Advertisement

Minimally Invasive Surgical Treatment of Pelvic Leak Points

  • Roberto Delfrate
  • Erika Mendoza
Chapter

Abstract

Pelvic leak points are responsible for reflux and visible varicose veins in 8.3% of all cases, as found in a nonpublished series of 4.411 CHIVA treatments, where the author found 366 cases of pelvic reflux: 90% of them in women (free of pelvic congestion syndrome). Analysing the pathway, six well-defined parietal pelvic leak points (PLPs) may be detectable on each side: the perineal point (PP), the inguinal point (IP), the obturator point (OP), the gluteal points (superior, SGP, and inferior, IGP) and the clitoridian point (CP). Perineal and inguinal points (PP and IP) represented 97% of all treated PLP in women. The PLPs are detectable, thanks to accurate duplex imaging assessment, and selected for surgery when refluxing at Valsalva test. They can be treated with mini-invasive surgery under local anaesthesia.

Literature

  1. 1.
    Franceschi C, Bahnini A. Points de fuite pelviens viscéraux et varices des membres inférieurs. Phlébologie. 2004;57:37–42.Google Scholar
  2. 2.
    Franceschi C, Bahnini A. Treatment of lower extremity venous insufficiency due to pelvic leak points in women. Ann Vasc Surg. 2005;19:284–8.CrossRefGoogle Scholar
  3. 3.
    Franceschi C. Anatomie fonctionnelle et diagnostic des points de fuite bulboclitoridiens chez la femme (point C). J Mal Vasc. 2008;33:42.Google Scholar
  4. 4.
    Pernkopf. Atlas of topographical and applied human anatomy. 1964. Vol. II, p. 222–3.Google Scholar
  5. 5.
    Lockhart LD, Hamilton GF. Fyfe Fv. Italian edition. Azzali G., Casa Editrice Ambriosana; 1973. p. 674.Google Scholar
  6. 6.
    Chiarugi G, Bucciante L. Istituzioni di anatomia dell’uomo. 11th ed. In: Vallardi F, editor. 1975. Vol. 2, p. 675–93. Vol. 3, p. 729–36.Google Scholar
  7. 7.
    Rouviere H. Anatomie humaine Masson édit. 1959. Vol. II, p. 731–2, 737–8.Google Scholar
  8. 8.
    Lechter A, Lopez G, Martinez C, Camacho J. Anatomy of the gonadal veins: a reappraisal. Surgery. 1991;109:735–9.PubMedGoogle Scholar
  9. 9.
    Lepage PA, Villavicencio JL, Gomez RE, Sheridan MN, Rich NM. The valvular anatomy of the iliac venous system ands its clinical implications. JVS. 1991;14(5):678–83.Google Scholar
  10. 10.
    Dixon JA, Mitchell WA. Venographic and surgical observations in vulvar varicose veins. Surg Gynecol Obstet. 1979;131:458–64.Google Scholar
  11. 11.
    Franceschi C, et al. CHIVA: hemodynamic concept, strategy and results. Int Angiol. 2016;35(1):8–30.PubMedGoogle Scholar
  12. 12.
    Franceschi C. Theorie et practique de la Cure Conservatrice et Hemodynamique de l’Insuffisance Veineuse en Ambulatoire. Precy-sous-Thil, France: Edition de l’Armançon; 1988.Google Scholar
  13. 13.
    Franceschi C, Zamboni P. Principles of venous haemodynamics. New York: Nova Science Publishers; 2010.Google Scholar
  14. 14.
    Delfrate R. Manuale di emodinamica venosa degli arti inferiori. Fantigrafica; 2010. ISBN 9788890496837.Google Scholar
  15. 15.
    Delfrate R. A new diagnostic approach to varicose veins: haemodynamic evaluation and treatment. Lorenadioni Publisher; 2014.Google Scholar
  16. 16.
    Delfrate R. Nuovo approccio diagnostic alle vene varicose. In: Dioni L, editor. 2014. p. 64.Google Scholar
  17. 17.
    Delfrate R, Bricchi M, Franceschi C, Goldoni M. Multiple ligation of the proximal greater saphenous vein in the CHIVA treatment of primary varicose veins. Veins Lymphat. 2014;3:19–21.CrossRefGoogle Scholar
  18. 18.
    Paraskevas N, Ayari R, Malikov S. ‘Pole test’ measurements in critical leg ischaemia. Eur J Vasc Endovasc Surg. 2006;31:253–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Pahlsson HI, Wahlberg E, Olofsson P, Swedenborg J. The toe pole test for evaluation of arterial insufficiency in diabetic patients. Eur J Vasc Endovasc Surg. 1999;18:133–7.PubMedGoogle Scholar
  20. 20.
    Lopez AJ. Female pelvic vein embolization: indications, techniques and outcomes. Cardiovasc Intervent Radiol. 2015;38:806–20.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Roberto Delfrate
    • 1
  • Erika Mendoza
    • 2
  1. 1.Responsible Surgery at Casa di Cura Figlie di San CamilloCremonaItaly
  2. 2.VenenpraxisWunstorfGermany

Personalised recommendations