This study preliminarily evaluates the efficacy of treating urinary symptoms in patients with pelvic venous disorders (PeVDs). A connection is hypothesized by the authors due to increased bladder inflammatory changes seen in a prior study involving rats with ligated common iliac veins. A retrospective review of 206 pelvic venograms, approximately 60 for PeVD, from 2019 to 2023 at a single institution identified 7 female patients (mean age 43.3 years) with interstitial cystitis (IC) or dominant urinary symptoms, including recurrent urinary tract infections, dysuria, and pelvic pain. Pelvic venous congestion or reflux was confirmed by venography. Treatment involved common iliac vein stenting or ovarian vein embolization. Outcomes were determined by patient reported symptoms 1–6 months postoperatively. All five patients with IC had symptom resolution within 5 months (mean: 1.9 months), while the remaining two patients without IC each had complete resolution at 1 month. These results suggest that treating PeVD may relate to improvement in IC and other urinary symptoms; thus, randomized trials and larger studies are needed to further explore PeVD and its relation to urinary symptoms.

Background/Objectives: The authors hypothesize that some vulvar varicosities are due to and can be treated by addressing underlying pelvic venous disorders (PeVDs). The purpose of this single center retrospective study is to evaluate vulvar varicosity resolution following treatment of an underlying PeVD. Methods: This study is a single center, retrospective case series from 2010 to 2025 of all patients evaluated in a single vein clinic with vulvar varicosities confirmed by examination and/or imaging, most commonly CT abdomen and pelvis with contrast. Inclusion criteria were presence of vulvar varicosities, evidence of an underlying PeVD, treatment with either left ovarian vein embolization or left iliac stenting, and at least one month of follow-up. PeVD was defined as a combination of suggestive imaging findings (left ovarian vein dilation or left common iliac compression) combined with associated symptoms including pelvic pain and pelvic fullness. Exclusion criteria included prior intervention for PeVDs, other vascular pathologies such as vascular malformations, incomplete documentation, and inaccessible imaging. Results: A total of 18 women with an average of 44 years of age met inclusion and exclusion criteria for the study. Thirteen patients (72.2%) presented with lower extremity varicosities at the same visit. Fifteen patients were multiparous at the time of presentation with a para status averaging 2.5. Ten patients (55.6%) had left ovarian reflux confirmed venographically and received ovarian vein embolization. Preoperative or intraoperative left ovarian venous diameter averaged 7.8 mm. Seven patients (38.9%) had left common iliac vein compression and received self-expandable left common iliac venous stenting. Preoperative CT suggested compression and all patients had intraoperative intravascular ultrasound (IVUS) prior to stenting with an average stenosis of 75.9%. One patient had both pathologies and received both treatments. No patients underwent right ovarian vein embolization nor had venographic evidence of right ovarian reflux. A total of 16 out of 18 patients (88.9%) had complete resolution of PeVDs. One patient had partial response for pelvic pain at one month of follow-up. Another patient had recurrence of pelvic pain symptoms and is being worked up for Nutcracker syndrome. All patients had resolution of their vulvar varicosities on follow-up examination. Conclusions: Vulvar varicosities may be indicative of an underlying PeVD. Vulvar varicosity resolution is associated with PeVD treatment in this case series. Therefore, vulvar varicosities are an important physical exam finding in pelvic examination and referral to a vein specialist should be considered. Additional higher powered, prospective, and randomized studies are indicated to further evaluate this relationship.

The Celt Arterial Closure Device (ACD) is a steel plug system that enables hemostasis for arteriotomies. Though typically used for femoral access, its precision and guide tube length allow for closure of nontraditional sites. A single center, retrospective review of 3609 Celt ACD cases from 2020 to 2024 identified two nonfemoral accesses. One used cone beam computed tomography-guided access of the posterior division of the internal iliac artery for endovascular aneurysm repair, and the other involved thoracic aortic access for endoleak embolization status post thoracic endovascular aortic repair. In the first case, a 5 Fr sheath at a depth of 5 cm was closed under fluoroscopic guidance, with stable device position at 7 months. In the second case, a 5 Fr sheath, 2.5 cm deep was closed after thoracic aortic access with stable device position at 1 month post procedure. The Celt ACD enabled successful closure in two nonfemoral, anatomically complex arterial access sites.

Purpose: To evaluate the technique of fiducial marker placement to guide cone-beam computed tomography (CBCT) trajectory planning and ablation predictive software for ablation of a segment IVB, biopsy-confirmed, 4.5 × 4.2 × 3.4 cm hepatocellular carcinoma in a patient refusing contrast administration. Methods: Utilizing ultrasound guidance and fluoroscopic confirmation, six coils were placed at the anatomic margins of the lesion. Following placement, a microwave antenna was advanced under ultrasound and CBCT guidance to abut the first fiducial marker. CBCT was then performed to confirm suitable positioning. Ablation predictive software was utilized to determine the maximal, yet safe, ablation zone for the probe position. This process was repeated at each fiducial marker to encompass the entire lesion with appropriate margins. Results: The total fluoroscopic time was 18.5 min; the cumulative dose was 1405 mGy. There were no intraoperative or immediate complications. The patient experienced mild post-ablation epigastric pain for 1 week following the procedure. At 1-month follow-up, the patient had no complaints. The initial post-procedure MRI, and now the most recent 26-month follow-up MRI, demonstrates complete response of the target lesion by mRECIST criteria. Conclusion: Ultrasound-guided fiducial marker placement for guidance of cone-beam CT trajectory planning combined with ablation predictive software is a viable technique for ablation of > 3-cm hepatocellular carcinoma when contrast is contraindicated. Future prospective studies are indicated to further evaluate this approach.