1Andriy Nykonenko

1Zaporizhzhia State Medical University

Background(s):

We analyzed 11 patients with pelvic congestion syndrome, who underwent endovascular coil embolization combined with sclerotherapy. Average age of patients was 43 years (from 27 to 55 years). BMI was 20,0 ± 3,1 points. Pain was scored with using of Visual Analogue Scale (VAS) and was 5 (from 4 to 8) points before the operation. The pain syndrome had the following manifestations: abdominal pain in 60%, lumbar pain in 18%, pain in the left upper quadrant – 40%, pain in the left flank – 25%, pelvic pain was observed in 80% of patients and usually worsened after physical activity.

Material(s) and Method(s):

All patients underwent standard diagnostic algorithm which include an abdominal and a transvaginal US, CT angiography. Before operation transvaginal US showed the diameter of right iliac veins: 11,3 ± 1,6 mm and left: 11,4 ± 1,6 mm, diameters of paraovarian veins from the right: 5,9 ± 1,6 mm and from the left 7,6 ± 1,6 mm, diameters of parametrium veins from the right: 5,6 ± 1,6 mm and from the left 7,0 ± 1,8 mm, and a diameter of left (8,4 ± 1,8 mm) and right (5,9 ± 1,6 mm) ovarian veins. All patients (n=11) underwent endovascular embolization of left ovarian vein combined with sclerotherapy of pelvic veins. We use right transfemoral access to common femoral vein with using a 6F introducer. After placing the catheter into the left renal vein diagnostic phlebography was performed. After that coil was placing in the lower third of ovarian vein (Tornado type in 7 cases, Nestor type in 4 cases). After installing the coil, a sclerosant foam was injected: 3% – 2 ml solution of ethoxysclerol.

Result(s):

Follow-up was in 3 – 6 months and included transvaginal US and CT imaging (in 6 month). VAS was 1 (from 0 to 2) points in 6 months after the intervention.  Tranvaginal US after treatment shows the statistically significant (p<0,005) decrease of the diameters:  iliac veins from the right: 11,1 ± 1,6 mm and from the left: 11,4 ± 1,6 mm, paraovarian veins from the right: 5,2 ± 1,2 mm and from the left 5,7 ± 1,4 mm, parametrium veins from the right: 5,4 ± 1,3 mm and from the left 4,6 ± 1,8 mm, right ovarian vein was 5,6 ± 1,0 mm. There was no visualization of left ovarian vein because of it`s obliteration. There was no blood reflux in pelvic veins in all cases. In 27% (n=3) use of additional coil was required after the injection of the sclerosant.

Conclusion(s):

A variety of unexplained chronic pain is associated with pelvic venous insufficienty, pelvic varicosities and the collateral blood flow.

  1. A variety of unexplained chronic pain is associated with pelvic venous insufficienty, pelvic varicosities and the collateral blood flow.
  2. The use of a diagnostic algorithm will allow us to exclude intrinsic disease and plan an appropriate treatment strategy in a patient with PCS.
  3. Sclerotherapy reduces the demand to use an additional embolization coils.
  4. The use of sclerosant helps to achieve the best results and total regression of symptoms in patients with pelvic congestion syndrome.