Posture commonly and considerably modifies stenosis of left common iliac and left renal veins in women diagnosed with pelvic venous disorder

Autor: Krzysztof Piotr Malinowski, Tomasz Aleksiejew-Kleszczynski, Agnieszka Sliwka, Marek Krzanowski, Lukasz Drelicharz, Malgorzata Mielnik, Karolina Marciniak, Lukasz Partyka, Marzena Frołow
Rok vydání: 2019
Předmět:
Adult
medicine.medical_specialty
Supine position
Valsalva Maneuver
medicine.medical_treatment
Constriction
Pathologic
Iliac Vein
030204 cardiovascular system & hematology
Severity of Illness Index
Inferior vena cava
Patient Positioning
Renal Veins
Pelvis
Young Adult
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Supine Position
Valsalva maneuver
Humans
Medicine
Prospective Studies
030212 general & internal medicine
Vein
Ultrasonography
Interventional
Vascular Patency
Aged
business.industry
Middle Aged
medicine.disease
Pelvic congestion syndrome
Surgery
Venous thrombosis
Stenosis
medicine.anatomical_structure
Venous Insufficiency
medicine.vein
Regional Blood Flow
Standing Position
cardiovascular system
Female
Poland
Cardiology and Cardiovascular Medicine
business
Common iliac vein
Zdroj: Journal of Vascular Surgery: Venous and Lymphatic Disorders. 7:845-852.e2
ISSN: 2213-333X
DOI: 10.1016/j.jvsv.2019.05.009
Popis: Objective 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. Methods 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. Results 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. Conclusions 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.
Databáze: OpenAIRE
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