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Peter J Pappas - One of the best experts on this subject based on the ideXlab platform.

  • pelvic venous insufficiency secondary to iliac Vein stenosis and Ovarian Vein reflux treated with iliac Vein stenting alone
    Journal of vascular surgery. Venous and lymphatic disorders, 2021
    Co-Authors: Gaurav Lakhanpal, Rick Kennedy, Sanjiv Lakhanpal, Levan Sulakvelidze, Peter J Pappas
    Abstract:

    Abstract Background We have previously reported that in women with a pelvic venous disorder secondary to pelvic venous insufficiency, 56% will present with an iliac Vein stenosis (IVS) and Ovarian Vein reflux (OVR). The purpose of the present investigation was to determine whether women with combined disease can be treated using iliac Vein stenting alone. Methods A retrospective review of prospectively collected data at the Center for Vascular Medicine was performed. We investigated women with pelvic pain or dyspareunia secondary to combined IVS and OVR who had undergone stenting alone. The patient demographics, pre- and 6-month postoperative visual analog scale (VAS) for pain scores, stent type, stent diameter, stent length, and Ovarian Vein diameters were assessed. All patients had undergone diagnostic venography of their pelvic Veins, left Ovarian Veins, and pelvic reservoirs and intravascular ultrasonography of their iliac Veins. Results From May 2016 to October 2019, 82 patients with a pelvic venous disorder secondary to IVS and OVR were identified. The present data analysis focused on 38 patients with complete pre- and postoperative VAS scores and duplex scan stent patency data at 6 months. The pelvic and dyspareunia VAS scores at the initial and 6-month follow-up visits were as follows: 6.83 ± 3.19 and 4.24 ± 2.65 and 1.72 ± 2.01 and 0.05 ± 2.0, respectively (P ≤ .001). At 6 months, 29 of the 38 women (76%) reported complete resolution of all symptoms, 26 of 28 (93%) reported complete resolution of their dyspareunia, 5 of 38 (13%) reported significant improvement, and 4 of 38 (10%) reported no improvement. The average Ovarian Vein diameter was 6.7 ± 2.5 mm. The average stent size and length was 18.20 ± 1.6 mm and 92.41 ± 18.5 mm, with 25 placed in the left common iliac, 2 in the right common iliac Vein, and 3 bilaterally. Of the 38 patients, 7 required reintervention (18%). An untreated pelvic reservoir was observed in 17 of the 38 patients (44%). One of the two with no response and six of the patients with improvement had OVR and an untreated pelvic reservoir. The remaining 10 patients with a pelvic reservoir had experienced complete resolution of their symptoms with stenting alone. Conclusions Of the 38 women with pelvic pain secondary to combined IVS and OVR, 76% achieved complete symptom resolution with iliac Vein stenting alone. Most of the women with a pelvic reservoir were asymptomatic and reported full symptom resolution after stenting alone. However, these data suggest that in some women, a relationship might exist between the presence of a pelvic reservoir and the persistence of symptoms. Therefore, for women with combined IVS and OVR, we recommend iliac Vein stenting alone and staged Ovarian Vein embolization only for women with persistent symptoms.

  • iliac Vein stenosis is an underdiagnosed cause of pelvic venous insufficiency
    Journal of vascular surgery. Venous and lymphatic disorders, 2017
    Co-Authors: Ratnam K N Santoshi, Gaurav Lakhanpal, Sanjiv Lakhanpal, Vinay Satwah, Michael Malone, Peter J Pappas
    Abstract:

