Optimization of the tactics of endovascular treatment of chronic pelvic pain syndrome caused by varicous diseases of the pelvic veins in women

Keywords: pelvis veins varicose; pelvic congestion syndrome; chronic pelvic pain syndrome; ovarian vein embolization; pelvic venous plexus vein embolization.

Abstract

Objective – to improve the selection criteria and the algorithm for examining patients with chro-nic pelvic pain syndrome caused by varicose pelvis veins. Optimize the technique of embolization of ovarian veins and veins of the pelvic venous plexus, to improve the results of endovascular treatment and prevent possible complications that may arise during the embolization procedure.
Materials and methods. The analysis of 24 sources of scientific and medical literature on the problem of etiology, pathogenesis, diagnostic and endovascular treatment of chronic pelvic pain syndrome in women by embolization of ovarian veins and veins of the pelvic venous plexus. The authors present their own results of endovascular treatment of 31 patients with varicose veins of the small pelvis and ovarian veins.
Results. The improved patient selection criteria based on careful history taking, preoperative confirmation of ovarian and pelvic varicose veins. The technique of phlebographic examination, embolization of ovarian veins and veins of the pelvic venous plexus was optimized. The causes of complications that arise during the embolization procedure have been analyzed. Practical recommendations for endovascular surgeons are given for the prevention of such complications in the future.
Conclusions. The failure of the ovarian and pelvic veins underlies the etiology of pelvis veins varicose. Pain syndrome against the background of pelvis veins varicose is the main reason for referring to gynecologists in 10–30 % of cases. Selective phlebography of the ovarian and pelvic veins has become the gold standard in the diagnosis of venous pelvic insufficiency, since only this technique is most likely to show the connection between the incompetent ovarian and internal iliac veins. Conservative therapy of pelvic congestion syndrome often turns out to be ineffective, and surgical approaches do not exclude organ loss. Endovascular surgery showed a disappearing or decrease in the clinical manifestations of chronic pelvic pain syndrome by up to 94 %, while maintaining a positive treatment result for up to 12–36 months. The main complication during embolization is the migration of the coils to the right heart and pulmonary artery. Careful adherence to the embolization technique, the correct selection of the length and diameter of the coil can minimize the occurrence of embolic complications and improve the results of treatment of chronic pelvic pain syndrome.

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References

Artymuk NV, Rudneva OD. Tazovaya venokongestiya kak odna iz vedushchikh prichin khronicheskoi tazovoi boli. Status Praesens. Ginekologiya, Akusherstvo, Besplodnyi Brak. 2015;4(27):42-9. (in Russian)

Nikishin LF, Popik MP. Klinicheskie lekcii po rentgenoendovaskulyarnoj hirurgii. Lvov: Kobzar; 1996. 188 p. (in Russian)

Grigorenko AN, Gordijchuk AB. Varikoznoe rasshirenie ven malogo taza i venoznyj kongestivnyj sindrom. Reproduktivnaya Endokrinologiya. 2017;6(38):42-52. https://doi.org/10.18370/2309-4117.38.42-52 (in Russian)

Verezgova SV. Rol rentgenendovaskulyarnyh metodov lecheniya varikoznoj bolezni malogo taza, sochetayushejsya s hronicheskimi tazovymi bolyami: Dis. … kand. med. nauk. SPb; 2018. 135 p. (in Russian)

Radzinskij VE, Orazov MR, Kostin IN. Hronicheskaya tazovaya bol v ginekologicheskoj praktike. Doktor.Ru. 2019;7(162):30-5. DOI: 10.31550/1727-2378-2019-162-7-30-35 (in Russian)

Lopatkin NA, Bochorishvili GG. Kliniko-diagnosticheskie paralleli pri ovarikovarikocele. Urologiya i Nefrologiya.1986;6:3-6. (in Russian)

Sokolov AA, Cvetkova NV. Varikoznoe rasshirenie ovarialnyh ven: diagnostika i lechenie. SonoAce International (Russian Edition). 1999;4:19-22. (in Russian)

Venbrux A, Chang A, Kim H et al. Pelvic congestion syndrome (pelvic venous incompetence): impact of ovarian and internal iliac vein еmbolotherapy on menstrual cycle and chronic pelvic pain. J Vasc Interv Radiol. 2002;13(2):171-8. doi: 10.1016/s1051-0443(07)61935-6.

