Pelvic Venous System Research Articles

Elevated periprostatic androgens, sneaky testosterone and its implications.

A subset of men with prostate cancer have elevated periprostatic androgens compared with levels in peripheral blood (termed the sneaky T phenomenon), which are associated with poor clinical outcomes after radical prostatectomy. These androgens are of testicular origin and reach the prostate, presumably through venous shunting. Varicocele physiology is accompanied by increased hydrostatic pressure within the pelvic venous system, providing a theoretical mechanistic explanation for the sneaky T phenomenon. These observations suggest a potential role for varicocele in contributing to prostate cancer pathophysiology through sneaky T, which if proved, could be a further indication for varicocele repair. Sneaky T can help to explain the differences in the natural history of benign or malignant prostatic diseases between individuals and could be a tool when deciding on the therapeutic course to take.

“VARIANT ANATOMY OF THE ILIAC VENOUS SYSTEM: A STUDY LINKED WITH LAPAROSCOPIC HERNIA REDUCTION AND PELVIC SURGERIES”

Background: Haemorrhage, whether retroperitoneal or intraperitoneal, is one of the most unwanted complications in any laparoscopic hernia reduction surgery or pelvic surgery, thus making variant anatomy of iliac venous system important as intraoperative injury to these venous channels can be one of its major causes. To study the existing communications betwe Aims and objectives: en the external and internal iliac venous system and perform its morphometric analysis. 24 formalin xed human hemi pelvises were di Material and Methods: ssected, internal (IIV) and external iliac veins (EIV) along with their tributaries were identied. Major venous anomalous communications were noted and measured accordingly. Results: 33.33% of all the observed pelvic halves had major anomalous venous communications between EIV and IIV. Knowledge Conclusion: anatomy of the pelvic venous system is vital to a surgeon especially in laparoscopic surgeries and even in the post-operative outcome of the patient.

Venous Anatomy and Collateral Pathways of the Pelvis: An Angiographic Review.

The pelvic venous system is complex, with the potential for numerous pathways of collateralization. Owing to stenosis or occlusion, both thrombotic and nonthrombotic entities in the pelvis may necessitate alternate routes of venous return. Although the pelvic venous anatomy and collateral pathways may demonstrate structural variability, a number of predictable paths often can be demonstrated on the basis of the given disease and the level of obstruction. Several general categories of collateral pathways have been described. These pathway categories include the deep pathway, which is composed of the lumbar and sacral veins and vertebral venous plexuses; the superficial pathway, which is composed of the circumflex and epigastric vessels; various iliofemoral collateral pathways; the intermediate pathway, which is composed of the gonadal veins and the ovarian and uterine plexuses; and portosystemic pathways. The pelvic venous anatomy has been described in detail in cadaveric and anatomic studies, with the aforementioned collateral pathways depicted on CT and MR images in several imaging studies. A comprehensive review of the native pelvic venous anatomy and collateralized pelvic venous anatomy based on angiographic features has yet to be provided. Knowledge of the diseases involving a number of specific pelvic veins is of clinical importance to interventional and diagnostic radiologists and surgeons. The ability to accurately identify common collateral patterns by using multiple imaging modalities, with accurate anatomic descriptions, may assist in delineating underlying obstructive hemodynamics and diagnosing specific occlusive disease entities. ©RSNA, 2022.

Advances of Laparoscopy for the Diagnosis of Pelvic Congestion Syndrome.

The objective of this review is to describe the effectiveness of laparoscopy in the diagnosis and treatment of pelvic congestion syndrome (PCS). PCS is a cause of chronic pelvic pain (CPP) and is associated with dysfunction of the pelvic venous system. PCS is more common in women of reproductive age, and hormonal changes are associated with its development along with other reasons (e.g., working and living habits). There is an urgent need to establish an effective algorithm for the diagnosis and treatment of CPP, which could have a dramatic effect in patients’ everyday life. This algorithm should be able to overcome known issues that lead to the underdiagnosis of PCS, such as the overlap of its symptoms with other diseases. Here, we present our findings from literature articles about the methods used in practice today for the diagnosis of this syndrome. We also compare the methods to propose the most promising technique for providing a diagnosis with high accuracy. In our understanding, laparoscopy is superior when compared to other methods. It can provide a diagnosis of PCS while excluding or identifying other comorbidities and can also lead toward the next steps for the treatment of PCS.