    Abstract Background Reflux in the Ovarian Veins, with or without an obstructive venous outflow component, is reported to be the primary cause of pelvic venous insufficiency (PVI). The degree to which venous outflow obstruction plays a role in PVI is currently ill-defined. Methods We retrospectively reviewed the charts of 227 women with PVI who presented to the Center for Vascular Medicine from January 2012 to September 2015. Assessments and interventions consisted of an evaluation for other causes of chronic pelvic pain by a gynecologist; preintervention and postintervention visual analog scale (VAS) pain score; complete venous duplex ultrasound examination; and Clinical, Etiology, Anatomy, and Pathophysiology classification. All patients underwent diagnostic venography of their pelvic and left Ovarian Veins as well as intravascular ultrasound of their iliac Veins. Patients were treated in one of six ways: Ovarian Vein embolization (OVE) alone (chemical ± coils), OVE with staged iliac Vein stenting, OVE with simultaneous iliac Vein stenting, iliac Vein stenting alone, OVE with venoplasty, and venoplasty alone. Results Of the 227 women treated, the average age and number of pregnancies was 46.4 ± 10.4 years and 3.36 ± 1.99, respectively. Treatment distribution was the following: OVE, n = 39; OVE with staged stenting, n = 94; OVE with simultaneous stenting, n = 33; stenting alone, n = 50; OVE with venoplasty, n = 8; and venoplasty alone, n = 3. Seven patients in the OVE and stenting groups (staged) and one patient in the OVE + venoplasty group required a second embolization of the left Ovarian Vein. Eighty percent (181/227) of patients demonstrated an iliac stenosis >50% by intravascular ultrasound. Average VAS scores for the entire cohort before and after intervention were 8.45 ± 1.11 and 1.86 ± 1.61 (P ≤ .001). In the staged group, only 9 of 94 patients reported a decrease in the VAS score with OVE alone. VAS score decreased from 8.6 ± 0.89 before OVE to 7.97 ± 2.10 after OVE. After the planned staged stenting, VAS score decreased to 1.33 ± 2.33 (P ≤ .001). Similarly, in the simultaneous group, preintervention scores were 8.63 ± 1.07 and decreased to 2.36 ± 2.67 after OVE + stenting (P ≤ .001). Conclusions The majority of patients in our series (80%) demonstrated a significant iliac Vein stenosis. These observations indicate that the incidence of iliac Vein outflow obstruction in PVI is greater than previously reported. In patients with combined Ovarian Vein reflux and iliac Vein outflow obstruction, our data suggest that pelvic venous outflow lesions should be treated first and that Ovarian Vein reflux should be treated only if symptoms persist. In women with an outflow lesion, Ovarian Vein reflux, and a large pelvic reservoir, we recommend simultaneous treatment.

A B Pinto - One of the best experts on this subject based on the ideXlab platform.

  • selective Ovarian Vein sampling to localize a leydig cell tumor
    Fertility and Sterility, 2005
    Co-Authors: Ryan D Dickerson, Michael J Putman, Michael E Black, Karen R Pinto, Norman G Diamond, Samuel P Marynick, A B Pinto
    Abstract:

    Objective To describe a patient with recent onset of rapidly progressive virilization who was diagnosed with an androgen-secreting tumor of the left ovary, localized by selective Ovarian Vein catheterization and hormonal sampling (SOVHS). Design Case report. Setting Tertiary community-based medical center. Patient(s) A 32-year-old woman presenting with progressive virilization over a period of 4 months was found to have a Leydig cell tumor of the left ovary. Intervention(s) Transvaginal ultrasound of the pelvis, followed by contrast-enhanced computerized tomography of the abdomen and the pelvis. Selective Ovarian Vein sampling was performed to localize the tumor. Laparoscopic left salpingo-oophorectomy and washings were also performed. Main Outcome Measure(s) Initial serum total T levels were 1,505 ng/dL, and the free serum T levels were 234 ng/dL. After SOVHS, the total serum T levels in the left Ovarian Vein is reported to be 20,967 ng/dL, and in the right Ovarian Vein, they were reported to be 1,351 ng/dL. Three months after laparoscopic left oophorectomy, the serum total T levels were 11 ng/dL. Institutional review board approval was obtained. Result(s) Patient's Ovarian tumor removed laparoscopically was reported to be a Leydig cell tumor. Rapid decreases in free and total T followed tumor removal. Conclusion(s) Selective Ovarian Vein catheterization and hormonal sampling is an effective diagnostic modality that can help localize small Ovarian tumors.

Gaurav Lakhanpal - One of the best experts on this subject based on the ideXlab platform.

