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Journal of Vascular Surgery. Venous and... May 2021As the importance of pelvic venous disorders (PeVD) has been increasingly recognized, progress in the field has been limited by the lack of a valid and reliable...
The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders.
As the importance of pelvic venous disorders (PeVD) has been increasingly recognized, progress in the field has been limited by the lack of a valid and reliable classification instrument. Misleading historical nomenclature, such as the May-Thurner, pelvic congestion, and nutcracker syndromes, often fails to recognize the interrelationship of many pelvic symptoms and their underlying pathophysiology. Based on a perceived need, the American Vein and Lymphatic Society convened an international, multidisciplinary panel charged with the development of a discriminative classification instrument for PeVD. This instrument, the Symptoms-Varices-Pathophysiology ("SVP") classification for PeVD, includes three domains-Symptoms (S), Varices (V), and Pathophysiology (P), with the pathophysiology domain encompassing the Anatomic (A), Hemodynamic (H), and Etiologic (E) features of the patient's disease. An individual patient's classification is designated as SVP. For patients with pelvic origin lower extremity signs or symptoms, the SVP instrument is complementary to and should be used in conjunction with the Clinical-Etiologic-Anatomic-Physiologic (CEAP) classification. The SVP instrument accurately defines the diverse patient populations with PeVD, an important step in improving clinical decision making, developing disease-specific outcome measures and identifying homogenous patient populations for clinical trials.
Topics: Decision Support Techniques; Evidence-Based Medicine; Hemodynamics; Humans; May-Thurner Syndrome; Pelvis; Phlebography; Predictive Value of Tests; Renal Nutcracker Syndrome; Terminology as Topic; Varicose Veins; Veins; Venous Insufficiency
PubMed: 33529720
DOI: 10.1016/j.jvsv.2020.12.084 -
Cureus Nov 2023Ovarian vein thrombosis (OVT) is an uncommon condition that occurs mainly in the peripartum period. Hyper-coagulable conditions have been reported to cause OVT outside... (Review)
Review
Ovarian vein thrombosis (OVT) is an uncommon condition that occurs mainly in the peripartum period. Hyper-coagulable conditions have been reported to cause OVT outside the peripartum period. The clinical presentation is usually nonspecific pain, but it can be asymptomatic in patients with underlying malignancy. Imaging plays an important role in diagnosis. Ultrasound is the initial imaging modality, but it is operator-dependent and has limited sensitivity. Computed tomography (CT) is the most commonly used modality for diagnosis. CT can show the luminal filling defect within the thrombosed vein and assess the extension of the thrombosis. MRI can show the thrombosed vein as a filling defect on post-contrast images; also, diffusion-weighted images may help in the diagnosis. Complications include extension into the inferior vena cava or renal veins. Pulmonary embolism is the most serious complication. Treatment includes anticoagulation plus antibiotics. Early diagnosis is essential to prevent complications.
PubMed: 38024035
DOI: 10.7759/cureus.48672 -
Seminars in Cell & Developmental Biology Jul 2019The kidney vasculature has a unique and complex architecture that is central for the kidney to exert its multiple and essential physiological functions with the ultimate... (Review)
Review
The kidney vasculature has a unique and complex architecture that is central for the kidney to exert its multiple and essential physiological functions with the ultimate goal of maintaining homeostasis. An appropriate development and coordinated assembly of the different vascular cell types and their association with the corresponding nephrons is crucial for the generation of a functioning kidney. In this review we provide an overview of the renal vascular anatomy, histology, and current knowledge of the embryological origin and molecular pathways involved in its development. Understanding the cellular and molecular mechanisms involved in renal vascular development is the first step to advance the field of regenerative medicine.
Topics: Animals; Gene Expression Regulation, Developmental; Humans; Kidney; Neovascularization, Physiologic; Nephrons; Regenerative Medicine; Renal Artery; Renal Veins
PubMed: 29879472
DOI: 10.1016/j.semcdb.2018.06.001 -
Journal of Vascular Surgery Cases and... Dec 2023Anatomic compression of the left renal vein in the angle between the aorta and superior mesenteric artery may be asymptomatic or may result in symptoms, including flank...
Anatomic compression of the left renal vein in the angle between the aorta and superior mesenteric artery may be asymptomatic or may result in symptoms, including flank pain, hematuria, or pelvic pain and/or congestion. Patients can be referred to a vascular surgeon due to symptoms and/or radiologic findings. Because symptoms of nutcracker syndrome can be vague and/or nondiagnostic, careful evaluation, assessment, and counseling with patients are required before undertaking intervention, which is often an open surgical procedure. The definitive diagnosis is ideally confirmed with diagnostic venography, including pressure measurements from the left renal vein and inferior vena cava. The optimal treatment includes open decompression of the left renal vein with renal vein transposition or gonadal vein transposition, with or without concomitant management of pelvic varicosities if symptomatic. Because most patients with nutcracker syndrome are young, long-term follow-up with scheduled ultrasound examinations should be maintained.
PubMed: 38054082
DOI: 10.1016/j.jvscit.2023.101344 -
Frontiers in Cardiovascular Medicine 2023Abdominal vascular compression syndrome (AVCS) is caused by the compression of abdominal blood vessels by adjacent structures or the compression of abdominal organs by... (Review)
Review
Abdominal vascular compression syndrome (AVCS) is caused by the compression of abdominal blood vessels by adjacent structures or the compression of abdominal organs by neighboring blood vessels. Such compressions can result in a variety of clinical symptoms. They are not commonly seen in ultrasound practices, and their presence may have been underrecognized and underdiagnosed. This article reviews the clinical features, ultrasound characteristics, and diagnostic criteria of four types of AVCS, namely, celiac artery compression syndrome, renal vein compression syndrome, iliac vein compression syndrome, and superior mesenteric artery syndrome to increase awareness of these conditions among ultrasound practitioners. The ultrasound criteria for AVCS are primarily based on studies with small sample sizes, and therefore, it is important to exercise caution if these criteria are used.
PubMed: 38173818
DOI: 10.3389/fcvm.2023.1282597 -
Korean Journal of Radiology Dec 2019Nutcracker syndrome (NCS) is a syndrome caused by compression of the left renal vein (LRV), between the abdominal aorta and the superior mesenteric artery, resulting in... (Review)
Review
Nutcracker syndrome (NCS) is a syndrome caused by compression of the left renal vein (LRV), between the abdominal aorta and the superior mesenteric artery, resulting in hypertension of the LRV and hematuria. Doppler ultrasonography (US) has been commonly used for the diagnosis of NCS. However, several technical issues, such as Doppler angle and sample volume, need to be considered to obtain satisfactory results. In addition, morphologic changes of the LRV and a jetting phenomenon across the aortomesenteric portion of the LRV on contrast-enhanced computed tomography (CECT) are diagnostic clues of NCS. With proper Doppler US and CECT, NCS can be diagnosed noninvasively.
Topics: Contrast Media; Diagnosis, Differential; Humans; Renal Nutcracker Syndrome; Renal Veins; Tomography, X-Ray Computed; Ultrasonography, Doppler
PubMed: 31854150
DOI: 10.3348/kjr.2019.0084