Relaxation-Enhanced Angiography without Contrast and Triggering (REACT) for pelvic MR venography in comparison to balanced gradient-echo and T2-weighted spin-echo techniques

Rationale and objectivesTo evaluate the imaging capabilities of the REACT pulse sequence in pelvic venous vessels compared to conventional non-contrast pulse sequences. Materials and methodsIn addition to routine MRI venography, non-contrast enhanced REACT pulse sequence was performed in 4 healthy volunteers and 21 patients with suspected or known deep venous thrombosis and post thrombotic syndrome. Acquired images were independently interpreted by two MRI radiologists. The sequence performance was subjectively evaluated on a four-point scale regarding the delineation of small peripheral, midsize and large proximal venous vessels, the imaging of vascular pathologies, and the degradation due to artifacts. To evaluate statistical differences in diagnostic accuracy Friedman's test with Dunn's correction was used. ResultsREACT depicted the peripheral veins superior to bTFE and T2-TSE with an average score of 3.39 compared to 2.33 in bTFE and 1.77 in T2-TSE. In midsize vessels REACT performed significantly better than T2-TSE (1.94) and bTFE (2.68) with a score of 3.64. For the large proximal vessels REACT (3.39), bTFE (3.33) and T2-TSE (3.56) performed equally without statistical difference. Visibility of venous pathologies was found to be equal between REACT (3.62), bTFE (3.51) and T2-TSE (3.52). The image degradation due to artifacts was rated best in T2-TSE (3.56), followed by REACT (3.39) and bTFE (3.33). ConclusionsREACT is a promising tool for the visualization of the pelvic venous system using magnetic resonance imaging.

PATHOGENETIC ASPECTS OF INFERTILITY IN WOMEN OF REPRODUCTIVE AGE WITH OVARIAN VARICOCELE

To date, the problem of reduced fertility is quite relevant. At the same time, it should be noted that the effectiveness of infertility treatment, even with the use of the latest techniques, tools and drugs does not exceed 35-40%. This can be explained by insufficient study of a number of causes that lead to impaired fertility.One of these little-known and poorly studied factors is pelvic venous plethora, in particular varicose veins of the ovaries. While anatomically similar disease in men - varicocele - is given great importance, in women, even the very existence of this pathology is controversial among some authors.All studies were conducted in compliance with the basic bioethical norms and requirements of the Declaration of Helsinki. 117 women of reproductive age (21 - 42 years) with infertility of functional genesis were examined.According to the results of the analysis, the clinical and anamnestic features of women with infertility and ovaric varicocele are increased proportion of patients with intellectual differentiation and psycho-emotional and physical stress, high frequency of infectious diseases with acyclic uterine bleeding, dysmenorrhea and premenstrual. Changes in the anatomical and functional state of the pelvic organs and venous system in women with infertility and ovarian varicocele have been established. It was found that the hormonal profile of women with infertility and ovarian varicocele is characterized by a decrease in estradiol and progesterone. A pathogenetically sound algorithm for the diagnosis and treatment of women with infertility and ovarian varicocele has been developed, which is based on clinical data and the results of instrumental methods of examination.

39. Uterine intravenous leiomyomatosis with intracardiac extension: Report of two cases

Background: Intravenous leiomyomatosis (IVL) is a histomorphologically benign smooth muscle neoplasm characterised by spindle-cell proliferation primarily located within the uterine and pelvic venous system, inferior vena cava, and in rare instances, extending to the heart.

Anatomical abnormalities of the pelvic venous system and their implications for endovascular management of pelvic venous reflux.

Background Pelvic venous reflux is often treated with pelvic vein embolisation; however, atypical pelvic venous anatomy may provide therapeutic challenges. Methods We retrospectively reviewed seven patient files and reported symptoms, diagnostic imaging, aberrant anatomy and means by which the interventional radiologist successfully completed the procedure. Any follow-up data were included if available. Results Four anatomical abnormalities were found: internal iliac veins draining into the contralateral common iliac vein, duplicated inferior vena cava, reverse-angle renal veins with atypical left ovarian vein drainage and direct drainage of the internal iliac vein to the inferior vena cava. All patients were successfully treated with pelvic vein embolisation. Conclusion Abnormal embryologic development may cause variable pelvic venous anatomy. Knowledge of this will enable interventional radiologists to successfully treat such patients.

PELVIC CONGESTION SYNDROME. METHODS OF DIAGNOSIS AND TREATMENT. LITERATURE REVIEW

Pelvic pain syndrome is not rare clinical condition without specific symptoms and usually affects multiparous women. Numerous controversies in the management such patients are still present in current publications. Different diagnostic modalities were and are now used to delineate of anatomy and physiology of pelvic venous system. The well-known and recently developed approaches to treat patients with pelvic congestion syndrome are discussed in present overview of the scientific literature.