  • pelvic venous insufficiency secondary to iliac Vein stenosis and Ovarian Vein reflux treated with iliac Vein stenting alone
    Journal of vascular surgery. Venous and lymphatic disorders, 2021
    Co-Authors: Gaurav Lakhanpal, Rick Kennedy, Sanjiv Lakhanpal, Levan Sulakvelidze, Peter J Pappas
    Abstract:

    Abstract Background We have previously reported that in women with a pelvic venous disorder secondary to pelvic venous insufficiency, 56% will present with an iliac Vein stenosis (IVS) and Ovarian Vein reflux (OVR). The purpose of the present investigation was to determine whether women with combined disease can be treated using iliac Vein stenting alone. Methods A retrospective review of prospectively collected data at the Center for Vascular Medicine was performed. We investigated women with pelvic pain or dyspareunia secondary to combined IVS and OVR who had undergone stenting alone. The patient demographics, pre- and 6-month postoperative visual analog scale (VAS) for pain scores, stent type, stent diameter, stent length, and Ovarian Vein diameters were assessed. All patients had undergone diagnostic venography of their pelvic Veins, left Ovarian Veins, and pelvic reservoirs and intravascular ultrasonography of their iliac Veins. Results From May 2016 to October 2019, 82 patients with a pelvic venous disorder secondary to IVS and OVR were identified. The present data analysis focused on 38 patients with complete pre- and postoperative VAS scores and duplex scan stent patency data at 6 months. The pelvic and dyspareunia VAS scores at the initial and 6-month follow-up visits were as follows: 6.83 ± 3.19 and 4.24 ± 2.65 and 1.72 ± 2.01 and 0.05 ± 2.0, respectively (P ≤ .001). At 6 months, 29 of the 38 women (76%) reported complete resolution of all symptoms, 26 of 28 (93%) reported complete resolution of their dyspareunia, 5 of 38 (13%) reported significant improvement, and 4 of 38 (10%) reported no improvement. The average Ovarian Vein diameter was 6.7 ± 2.5 mm. The average stent size and length was 18.20 ± 1.6 mm and 92.41 ± 18.5 mm, with 25 placed in the left common iliac, 2 in the right common iliac Vein, and 3 bilaterally. Of the 38 patients, 7 required reintervention (18%). An untreated pelvic reservoir was observed in 17 of the 38 patients (44%). One of the two with no response and six of the patients with improvement had OVR and an untreated pelvic reservoir. The remaining 10 patients with a pelvic reservoir had experienced complete resolution of their symptoms with stenting alone. Conclusions Of the 38 women with pelvic pain secondary to combined IVS and OVR, 76% achieved complete symptom resolution with iliac Vein stenting alone. Most of the women with a pelvic reservoir were asymptomatic and reported full symptom resolution after stenting alone. However, these data suggest that in some women, a relationship might exist between the presence of a pelvic reservoir and the persistence of symptoms. Therefore, for women with combined IVS and OVR, we recommend iliac Vein stenting alone and staged Ovarian Vein embolization only for women with persistent symptoms.

  • iliac Vein stenosis is an underdiagnosed cause of pelvic venous insufficiency
    Journal of vascular surgery. Venous and lymphatic disorders, 2017
    Co-Authors: Ratnam K N Santoshi, Gaurav Lakhanpal, Sanjiv Lakhanpal, Vinay Satwah, Michael Malone, Peter J Pappas
    Abstract:

    Abstract Background Reflux in the Ovarian Veins, with or without an obstructive venous outflow component, is reported to be the primary cause of pelvic venous insufficiency (PVI). The degree to which venous outflow obstruction plays a role in PVI is currently ill-defined. Methods We retrospectively reviewed the charts of 227 women with PVI who presented to the Center for Vascular Medicine from January 2012 to September 2015. Assessments and interventions consisted of an evaluation for other causes of chronic pelvic pain by a gynecologist; preintervention and postintervention visual analog scale (VAS) pain score; complete venous duplex ultrasound examination; and Clinical, Etiology, Anatomy, and Pathophysiology classification. All patients underwent diagnostic venography of their pelvic and left Ovarian Veins as well as intravascular ultrasound of their iliac Veins. Patients were treated in one of six ways: Ovarian Vein embolization (OVE) alone (chemical ± coils), OVE with staged iliac Vein stenting, OVE with simultaneous iliac Vein stenting, iliac Vein stenting alone, OVE with venoplasty, and venoplasty alone. Results Of the 227 women treated, the average age and number of pregnancies was 46.4 ± 10.4 years and 3.36 ± 1.99, respectively. Treatment distribution was the following: OVE, n = 39; OVE with staged stenting, n = 94; OVE with simultaneous stenting, n = 33; stenting alone, n = 50; OVE with venoplasty, n = 8; and venoplasty alone, n = 3. Seven patients in the OVE and stenting groups (staged) and one patient in the OVE + venoplasty group required a second embolization of the left Ovarian Vein. Eighty percent (181/227) of patients demonstrated an iliac stenosis >50% by intravascular ultrasound. Average VAS scores for the entire cohort before and after intervention were 8.45 ± 1.11 and 1.86 ± 1.61 (P ≤ .001). In the staged group, only 9 of 94 patients reported a decrease in the VAS score with OVE alone. VAS score decreased from 8.6 ± 0.89 before OVE to 7.97 ± 2.10 after OVE. After the planned staged stenting, VAS score decreased to 1.33 ± 2.33 (P ≤ .001). Similarly, in the simultaneous group, preintervention scores were 8.63 ± 1.07 and decreased to 2.36 ± 2.67 after OVE + stenting (P ≤ .001). Conclusions The majority of patients in our series (80%) demonstrated a significant iliac Vein stenosis. These observations indicate that the incidence of iliac Vein outflow obstruction in PVI is greater than previously reported. In patients with combined Ovarian Vein reflux and iliac Vein outflow obstruction, our data suggest that pelvic venous outflow lesions should be treated first and that Ovarian Vein reflux should be treated only if symptoms persist. In women with an outflow lesion, Ovarian Vein reflux, and a large pelvic reservoir, we recommend simultaneous treatment.

