Abstract
Purpose: To evaluate medium-term clinical outcomes of transcatheter embolization and stenting in women with several pelvic venous disorders responsible for chronic pelvic pain and varicose veins of the lower limbs.Materials and Methods: The study population included 327 consecutively recruited patients referred to the interventional radiology unit from January 2014 to December 2019 due to chronic pelvic congestion (91; 27.83%), lower limb varices (15; 4.59%), or a combination of both the symptoms (221; 67.58%). Preprocedural pelvic, transvaginal Doppler ultrasound (US), and MRI were conducted in all the patients and revealed anatomical varicosities and incompetent pelvic veins in 312 patients. In all the patients, selective catheterization demonstrated uterine venous engorgement, ovarian plexus congestion, or pelvic vein filling. Retrograde flow was detected on catheter venography in the left ovarian vein (250; 78%), the right ovarian vein (85; 26%), the left internal iliac vein (222; 68%), and the right internal iliac vein (185; 57%). Patients were followed-up at 1, 6, and 12 months, and years thereafter systematically by the referring angiologist and the interventional radiologist of center. They were contacted by telephone in November and December 2020 to assess pain perception and quality of life by using the visual analog scales from 0 to 10 with assessments made at the baseline and last follow-up. Of the 327 patients (mean age, 42 ± 12 years), 312 patients were suffering from pelvic congestion syndrome and 236 patients was suffering from lower limb varices. All underwent embolization by using ethylene vinyl alcohol copolymer (Onyx®). Eighty-five right ovarian veins, 249 left ovarian veins, 510 tributaries of the right internal iliac vein, and 624 tributaries of the left internal iliac vein were embolized. A cohort of patients also underwent nutcracker syndrome angioplasty (6.7%) and May–Thurner syndrome angioplasty (14%) with a stent placement.Results: The initial technical success rate was 80.9% for embolization of pathological veins and 100% for stenting of stenoses. Overall, 307 patients attended 12-month follow-up visits and 288 (82%) patients completed the telephone survey at mean 39 (±18)-month postintervention. Main pelvic pain significantly improved from 6.9 (±2.4) pre- to 2.0 (±2.4) postembolization (p < 0.001), as did specific symptoms in each category. Improvement or disappearance of pain was achieved in 266/288 (92.36%) patients with improved quality of life in 276/288 (95.8%) patients. There were 16 minor and 4 major adverse events reported on the follow-up.Conclusion: Pelvic vein embolization (Onyx®) is an effective and safe procedure with high clinical success and quality of life improvement rates.
Highlights
Chronic pelvic pain (CPP) is a common health problem among women of childbearing age, which is responsible for about 10% of gynecological consultations [1]
The clinical examination, pelvic and transvaginal Doppler US, and pelvic MRI were instrumental in confirming pelvic congestion syndrome” (PCS) diagnosis in 315 (96.3%) patients (Table 2)
614 embolization procedures were performed in 327 patients on overall 1,468 veins, meaning that 1.9 (±0.9) procedures on 4.5 veins were performed per patient on average, including 249 (76%) left ovarian vein and 85 (26%) right ovarian vein, 510 tributaries of the right internal iliac vein, and 624 tributaries of the left internal iliac vein embolizations
Summary
Chronic pelvic pain (CPP) is a common health problem among women of childbearing age, which is responsible for about 10% of gynecological consultations [1]. While several pelvic venous disorders (PeVDs) definitions have been put forth, they all fundamentally encompass CPP as being linked to incompetent pelvic valves and structural vein abnormalities, causing gonadal vein reflux, iliac venous insufficiency, and pelvic venous engorgement [3]. Both the clinical and radiological approaches that reveal pelvic vein incompetence are keys to the therapeutic workup. The prevalence of pelvic varices has been estimated at about 10% in the general female population, while up to 40% of them are likely to develop PeVD [4] This syndrome is characterized by CPP with chronic pelvic vein incompetence (CPVI), without any other identified cause, which persists for more than 6 months [5]. Risk factors for PeVD include multiple pregnancies and hormonal influences [6]
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