary. 2 patients who had prophylactic vena-cava clips and ligation of ovarian veins escaped pulmonary complications. All patients survived without physiologic disturbances.