Objective

Comparison of the efficacy and safety of endovascular and endoscopic interventions on the gonadal vein in the treatment of patients with pelvic congestion syndrome (PCS).

Methods

We evaluated the treatment outcomes in 95 patients with PCS who underwent endovascular embolization of gonadal veins (EEGV) (group 1, n = 67) or endoscopic resection of the gonadal veins (ERGV) (group 2; n = 28). A comparative analysis of the efficacy and safety of EEGV and ERGV in the treatment of PCS included assessments of their effects on pelvic venous pain, pelvic venous reflux, diameter of the pelvic veins, and restoration of daily activity, as well as treatment safety assessment. Clinical examinations and ultrasound studies of the pelvic veins were repeated at 1, 10, and 30 days, and 36 months after EEGV and ERGV. Pain was assessed using a visual analogue scale and the Von Korff questionnaire.

Results

A decrease in pelvic venous pain intensity was observed at 3.6 ± 1.4 days after EEGV and 2.5 ± 0.8 days after ERGV (P = .49 between the groups). At 1 month after the intervention, a complete relief of pelvic pain was reported by 52 and 25 patients in the EEGV and ERGV groups, respectively. The rates of valvular incompetence of the uterine veins were decreased from 85% in both groups at baseline to 3% in group 1 and 0% in group 2 at 36 months after the intervention, respectively. In the early postprocedural period, pain in the femoral or jugular vein puncture site was reported by eight patients (12%) who underwent EEGV (2.2 ± 0.7 scores). Postembolization syndrome was diagnosed in 13 patients (19.4%). After ERGV, all patients experienced pain in the area of the surgical wound, with a severity of 3.9 ± 0.5 scores. Hematoma at the puncture site of the main vein was observed in 6% of patients after EEGV. Protrusion of coils was identified in three patients (4.5%). The VTE incidence was four times greater in group 1 vs group 2 (14 vs 3 patients; P < .05). The relative risk of this complication after EEGV was 1.4 (95% confidence interval, 1.146-1.732). In two patients (7.1%) after the bilateral laparoscopic resection of the gonadal veins, an ileus developed. No complications of anesthesia were observed in either group.

Conclusions

Endovascular and endoscopic techniques for decreasing blood flow through the gonadal veins are effective and safe in treating the PCS. The obvious advantages of EEGV are minimal injury and possibility to perform procedure under local anesthesia. The ERGV is associated with at least similar and, in some cases, even superior outcomes, in the terms of significantly (P < .05) shorter time to the postprocedural pain relief and avoiding postembolization syndrome.

中文翻译：

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性腺静脉血管内和内镜干预治疗盆腔充血综合征的疗效和安全性的比较分析。

目的

腔内静脉内镜和内镜干预治疗盆腔充血综合征（PCS）的疗效和安全性比较。

方法

我们评估了接受性腺静脉血管内栓塞术（EEGV）（第1组，n = 67）或经内镜切除性腺静脉（ERGV）（组2； n = 28）的95例PCS患者的治疗结果。对EEGV和ERGV治疗PCS的疗效和安全性的比较分析包括评估其对盆腔静脉疼痛，盆腔静脉反流，盆腔静脉直径和日常活动恢复的影响，以及治疗安全性评估。在EEGV和ERGV后的第1、10、30天和36个月重复进行盆腔静脉的临床检查和超声检查。使用视觉模拟量表和冯·科夫问卷对疼痛进行评估。

结果

在EEGV后3.6±1.4天和ERGV后2.5±0.8天观察到骨盆静脉疼痛强度降低（P = 0.49）。干预后1个月，EEGV和ERGV组分别有52名和25名患者报告了骨盆疼痛的完全缓解。干预后36个月，子宫静脉瓣膜功能不全的发生率分别从两组的基线水平的85％降至1组的3％和2组的0％。在术后早期，有8例（12％）接受EEGV（2.2±0.7评分）的患者报告了股静脉或颈静脉穿刺部位疼痛。栓塞后综合症诊断为13例（19.4％）。ERGV后，所有患者均在手术伤口区域经历疼痛，严重程度为3.9±0.5分。EEGV后6％的患者观察到主静脉穿刺部位的血肿。在三名患者中发现了线圈突出（4.5％）。P  <.05）。EEGV后此并发症的相对风险为1.4（95％置信区间，1.146-1.732）。在腹腔镜双侧腹腔镜切除性腺静脉后，有两名患者（7.1％）出现肠梗阻。两组均未观察到麻醉并发症。

结论

减少通过性腺静脉血流量的血管内和内窥镜技术在治疗PCS方面是有效和安全的。EEGV的明显优势是损伤最小，并且可以在局部麻醉下进行手术。就显着 缩短（P <.05）手术后疼痛缓解时间和避免栓塞后综合症而言，ERGV至少具有相似的效果，在某些情况下甚至具有更好的效果。