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