Hedi Khairi - One of the best experts on this subject based on the ideXlab platform.

  • postpartum Ovarian Vein thrombophlebitis report of a case and review of the literature
    North American Journal of Medical Sciences, 2010
    Co-Authors: Abdeljalil Khlifi, Sahbi Kebaili, Mohamed Hammami, Lassad Berregaya, Samir Hidar, Najmeddine Affes, Hedi Khairi
    Abstract:

    Context: Postpartum Ovarian Vein thrombophlebitis is an uncommon life-threatening situation. It should be systematically evoked in case of persistent fever during the postpartum. Diagnosis is often not immediately apparent clinically and there are many that mimic this condition. Case Report: A 26-year-old female presented with fever and acute right loin pain during four days after delivery. Right Ovarian venous thrombosis was demonstrated on sonography and confirmed with computed tomography. The patient was given antibiotics and anticoagulation therapy with good response. Conclusion: Search for postpartum Ovarian Vein thrombophlebitis should be undertaken in patients with persistent fever. Treatment is more often medical.

Sanjiv Lakhanpal - One of the best experts on this subject based on the ideXlab platform.

  • pelvic venous insufficiency secondary to iliac Vein stenosis and Ovarian Vein reflux treated with iliac Vein stenting alone
    Journal of vascular surgery. Venous and lymphatic disorders, 2021
    Co-Authors: Gaurav Lakhanpal, Rick Kennedy, Sanjiv Lakhanpal, Levan Sulakvelidze, Peter J Pappas
    Abstract:

    Abstract Background We have previously reported that in women with a pelvic venous disorder secondary to pelvic venous insufficiency, 56% will present with an iliac Vein stenosis (IVS) and Ovarian Vein reflux (OVR). The purpose of the present investigation was to determine whether women with combined disease can be treated using iliac Vein stenting alone. Methods A retrospective review of prospectively collected data at the Center for Vascular Medicine was performed. We investigated women with pelvic pain or dyspareunia secondary to combined IVS and OVR who had undergone stenting alone. The patient demographics, pre- and 6-month postoperative visual analog scale (VAS) for pain scores, stent type, stent diameter, stent length, and Ovarian Vein diameters were assessed. All patients had undergone diagnostic venography of their pelvic Veins, left Ovarian Veins, and pelvic reservoirs and intravascular ultrasonography of their iliac Veins. Results From May 2016 to October 2019, 82 patients with a pelvic venous disorder secondary to IVS and OVR were identified. The present data analysis focused on 38 patients with complete pre- and postoperative VAS scores and duplex scan stent patency data at 6 months. The pelvic and dyspareunia VAS scores at the initial and 6-month follow-up visits were as follows: 6.83 ± 3.19 and 4.24 ± 2.65 and 1.72 ± 2.01 and 0.05 ± 2.0, respectively (P ≤ .001). At 6 months, 29 of the 38 women (76%) reported complete resolution of all symptoms, 26 of 28 (93%) reported complete resolution of their dyspareunia, 5 of 38 (13%) reported significant improvement, and 4 of 38 (10%) reported no improvement. The average Ovarian Vein diameter was 6.7 ± 2.5 mm. The average stent size and length was 18.20 ± 1.6 mm and 92.41 ± 18.5 mm, with 25 placed in the left common iliac, 2 in the right common iliac Vein, and 3 bilaterally. Of the 38 patients, 7 required reintervention (18%). An untreated pelvic reservoir was observed in 17 of the 38 patients (44%). One of the two with no response and six of the patients with improvement had OVR and an untreated pelvic reservoir. The remaining 10 patients with a pelvic reservoir had experienced complete resolution of their symptoms with stenting alone. Conclusions Of the 38 women with pelvic pain secondary to combined IVS and OVR, 76% achieved complete symptom resolution with iliac Vein stenting alone. Most of the women with a pelvic reservoir were asymptomatic and reported full symptom resolution after stenting alone. However, these data suggest that in some women, a relationship might exist between the presence of a pelvic reservoir and the persistence of symptoms. Therefore, for women with combined IVS and OVR, we recommend iliac Vein stenting alone and staged Ovarian Vein embolization only for women with persistent symptoms.

