Clinical research studies
Pelvic venous disorders
Comparative analysis of the efficacy and safety of endovascular and endoscopic interventions on the gonadal veins in the treatment of pelvic congestion syndrome

https://doi.org/10.1016/j.jvsv.2020.05.013Get rights and content

Abstract

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.

Section snippets

Methods

This retrospective cohort comparative study included 95 patients with PCS who were treated at the Savelyev University Surgical Clinic from 2012 to 2019. The study protocol was approved by the institutional ethics committee. Informed consent was not obtained owing to the retrospective nature of this analysis. Two groups of patients were studied: group 1 with endovascular embolization of the gonadal veins (EEGV), and group 2 with ERGV.

Results

A total of 95 patients were included in the analysis (67 in group 1 and 28 in group 2); the mean patient age was 32.3 ± 3.5 years (range, 22-42 years). The baseline demographic and clinical characteristics of study population and types of intervention are presented in Table I. Indications for EEGV and ERGV were the presence of clinical signs of PCS, pathologic blood reflux (>0.5 second) in the gonadal veins, valvular incompetence of the parametrium and uterine veins according to transvaginal

Discussion

Surgical and endovascular interventions on the gonadal veins developed at the end of the twentieth century for the treatment of PCS14,15 have been successfully used to date. The use of new embolizing agents and the development of endoscopic interventions on the ovarian veins made it possible to significantly improve the quality of treatment for patients with PCS, but did not answer the question of which method is preferable in decreasing blood flow through the ovarian veins. The attractiveness

Conclusions

Endovascular and endoscopic interventions on the gonadal veins are highly effective and safe in eliminating pathologic blood reflux along the gonadal veins and in the PVP relief in PCS. The obvious advantages of EEGV should be recognized as minimal trauma and the ability to perform the procedure under local anesthesia. Endoscopic resection of the ovarian veins is associated with at least similar and, in some cases, even superior outcomes in treating patients with PCS, and PVP relief, in the

Author contributions

Conception and design: SG, AS

Analysis and interpretation: SG, AS, GK, EM, NM

Data collection: SG, AS, GK, EM, NM

Writing the article: SG, AS

Critical revision of the article: SG, AS, GK, EM, NM

Final approval of the article: SG, AS, GK, EM, NM

Statistical analysis: GK, EM, NM

Obtained funding: Not applicable

Overall responsibility: SG

References (26)

  • S.G. Gavrilov

    Pelvic varicose veins: when and how to treat? «Flebologiya»

    J Venous Disord

    (2007)
  • V.N. Shipovsky et al.

    Endovascular embolization of ovarian veins in pelvic varicose veins

    Angiol Sosud Khir

    (2008)
  • S.J. Dos Santos et al.

    Long-term results of transjugular coil embolisation for pelvic vein reflux - results of the abolition of venous reflux at 6-8 years

    Phlebology

    (2016)

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    Author conflict of interest: none.

    The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.

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    © 2020 by the Society for Vascular Surgery. Published by Elsevier Inc.