Angio-Medicus Angiology Clinic, Krakow, Poland.
Angio-Medicus Angiology Clinic, Krakow, Poland; Department of Angiology, Jagiellonian University Medical College, Krakow, Poland.
J Vasc Surg Venous Lymphat Disord. 2019 Nov;7(6):845-852.e2. doi: 10.1016/j.jvsv.2019.05.009. Epub 2019 Aug 20.
Pelvic venous incompetence or pelvic congestion syndrome (commonly referred to as pelvic venous disorder [PVD]) is increasingly diagnosed, especially in multiparous women. This may be either primary or secondary to pelvic venous outflow obstruction-left common iliac vein (LCIV) or left renal vein (LRV) stenosis. Intravascular ultrasound (IVUS) examination performed in the supine position is commonly used for diagnosis of LRV and LCIV stenosis; however, body position may affect the cross-sectional area (CSA) of both of these veins during IVUS. The aim of the study was to test the hypothesis that postural changes may significantly affect the CSA of the LRV and LCIV.
A single-arm, single-center cohort study of women suffering from PVD was performed at a tertiary hospital in Poland. It comprised consecutive patients with either pelvic vein reflux or suggestion of LCIV or LRV obstruction but no signs of deep venous thrombosis. IVUS examination of the iliac veins, inferior vena cava, and LRV was performed in the supine position. IVUS of the LRV and LCIV was performed also with a Valsalva maneuver and with patients lying on the left side and standing. A 60% CSA reduction was used as a cutoff value between significant and nonsignificant vein stenosis.
A total of 41 women were examined. Significant stenosis of the LRV was seen in 22 patients (55%) supine but in only 4 (10%) patients studied when lying on the left side and in 27 (67.5%) patients studied while standing. Significant stenosis of the LCIV was seen in 26 supine patients (63.4%), in 8 lying on the left side (19.5%), and in 10 (24.4%) standing.
Postural changes dramatically affect CSA of the LCIV and LRV and thus the degree of stenosis in women diagnosed with PVD. Stenosis found in patients while supine often disappears when the position is changed to lying on the left side or to standing. Therapeutic decisions based on assessment of CSA reduction in the supine position are likely to be inadequate.
盆腔静脉功能不全或盆腔淤血综合征（通常称为盆腔静脉疾病[PVD]）的诊断率日益增高，尤其是在多产妇中。这种情况既可能是原发性的，也可能是继发于盆腔静脉流出道阻塞——左髂总静脉（LCIV）或左肾静脉（LRV）狭窄。在仰卧位进行的血管内超声（IVUS）检查通常用于诊断 LRV 和 LCIV 狭窄；然而，体位可能会影响 IVUS 检查过程中这两条静脉的横截面积（CSA）。本研究旨在验证体位变化可能显著影响 LRV 和 LCIV CSA 的假设。
在波兰的一家三级医院进行了一项针对患有 PVD 的女性的单臂、单中心队列研究。该研究纳入了有盆腔静脉反流或 LCIV 或 LRV 阻塞但无深静脉血栓形成迹象的连续患者。在仰卧位进行髂静脉、下腔静脉和 LRV 的 IVUS 检查。还进行了 LRV 和 LCIV 的 Valsalva 动作和左侧卧位及站立位 IVUS 检查。将 60%的 CSA 减少作为显著和非显著静脉狭窄的截断值。
共检查了 41 名女性。22 名患者（55%）仰卧位时 LRV 狭窄明显，但左侧卧位时仅 4 名（10%）患者狭窄，站立位时 27 名（67.5%）患者狭窄。26 名仰卧位患者（63.4%）、8 名左侧卧位患者（19.5%）和 10 名站立位患者（24.4%）LCIV 狭窄明显。
体位变化显著影响 PVD 女性 LCIV 和 LRV 的 CSA，从而影响狭窄程度。患者仰卧位时发现的狭窄在改为左侧卧位或站立位时往往会消失。基于仰卧位 CSA 减少评估做出的治疗决策可能不够充分。
