The Effect of Venoactive Drug Therapy on the Development and Severity of Post-Embolization Syndrome in Endovascular Interventions on the Gonadal Veins.

Sergey Gennadievich Gavrilov,Oksana Igorevna Efremova,Igor Anatolievich Zolotukhin,Nadezhda Yurievna Mishakina,Gennady Vladimirovich Krasavin

doi:10.3390/jpm11060521

Abstract

Objective. To evaluate the incidence of post-embolization syndrome (PES) and the effect of venoactive therapy on its development, severity, and duration after endovascular embolization of gonadal veins (EEGV) with coils in patients with pelvic congestion syndrome (PCS). Materials and Methods. We analyzed the outcomes of EEGV with coils in 70 female patients who received (n = 38; group 1) or did not receive (n = 32; group 2) treatment with a venoactive drug (VAD) before and after the procedure. Assessments of the EEGV efficacy and for possible signs of PES were done on days 1, 5, 10, 15, 20, and 30 after the intervention. All patients underwent transvaginal and transabdominal duplex ultrasound scanning (DUS) after EEGV. In addition, patients with PES were examined using the computed tomography of the pelvic veins in the postprocedural period. Results. Technical success of EEGV was achieved in 100% of patients. Pelvic venous pain (PVP) reduction after EEGV was observed in 77.1% of patients. The PES was diagnosed in 18.6% of cases (10.5% in group 1 vs. 28.1% in group 2, p > 0.05). In three patients of group 1, the protrusion of coils was suspected and eventually verified during the resection of the left gonadal vein with coils. The group 1 patients had less severe post-embolization pain (6.2 ± 0.4 vs. 7.8 ± 0.3 scores in group 2; p = 0.009) and three times shorter duration of PES (5.0 ± 1.2 vs. 16.2 ± 2.7 days; p = 0.003). No significant differences in the diameters of gonadal veins, side of embolization, and number of coils were revealed between patients with and without PES. The rate of parametrium vein thrombosis was found to be significantly higher in patients with PES than in those without PES (30.7% vs. 18.5%, respectively; p < 0.05). Conclusion. The PES is a frequent complication of EEGV with coils and occurs in 18.6% of patients. Venoactive treatment does not effect the incidence of this complication but reduces the PES severity and duration.

Highlights

Endovascular embolization of the gonadal veins (EEGV) is a pathogenetic and minimally invasive method for eliminating pelvic venous reflux in patients with pelvic congestion syndrome (PCS) [1,2,3,4]
We examined the incidence of post-embolization syndrome (PES) after EEGV and the effect of venoactive drug therapy on its development and severity
While we found no difference in the rate of this condition between patients with and without PES, it may be assumed that development of thrombotic process in the visceral pelvic veins after EEGV may serve as one of the triggers of PES

Summary

Introduction

Endovascular embolization of the gonadal veins (EEGV) is a pathogenetic and minimally invasive method for eliminating pelvic venous reflux in patients with pelvic congestion syndrome (PCS) [1,2,3,4]. Despite its high efficacy in relieving PCS, a number of researchers reported persistence or even an increase of pain after the procedure [5,6,7] This condition is known as post-embolization syndrome (PES). After implantation of metal coils into ovarian veins, some patients experience worsening of pelvic pain, occurrence of pain along the embolized vessel, and a low-grade fever. This can be explained by the development of aseptic inflammation in the venous wall and/or by the patient’s hypersensitivity to metals and alloys of which coils are made. Pathophysiological mechanisms underlying the analgesic action of VADs are thought to be the effect of VAD on leukocyte adhesion, a decrease in venous wall inflammation, and a decrease in the synthesis of algogens

Methods

Discussion

Conclusion