{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:37:58Z","timestamp":1791607078044,"version":"4.3.4"},"reference-count":81,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T00:00:00Z","timestamp":1683244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Royal Liverpool University Hospital","award":["RG2137"],"award-info":[{"award-number":["RG2137"]}]},{"DOI":"10.13039\/501100000325","name":"Wellbeing of Women","doi-asserted-by":"publisher","award":["RG2137"],"award-info":[{"award-number":["RG2137"]}],"id":[{"id":"10.13039\/501100000325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cells"],"abstract":"<jats:p>Deep endometriosis (DE) is the most severe subtype of endometriosis, with the hallmark of lesions infiltrating adjacent tissue. Abnormal vascularisation has been implicated in contributing to endometriosis lesion development in general, and how vascularisation influences the pathogenesis of DE, in particular, is of interest. This systematic review followed the PRISMA guidelines to elucidate and examine the evidence for DE-specific vascularisation. A literature search was performed using MEDLINE, Embase, PubMed, Scopus, Cochrane CENTRAL Library and Europe PubMed Central databases. The databases were searched from inception to the 13 March 2023. A total of 15 studies with 1125 patients were included in the review. The DE lesions were highly vascularised, with a higher microvessel density (MVD) than other types of endometriotic lesions, eutopic endometrium from women with endometriosis and control tissue. Vascular endothelial growth factor, its major subtype (VEGF-A) and associated receptor (VEGFR-2) were significantly increased in the DE lesions compared to superficial endometriosis, eutopic endometrium and control tissue. Progestin therapy was associated with a significant decrease in the MVD of the DE lesions, explaining their therapeutic effect. This review comprehensively summarises the available literature, reporting abnormal vascularisation to be intimately related to the pathogenesis of DE and presents potentially preferential therapeutic targets for the medical management of DE.<\/jats:p>","DOI":"10.3390\/cells12091318","type":"journal-article","created":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T08:12:11Z","timestamp":1683274331000},"page":"1318","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Vascularisation in Deep Endometriosis: A Systematic Review with Narrative Outcomes"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5553-5286","authenticated-orcid":false,"given":"Simon G.","family":"Powell","sequence":"first","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health, Institute of Life Course and Medical Science, University of Liverpool, Liverpool L8 7SS, UK"},{"name":"Liverpool Women\u2019s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK"},{"name":"Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Sharma","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Liverpool, Liverpool L8 7SS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Masterson","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Liverpool, Liverpool L8 7SS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Wyatt","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health, Institute of Life Course and Medical Science, University of Liverpool, Liverpool L8 7SS, UK"},{"name":"Liverpool Women\u2019s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK"},{"name":"Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilyas","family":"Arshad","sequence":"additional","affiliation":[{"name":"Liverpool Women\u2019s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shakil","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3606-1361","authenticated-orcid":false,"given":"Gendie","family":"Lash","sequence":"additional","affiliation":[{"name":"Guangzhou Institute of Pediatrics, Guangzhou Women and Children\u2019s Medical Center, Guangzhou Medical University, Guangzhou 510180, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Cross","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3GE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0270-0150","authenticated-orcid":false,"given":"Dharani K.","family":"Hapangama","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health, Institute of Life Course and Medical Science, University of Liverpool, Liverpool L8 7SS, UK"},{"name":"Liverpool Women\u2019s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2698","DOI":"10.1093\/humrep\/dei135","article-title":"ESHRE guideline for the diagnosis and treatment of endometriosis","volume":"20","author":"Kennedy","year":"2005","journal-title":"Hum. 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