Eficacia y seguridad de la embolización en pacientes con diagnóstico de varices pélvicas

Abstract

ObjectivePelvic congestion syndrome (PCS), or pelvic varices (PV), is an entity suffered by millions of women worldwide, and its occurrence can reach up to 39%. Multiple factors contribute the pathophysiology of the PCS. Up to 15% of women between the ages of 20 and 50 years-old have varicose veins in the pelvis, although not all experience symptoms.The aim of this study was to determine the efficacy and safety of phlebography and embolisation of the PV as treatment for PCS. Material and methodsThe study included 75 symptomatic women, who were enrolled from June 2014 to December 2015 after being referred from other centres with a diagnosis of PCS. Of these, 24 patients (aged 26-55 years with a mean of 37 years) were diagnosed with the presence of PV using transvaginal ultrasound. A venography was performed on this group to verify the diagnosis, and immediate embolisation was performed, if this was possible and required. The VAS score was measured to clinically determine the success of the procedure at 3, 6, 9, and 12 months of follow-up, correlating with prior to the procedure base. Transvaginal ultrasound was also performed at 6 months to determine the closure or rechannelling, as well as a phlebography at 12 months, with the same objective. These parameters were collected in a base template. ResultsThe presence of PV associated with PCS in our city, due to being a central institution of national reference, was 3.9% of the female population seen from June of 2014 to December 2015. All the 24 patients were symptomatic, with dyspareunia being one of the most referred to factors; 100%. All the study population presented with multiparity as risk factor, and only 37% of them showed varices in the lower limbs. When phlebography was performed the diagnosis was confirmed in only 83% (n=20) of patients referred due to PV observed in the transvaginal ultrasound. There were no complications during the follow-up of the procedure, 8.3% of patients had recurrence of symptoms at 9 months follow-up. A phlebography was performed and ectatic venous vessels dependent on the right internal iliac vein and gonadal right were embolised, respectively.There was no recurrence of symptoms in any of them after 12 months of follow-up. No differences were observed in the successful occlusion with the use of coils vs polidocanol. ConclusionPhlebography is a specific test and with a low complication rate for the diagnosis of PV. Embolisation of pelvic varices using coils or polidocanol is an effective and safe method for the treatment of PCS.