Evaluation of effectiveness of endovascular embolisation for the treatment of pelvic congestion syndrome – preliminary study
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(14) 2 1. Zakład Radiologii Zabiegowej i Neuroradiologii Uniwersytetu Medycznego w Lublinie, Polska III Katedra i Klinika Ginekologii Uniwersytetu Medycznego w Lublinie, Polska 3 Zakład Radiologii Lekarskiej i Medycyny Nuklearnej Uniwersytetu Medycznego w Lublinie, Polska 2. Abstract Objectives: The Aim: The aim of the study was to evaluate the effectiveness, safety and clinical outcomes of endovascular embolisation of pelvic congestion syndrome (PCS). Material and methods: This prospective, observational study carried out between January and May of 2014 encompassed 24 female patients aged 22-44 years (average - 31 years) diagnosed with PCS. Diagnosis of PCS was established by medical history, physical examination, transvaginal Doppler ultrasound examination and confirmed by MRI. The patients were qualified for phlebography and ovarian vein embolization with 0.035” detachable coils and/or microcoils. Pelvic pain scores were assessed before and 3 months after the procedure with the visual analog scale (VAS; 0 – no pain, 10 – unbearable pain). Results: Embolisation procedures were performed in 23 out of 24 patients. Nineteen patients underwent unilateral and 4 patients bilateral embolisation of the ovarian vein. In one case, safe and selective vessel catheterization was not possible due to the anatomical variant of venous flow. Nineteen patients underwent unilateral embolisation of the left ovarian vein. Four patients had the left and right ovarian veins embolized; in one of them, the internal iliac vein was additionally closed (the two-stage procedure). The technical success rate was 96%. Procedures lasted 23-78 minutes (32 minutes on average). An average of 40 ml of contrast was administered during the procedures. The total mean radiation dose at the reference point was 389 mGy (from 127 mGy to 1112 mGy). A decrease in pelvic pain intensity according to VAS was considered a clinical success. The median VAS pelvic pain score before the procedure was 8. Three months after the procedure median pelvic pain score decreased to 1 (p < 0.001). In two cases, the ovarian vein was injured and the contrast medium extravasated, which was clinically insignificant. In one case, a small injection site haematoma developed. Conclusion: Embolisation is a minimally invasive, effective and safe method of treatment for PCS. The cooperation between gynaecologists and interventional radiologists is essential for successful outcomes.. Key words: embolisation / pelvic congestion syndrome / ovarian vein embolisation /. Adres do korespondencji: Krzysztof Pyra Zakład Radiologii Zabiegowej i Neuroradiologii Uniwersytetu Medycznego w Lublinie Polska, 20-954 Lublin, ul. Jaczewskiego 8 Tel./fax.: +48 81 7244154 e-mail: k.pyra@poczta.fm. 346. © Polskie Towarzystwo Ginekologiczne. Otrzymano: 12.11.2014 Zaakceptowano do druku: 15.01.2015. Nr 5/2015.
(15) Ginekol Pol. 2015, 86, 346-351. P R A C E. O R Y G I N A L N E g i n e kol og i a. Krzysztof Pyra, et al. Evaluation of effectiveness of endovascular embolisation for the treatment of pelvic congestion syndrome – preliminary study.. Streszczenie Cel pracy: Celem badania była ocena skuteczności, bezpieczeństwa i wyniku klinicznego przeznaczyniowej embolizacji zespołu przekrwienia biernego miednicy. Materiał i metody: W prospektywnym, obserwacyjnym badaniu od stycznia do maja 2014 do zabiegu embolizacji PCS zakwalifikowano 24 chore, w wieku od 22 do 44 lat (średnio 31). Diagnozę postawiono na podstawie objawów klinicznych, badania fizykalnego, przezpochwowego USG Doppler i/lub MRI. Pacjentki zakwalifikowano do badania czynnościowego układu żylnego, flebografii i ewentualnej embolizacji żył jajnikowych przy użyciu spiral. Ocenianio średnie nasilenie dolegliwości bólowych miednicy w wizualnej skali analogowej VAS przed i 3 miesiące po zabiegu embolizacji. Wyniki: Zabieg wykonano u 23 z 24 chorych. U 19 chorych wykonano jednostronną embolizację lewej żyły jajnikowej. U 4 pacjentek wykonano embolizację lewej i prawej żyły jajnikowej. Sukces techniczny wyniósł 96 %. Procedury trwały od 23 do 78 min (średnio 32 minuty). W czasie zabiegu podano średnio 40 ml kontrastu. Łączna średnia dawka promieniowania w punkcie referencyjnym wyniosła 389 mGy. Za sukces kliniczny uznano zmniejszenie stopnia natężenia bólu w miednicy mierzonej w skali VAS. Średni ból miednicy w skali VAS przed zabiegiem wynosił 8 pkt. Trzy miesiące po zabiegu ból miednicy w skali VAS zmniejszył się do 1 (p < 0.001). W dwóch przypadkach doszło do wynaczynienia środka cieniującego bez znaczenia klinicznego. Wnioski: Embolizacja w leczeniu PCS jest małoinwazyjną, skuteczną i bezpieczną metodą leczenia. Współpraca ginekologa i radiologia zabiegowego odgrywa tutaj kluczową rolę.. Słowa kluczowe: embolizacja /
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