Anatomy and Physiology of the Lower-Extremity Deep and Superficial Veins

A thorough understanding of venous anatomy and physiology is foundational to the diagnosis and management of venous disease. Compared with the arterial system, there is significantly greater developmental variation in the venous system. The veins of the lower extremity include the superficial and deep veins, which are defined by their respective relationships to the muscular fascia. Perforating veins traverse the muscular fascia to connect superficial and deep veins. Communicating veins connect veins within the same venous compartment, either deep to deep or superficial to superficial. The deep veins of the lower extremities primarily drain muscles and are encompassed by muscular fascia. The veins located between the skin and the muscular fascia are considered superficial veins. Superficial veins drain the cutaneous microcirculation. The pelvic venous system is a complex transitional outflow pathway between the lower extremities, the pelvic structures, and the inferior vena cava. The terminology used to describe lower-extremity, pelvic, and abdominal vasculature conforms to published international standards.

Intravenous leiomyomatosis with right heart involvement—A report of 4 cases and literature review

Intravenous leiomyomatosis (IVL) is a rare benign neoplasm which originates from the smooth muscle cells and is usually confined to the pelvic venous system. Rarely, intracaval and intracardiac extension has been described. Death can occur as a result of intracardiac involvement. We reported 4 cases of IVL with right heart involvement (intracardiac leiomyomatosis, ICL). Three of them suffered recurrent sudden syncope, and the other one was totally asymptomatic. All of them were successfully treated through one-stage operation under extracorporeal circulation.

Intravenous Uterine Leiomyomatosis with Right Heart Extension: Successful Two-Stage Surgical Removal

Intravenous leiomyomatosis is an uncommon nonmalignant tumor which originates from the smooth muscle cells and is usually confined to the pelvic venous system. Rarely, intracaval and intracardiac extension has been described: the literature includes only 100 cases with cardiac involvement. We report a case of a young woman with intravenous leiomyomatosis originating from the uterus and extending into the right atrium, successfully treated through a two-stage surgical approach.

Inferior vena cava filters prevent pulmonary emboli in patients with metastatic pathologic fractures of the lower extremity.

The records of 47 consecutive patients with metastatic pathologic fractures of the lower extremity were analyzed with respect to thromboembolic complications. All patients were unable to receive pharmacologic deep venous thrombosis prophylaxis, and were stratified into two groups, based on use of an inferior vena cava filter. Group I (n = 24) consisted of patients who had an inferior vena cava filter plus mechanical deep venous thrombosis prophylaxis (compression stockings and sequential compression boots); Group II (n = 23) consisted of a group of patients receiving only mechanical deep venous thrombosis prophylaxis. All patients had routine lower extremity venous duplex imaging preoperatively, postoperatively, and before hospital discharge. At final followup, patients were examined for deep venous thrombosis and reviewed for thromboembolic events. At a mean followup of 11.5 months, Group I had two detectable deep venous thromboses and no pulmonary emboli; Group II had one detectable deep venous thrombosis and five pulmonary embolisms. In Group II, 40% (two of five) of pulmonary embolisms were fatal, yielding an 8.7% (two of 23) group mortality rate. Overall, the entire group had an approximately 17% deep venous thrombosis rate. Only 6.4% (three of 47) of deep venous thromboses were detectable by standard duplex imaging. The majority of deep venous thromboses (five of eight, 62.5%) were nondetectable by duplex imaging. Overall, a 4.3% (two of 47) death rate was attributable to pulmonary embolism. In contrast, an 8.6% (four of 47) mortality rate occurred in Group II alone. All pulmonary embolisms occurred in patients who did not receive an inferior vena cava filter. The majority of venous thromboses (62.5%) were not detectable on duplex scanning, therefore were thought to arise from the pelvic venous system. Complications related to inferior vena cava filter insertion were minimal. For patients with metastatic pathologic fractures of the lower extremities who are unable to receive pharmacologic deep venous thrombosis prophylaxis, the use of inferior vena cava filters, in conjunction with standard mechanical deep venous thrombosis prophylaxis, is a procedure that has a low risk and is useful adjunct to prevent fatal pulmonary embolisms.

