Gonadal Veins Embolization for the Management of Pelvic Varices in Females

Abstract

Background Solid evidence suggests that the treatment of choice for pelvic varicose veins is embolization. The embolization procedure is a simple technique with high success rates in all cases. Recently many series have been published over the past decade regarding the use of various embolic agents namely; coils, N2 Butyl Cyano Acrylate (Medical glue), sclerosing agents namely Polydecanol as well as combination of the previously mentioned agents with a technical success rate close to 100% and clinical success rate for symptoms control of more than 90%. Our study shows the technical and clinical success rates in Ain Shams University Hospitals with the use of all known embolic agents. Patients and Methods 18 patients were included in a prospective cohort study, Foam used as embolic substance in 7 of the included patients, coils used in 2 of them, combined foam and coils used in 8 patients and combined foam and glue used in one patient, follow up done using the Visual analogue scale (VAS) and trans-vaginal ultra-sound (TVUS) 2 weeks and 6months after the embolization. Results Catherization and embolization were successful in all patients. No major complications were observed during the procedure. With significant decline of the preprocedure VAS from 8.67±1.33 to 1.67±0.59 post-procedure revealing significant improvement in the degree of pain (p value= -3.740), technical success rate was 100%, two weeks after embolization TVUS in all the patients showed complete thrombosis of uteroovarian varices, 6 months after embolization 4 patients showed recurrence of the findings with presence of recanalized pelvic varices, with a recurrence rate of 22%, in all the recurrent cases, the embolic substance used was foam, among 7 patients were embolized by foam, 4 of them experienced recurrence 6 months after the procedure, so the recurrence rate using foam only is 57%, with no recurrence in the patients that were embolized using coils, combined foam and coil, or combined foam and glue. Conclusion Gonadal veins embolization in the management of pelvic congestion syndrome is a safe and effective procedure with no significant difference between the different used embolic substances as regard the technical success rate and pain improvement, however the recurrence rate is higher with foam only compared to no recurrence rate using combined embolic substances or coils.