Evaluation of Effectiveness of Embolization in Pelvic Congestion Syndrome with the New Vascular Occlusion Device (ArtVentive EOS™): Preliminary Results.

Krzysztof Pyra,Andrzej Wolski,Tomasz Jargiełło,Sławomir Woźniak,Anna Drelich-Zbroja

doi:10.1007/s00270-016-1380-8

Krzysztof Pyra, Andrzej Wolski + Show 3 more

Open Access

https://doi.org/10.1007/s00270-016-1380-8

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Abstract

PurposeThis study aimed to collect confirmatory data in support of the safety and efficiency of the ArtVentive EOS™ for the treatment of the pelvic congestion syndrome (PCS). This study was based on the OCCLUDE 1 Study Protocol approved by the Local Ethics Committee.Materials and MethodsA prospective study carried out in June and July 2014 included 12 women aged 21–48 years (mean 31 years) scheduled for PCS embolization using the ArtVentive EOS™. The inclusion criteria were clinical symptoms of PCS documented by transvaginal Doppler ultrasound and pelvic MRI. The pelvic pain was assessed by VAS score from 0 to 10 (0 represents lack of pain and 10 unbearable pain). A decrease in pelvic pain intensity based on the VAS was considered a clinical success.ResultsSuccessful embolization procedures with ArtVentive EOS™ were performed in 11 out of 12 patients. Nine patients underwent unilateral embolization of the left ovarian vein, and two had bilateral embolization of the ovarian veins. Complete ovarian vein occlusion confirmed by post deployment venography was achieved in all 11 patients. Procedures lasted from 19 to 45 min (average 28 min). Pain intensity decrease was observed in all 11 patients—a decrease of 5.6 points—from 7.3 pre-procedure to 1.6 post-embolization (standard deviation: 0.67). In one case, the left ovarian vein was injured by guide wire manipulation with contrast extravasation—not clinically significant.ConclusionsThe use of ArtVentive EOS™ for occlusion of the ovarian veins in PCS patients is safe and effective.

Highlights

Pelvic congestion syndrome (PCS) is a common cause of chronic lower abdominal/pelvic pain, estimated to affect about 10–15 % of women, predominantly between the ages of 30 and 45 [1]
Complete ovarian vein occlusion confirmed by post deployment venography was achieved in all 11 patients
Pain intensity decrease was observed in all 11 patients—a decrease of 5.6 points—from 7.3 pre-procedure to 1.6 post-embolization

Summary

Introduction

Pelvic congestion syndrome (PCS) is a common cause of chronic lower abdominal/pelvic pain, estimated to affect about 10–15 % of women, predominantly between the ages of 30 and 45 [1]. PCS is anatomically characterized by the presence of varicose and incompetent parametrial veins [2]. In the majority of patients, PCS manifests with non-cyclic abdominal or pelvic pain lasting for at least half a year. It is characterized by chronic, dull and continuous discomfort, increasing on prolonged standing during menstruation and after sexual intercourse. Other symptoms include vulvar swelling, lower limb oedema and urinary urgency. Women with PCS are typically premenopausal, and a relationship between PCS and endogenous oestrogen

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