  • iliac Vein stenosis is an underdiagnosed cause of pelvic venous insufficiency
    Journal of vascular surgery. Venous and lymphatic disorders, 2017
    Co-Authors: Ratnam K N Santoshi, Gaurav Lakhanpal, Sanjiv Lakhanpal, Vinay Satwah, Michael Malone, Peter J Pappas
    Abstract:

    Abstract Background Reflux in the Ovarian Veins, with or without an obstructive venous outflow component, is reported to be the primary cause of pelvic venous insufficiency (PVI). The degree to which venous outflow obstruction plays a role in PVI is currently ill-defined. Methods We retrospectively reviewed the charts of 227 women with PVI who presented to the Center for Vascular Medicine from January 2012 to September 2015. Assessments and interventions consisted of an evaluation for other causes of chronic pelvic pain by a gynecologist; preintervention and postintervention visual analog scale (VAS) pain score; complete venous duplex ultrasound examination; and Clinical, Etiology, Anatomy, and Pathophysiology classification. All patients underwent diagnostic venography of their pelvic and left Ovarian Veins as well as intravascular ultrasound of their iliac Veins. Patients were treated in one of six ways: Ovarian Vein embolization (OVE) alone (chemical ± coils), OVE with staged iliac Vein stenting, OVE with simultaneous iliac Vein stenting, iliac Vein stenting alone, OVE with venoplasty, and venoplasty alone. Results Of the 227 women treated, the average age and number of pregnancies was 46.4 ± 10.4 years and 3.36 ± 1.99, respectively. Treatment distribution was the following: OVE, n = 39; OVE with staged stenting, n = 94; OVE with simultaneous stenting, n = 33; stenting alone, n = 50; OVE with venoplasty, n = 8; and venoplasty alone, n = 3. Seven patients in the OVE and stenting groups (staged) and one patient in the OVE + venoplasty group required a second embolization of the left Ovarian Vein. Eighty percent (181/227) of patients demonstrated an iliac stenosis >50% by intravascular ultrasound. Average VAS scores for the entire cohort before and after intervention were 8.45 ± 1.11 and 1.86 ± 1.61 (P ≤ .001). In the staged group, only 9 of 94 patients reported a decrease in the VAS score with OVE alone. VAS score decreased from 8.6 ± 0.89 before OVE to 7.97 ± 2.10 after OVE. After the planned staged stenting, VAS score decreased to 1.33 ± 2.33 (P ≤ .001). Similarly, in the simultaneous group, preintervention scores were 8.63 ± 1.07 and decreased to 2.36 ± 2.67 after OVE + stenting (P ≤ .001). Conclusions The majority of patients in our series (80%) demonstrated a significant iliac Vein stenosis. These observations indicate that the incidence of iliac Vein outflow obstruction in PVI is greater than previously reported. In patients with combined Ovarian Vein reflux and iliac Vein outflow obstruction, our data suggest that pelvic venous outflow lesions should be treated first and that Ovarian Vein reflux should be treated only if symptoms persist. In women with an outflow lesion, Ovarian Vein reflux, and a large pelvic reservoir, we recommend simultaneous treatment.