A Novel Screening Tool for Pelvic Venous Disorders

Tuesday, September 19, 2023

9:06 AM – 9:16 AM US EDT

Location: Grand Ballroom A

Additional Co-Author - Konstantinos Kavallieros Introduction, Objectives, and/or Purpose: Introduction
Pelvic congestion syndrome (PCS) remains a common yet under-diagnosed condition worldwide resulting in significantly decreased quality of life among affected women. The condition remains challenging to diagnose. Symptoms can be non-specific and difficult to differentiate from those of other diseases, including gynaecological and urological conditions. To aid the identification of women with PCS, a screening questionnaire was developed.
Objective
1. To assess the accuracy of the PCS screening questionnaire in identifying women appropriate for vascular review.

Methods: Methods
This was a retrospective study of consecutive female patients referred to vascular clinic between 2018 to 2022 with symptoms suggestive of PCS. The screening questionnaire was a self-assessed 6-item basic PCS score where >/=2 is considered positive. In 2022, a 4-item PCS specific score was developed as an adjunct to the questionnaire to improve the specificity and sensitivity of the screening score. All women underwent duplex ultrasonography to confirm a diagnosis of PCS. The duplex criteria for significant pelvic venous disorder includes any one of the following: spontaneous continuous reflux in the gonadal veins in supine position; gonadal veins >6 mm; reversal of flow in the adnexal (para uterine) veins or size >5 mm; spontaneous continuous reflux in the internal iliac veins in supine position; and any reflux (Valsalva >500 ms or spontaneous) below the pelvic floor in para vaginal, para urethral or presacral veins. AUROC was plotted for the basic and specific PCS scores using SPSS® software. Sensitivity, specificity, positive predictive and negative predictive values were calculated. Demographic data were also collected and SPSS® software was used for analysis.

Results: Results
Of 94 women referred for PCS evaluation during the study period, 73 (78%) met the duplex criteria for significant pelvic venous disorder (median age: 41 years, range: 16-67 years). In this group, 71 (76%) had a parity of >/=1, of which 60 (85%) had vaginal deliveries (median parity: 2 range: 0-4), and 4 (4%) had haematuria. There was no significant difference in mean age between the patients meeting the duplex criteria for significant pelvic venous disorder (mean 40.11, SD 8.95) and those that did not (mean 41.90, SD 10.76) (P=0.441, 95% CI -6.41-2.82). The mean number of vaginal deliveries and parity of women with Duplex evidence for pelvic venous disorder was significantly higher than those not meeting the criteria at 1.44 (SD 1.12) versus 0.71 (SD 1.01) (P=0.009, 95% CI 0.182-1.262 ) and 1.68 (SD 1.01) versus 0.95 (SD 1.16) (P=0.007, 95% CI 0.207-1.240 ), respectively.
Using a basic PCS score cut-off value of >/=2, resulted in a sensitivity of 0.97, specificity of 0.43, positive predictive value of 0.86 and negative predictive value of 0.82. The AUROC of the basic score was 0.878 (SE +/- 0.050, 95% CI 0.779-0.977), and this was increased to 0.969 (SE +/- 0.031, 95% CI 0.909-1.000) with the addition of the specific score component. The cut-off value for the total score that gave the greatest specificity without sacrificing sensitivity was >/=3, with a sensitivity of 0.97 and a specificity of 0.80.

Conclusion(s): Diagnosis of pelvic venous disorders represents a clinical challenge due to its multiformity and wide differential diagnosis spanning multiple specialities. We present a highly specific and sensitive screening tool for PCS that can be used by clinicians to aid its recognition and the implementation of further investigations and treatment. Further studies including validation of the total PCS score in a larger prospective cohort is required.

Presenting Author(s)

Tasneem G. Pope, MBBS Cantab

Honorary Clinical Research Fellow
Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London
London, United Kingdom

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.

Co-Author(s)

MT

Matthew Tan, MBBS BSc (Hons) MRCS AFHEA

Clinical Research Fellow
Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, United Kingdom

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
Adam M. Gwozdz, MD PhD

Clinical Lecturer in Vascular Surgery
Imperial College London
Imperial College London
London, England, United Kingdom

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose. or AVLS has reviewed / mitigated there are no relevant financial relationships with ineligible companies.

PDF
AY

Alice Yong, NA

Miss
The Harley Street Heart and Vascular Centre Singapore, United States

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
WZ

Weiling Zhang, NA

Miss
The Harley Street Heart and Vascular Centre Singapore, United States

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
Alun H. Davies, MA, DM, DSc, FRCS, FHEA, FEBVS, FLSW, FACPh

Professor of Vascular Surgery
Section of Vascular Surgery, Imperial College London
Imperial College
London, England, United Kingdom

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose. or AVLS has reviewed / mitigated there are no relevant financial relationships with ineligible companies.
Sriram Narayanan, MMBS, MS,FRCS (he/him/his)

Director and Senior Consultant Vascular Surgeon
The Harley Street Heart and Vascular Centre
National University of Singapore
Singapore, Singapore

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose. or AVLS has reviewed / mitigated there are no relevant financial relationships with ineligible companies.