Intraspinal gas associated with intestinal necrosis detected by CT

We report the case of a 63-year-old woman with necrosis of the small intestine and intraspinal collections of gas, which were detected using computed tomography (CT). Abdominal CT revealed extensive collections of gas in the portal and mesenteric veins and within the intestinal walls. Gas radiolucencies were also noted in the epidural spaces of her spine. This gas was considered to have migrated from the pelvic venous system into the internal venous plexus of the spine. Intestinal necrosis should be included in the differential diagnosis of intraspinal gas collections during CT.

PROSPECTIVE ULTRASOUND EVALUATION OF VENOUS THROMBOSIS IN HIGH-RISK TRAUMA PATIENTS

To determine the incidence of venous thrombosis (VT), high-risk trauma patients were evaluated prospectively biweekly with Doppler ultrasound (US). Fifty-seven patients during an 8-month period met high-risk criteria for VT including age > 45 years, > 2 days bed rest, previous history of thromboembolism, spine fracture, coma, spinal cord injury, pelvic fracture, lower extremity injury, or femoral vein catheter. Doppler ultrasound showed 16 VTs in 12 patients. Venous thrombosis occurred despite prophylaxis (heparin or compression devices) in 9 of 12 patients. Iliac VT was noted in four patients, two of whom had no lower extremity VT. Upper extremity VT occurred in two patients who had received central venous catheters. (1) US surveillance may be valuable in high-risk trauma patients because VT is a common finding (21%), despite prophylactic measures. (2) Examination of the upper extremity and pelvic venous system appears to be important, since 33% (4 of 12) of our patients with VT developed thrombi isolated to these regions. These would not have been identified during routine lower extremity duplex studies.

Dynamic Cavernosography: Venous Outflow Studies of Cavernous Bodies

Based on dynamic cavernosography studies in 15 patients, including 8 with simultaneous passive erection, we present more precise details of the venous drainage of the penis. The venous drainage is comprised of 3 different systems. The superficial dorsal vein drains mainly the penile skin and prepuce, and empties via the external pudendal veins into the femoral vein. The deep dorsal vein, located between the tunica albuginea and Buck’s fascia, drains the glans and all 3 corpora. The venae profundae penis emerge from each crus of the corpora cavernosa and drain only the corpora themselves. Considerable individual differences were found regarding further drainage via the pelvic venous system, including the prostatovesical plexus and internal pudendal veins.Passive erection was tried in 11 patients and was successful immediately after cavernosography in 8. The flow rates to induce an erection averaged 111ml. per minute (range 55 to 160ml. per minute), while the rate to maintain the erection was 48ml. per minute (range 12 to 90ml. per minute).

Radionuclide venography: Its place as a modality for the investigation of thromboembolic phenomena

The radionuclide venogram graphically depicts thrombotic disease and appears particularly helpful in the visualization of the external pelvic venous system, inferior vena cava, and veins of the thigh. Since the pulmonary scintigram also may be performed in conjunction with the radionuclide venogram, the patient also is screened for possible pulmonary emboli. The extent of thrombotic disease in the area imaged by radionuclide venography appears to be related to the incidence of pulmonary emboli. It is likely to image nonocclusive thrombi, those which are more likely to embolize. It provides information regarding the status of venus channels, varicose veins and venous insufficiency, in addition to the presence of thrombi. Several authors have shown a better than 90% correlation between the findings on radionuclide venography and those of the most widely accepted means of assessing thrombosis in leg veins, radiographic phlebography. The technique and clinical results of radionuclide venography as well as its advantages and disadvantages in comparison to radiographic phlebography are discussed here. A simplified, standardized method of performing radionuclide venography with a moving-table accessory is described and illustrated.

Effect of radiation on metastatic pelvic lymph nodes judged by pelvic venograms.

The proper management of any neoplasm depends upon accurate determination of its full extent. This applies not only to the primary lesion, but to metastases as well. While lymph-node metastases from some tumors lend themselves to inspection and palpation, node involvement from pelvic organs may remain hidden. Because of the frequency with which these pelvic nodes are involved, therapy has often been directed to include them even though in an individual case their true status is obscure. Metastatic lymph nodes can be demonstrated by distortion of the opacified pelvic venous system (1–3). Demonstration of such metastases is not only of value prognostically but contributes to proper management of the neoplasm. Since many pelvic tumors are treated by irradiation, it should then be possible to use pelvic venography to disclose the effects of radiation on the metastatic nodes. The draining lymph nodes from the pelvis lie along vascular channels, viz., the hypogastric and the external and common iliac vessels, t...