Assessment of efficacy of intravascular ovarian vein occlusion for the treatment of pelvic congestion syndrome
Journal Title: Postępy Nauk Medycznych - Year 2015, Vol 28, Issue 2
Abstract
Introduction. Chronic pelvic pain (CPP) is responsible for 20% of gynaecological outpatient visists. Pelvic congestion syndrome (PCS) is a common cause of CPP, which is underlain by the varicose and incompetent veins within the pelvis minor. According to estimates, such changes can develop in about 10-15% of women, predominantly under the age of 45 years.Aim. Assessment of efficacy of intravascular occlusion of ovarian veins for the treatment of pelvic congestion syndrome.Material and methods. In the prospective observational study carried out between January and September of 2014, 35 patients were scheduled for ovarian vein embolisation. Each patient experienced pelvic pain for at least one year – the visual analogue score (VAS) (0 – no pain, 10 – the most severe pain). The qualified patients were referred to phlebography to assess the extent of retrograde inflow to ovarian veins and occlusion of the appropriate ovarian veins. Phlebographies were carried out during the Valsalva manoeuvre from the catheter placed in the left renal vein; on the right side – at the ovarian vein ostium. Ovarian veins were occluded using detachable coils 0.035, 0.018 or a vascular occluder EOS. in cases of numerous collaterals, the obliterating material was additionally used, i.e. aethoxysclerol foam.Results. The procedures were performed in 34 out of 35 patients. In one cases, none of the ovarian veins was successfully selectively catheterised. In 7 patients embolisations were performed using a vascular occluder EOS, in the remaining 27 using coils. In 9 cases additionally were used aethoxysclerol. A technical success was considered safe closure of veins/vein and lack of contrast medium inflow in follow-up phlebography using the Valsalva manoeuvre. The technical efficacy was found to be 97%. In 4 cases embolisation was ineffective. The clinical efficacy of the procedure was assessed using VAS and was considered as the pain score 2 or less. It was found to be 97% including 3 cases in which the pain subsided completely.Conclusions. PCS embolisation seems to be an effective and safe treatment measure characterised by a high rate of clinical and technical success. However, further research is required on this method. In addition, an essential element is a good cooperation of gynaecologists and interventional radiologists in qualification of the patient for the treatment.
Authors and Affiliations
Krzysztof Pyra, Sławomir Woźniak, Piotr Czuczwar, Anna Drelich-Zbroja, Tomasz Roman, Łukasz Światłowski
Keywords
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