title: Venous intravasation as a complication and potential pitfall during hysterosalpingography: re-emerging study with a novel classification.
abstract: OBJECTIVE
  Presently, hysterosalpingography (HSG) is used as a means to evaluate women with infertility and repetitive pregnancy loss. Venous intravasation is a complication and potential pitfall during HSG and analogous procedures including hysteroscopy. The aim of our study was to assess the venous intravasation and to obtain critical information for more secure and more accurate procedures. In particular, the primary goal of the present study was to compare HSG without and with intravasation to identify differences seen on HSG and to assess the predisposing factors of intravasation. The secondary goal was to describe clinical- and imaging-based novel classification of intravasation.
  
  
  METHODS
  This study included a patient cohort of 569 patients who underwent HSG between 2008 and 2011 at our center in the absence (control group) or presence (study group) of intravasation. Intravasation classified from level 0 (no intravasation) to level 3 (severe intravasation) was compared with preprocedural (demographic and clinical) and procedural (HSG) data. Data were analyzed using Statistical Package for Social Sciences (SPSS) statistical software.
  
  
  RESULTS
  Of the 569 patients undergoing HSG, 528 showed no intravasation and 41 (7.2%) patients showed intravasation when associated with preprocedural (leukocytes, menometrorrhagia, secondary infertility, ectopic pregnancy, abortus, polycystic ovaries, endometriosis, and interventions) and procedural (pain, scheduling, endometrial-uterine nature, and spillage) parameters. Moreover, intravasation was lower in women with smooth endometrium, triangular uterus, and homogeneous peritoneal spillage. No association was found between age, tubal patency, increased pressure, and intravasation.
  
  
  CONCLUSIONS
  Using a novel classification method, intravasation can be observed in women during HSG and associates with preprocedural and procedural predisposing factors in subsumed conditions. This classification method will be useful for improving the efficiency and accuracy of HSG and related procedures by minimization of severe complications caused by intravasation.
authors.affiliation: Department of Radiology, Dicle University, Diyarbakir, Turkey.
authors.forename: Abdurrahim
authors.initials: A
authors.lastname: Dusak
authors.affiliation: Department of Obstetrics and Gynecology, Dicle University, Diyarbakir, Turkey.
authors.forename: Hatice E
authors.initials: HE
authors.lastname: Soydinc
authors.affiliation: Department of Radiology, Dicle University, Diyarbakir, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Onder
authors.affiliation: Department of Radiology, Dicle University, Diyarbakir, Turkey.
authors.forename: Faysal
authors.initials: F
authors.lastname: Ekinci
authors.affiliation: Department of Obstetrics and Gynecology, Dicle University, Diyarbakir, Turkey.
authors.forename: Neval Y
authors.initials: NY
authors.lastname: Görük
authors.affiliation: Department of Radiology, Dicle University, Diyarbakir, Turkey.
authors.forename: Cihat
authors.initials: C
authors.lastname: Hamidi
authors.affiliation: Department of Radiology, Dicle University, Diyarbakir, Turkey.
authors.forename: Aslan
authors.initials: A
authors.lastname: Bilici
keywords: Complications; hysterosalpingography; novel classification; potential pitfalls venous intravasation