Uralskova M V. Varikoznoe rasshirenie ven matki: diagnostika i vrachebnaya taktika: Avtoref. dis. … kand. med. nauk: 14.00.01. SPb.; 2005. 24 p. (in Russian)

Gavrilov SG. Diagnostika i lechenie varikoznoj bolezni ven taza: Avtoref. dis. … d-ra med. nauk: 14.00.27. M.; 2008. 25 p. (in Russian)

Beard R, Kennedy R, Gangar K et al. Bilateral oophorectomy and hysterectomy in the treatment of intractable pelvic pain associated with pelvic congestion. Br J Obstet Gynaecol. 1991;98:988-92. DOI: 10.1111/j.1471-0528.1991.tb15336.x

Carter J. Surgical treatment for chronic pelvic pain. J Soc Laparoendosc Surg. 1998;2:129-39. PMID: 9876726. PMCID: PMC3015288.

Edwards RD, Robertson IR, MacLean AB, Hemingway AP. Case report: pelvic pain syndrome–successful treatment of a case by ova-rian vein embolization. Clin Radiol. 1993;47:429-31. DOI: 10.1016/S0009-9260 (05) 81067-0.

Galkin EV, Grakova LS, Naumova EB. Rentgenoendovaskulyarnaya hirurgiya gipofunkcii yaichnikov pri varikoznom rasshirenii ovarialnyh ven. Vestn Rentgenol Radiol 1991;5:51-8. (in Russian)

Tarazov PG, Ryzhkov VK, Prozorovskij KV. Chrezkateternaya embolizaciya pri hronicheskom bolevom sindrome, vyzvannom varikoznym rasshireniem ovarialnyh ven. Akusherstvo i Ginekologiya.1995;4:48-9. (in Russian)

Swanton A, Reginald P. Medical management of chronic pelvic pain: The evidence. Rev Gynaecol Pract. 2004;4:65-70. DOI: 10.1016/S1471-7697(03)00090-X

Capasso P, Simons C, Dondelinger RF, Henroteaux D, Gaspard U. Treatment of symptomatic pelvic varices by ovarian vein embolization. Cardiovasc Interv Radiol. 1997;20:107-11. DOI: 10.1007/s002709900116.

Lopez AJ. Female pelvic vein embolization: indications, techniques, and outcomes. Cardiovasc Intervent Radiol. 2015;38(4):806-20. Published online 2015 Mar 25. doi: 10.1007/s00270-015-1074-7

Marsh P, Holdsock J, Harrison C et al. Pelvic vein reflux in female patients with varicose veins: comparison of incidence between a specialist private vein clinic and the vascular department of a National Health Service District General Hospital. Phlebology. 2009;24(3):108-13. doi: 10.1258/phleb.2008.008041.

Ganeshan A, Upponi S, Hon LQ, Uthappa MC, Warakaulle DR, Uberoi R. Chronic pelvic pain due to pelvic congestion syndrome: the role of diagnostic and interventional radiology. Cardiovasc Interv Radiol. 2007;30(6):1105-111. doi: 10.1007/s00270-007-9160-0.

Laborda A, Medrano J, de Blas I, Urtiaga I, Carnevale FC, de Gregorio MA. Endovascular treatment of pelvic congestion syndrome: visual analogue scale (VAS) long-term follow up clinical evaluation in 202 patients. Cardiovasc Interv Radiol. 2013;36(4):1006-14. doi: 10.1007/s00270-013-0586-2.

Lopez AJ, Holdstock J, Harrison C, Price B, Whiteley MS Transjugular pelvic vein embolization in the management of lower limb varicosities: experience gained in 1000 patients. Abstracts from Global Embolization Symposium and Technologies (May 3–6 2012). www.jvir.org/article/S1051-0443(12)00205-9/pdf

Rudik NV, Rudik IV. Emboliya legochnoj arterii inorodnymi telami. Sluchaj iz praktiki. Zaporozh Med Zhurn. 2018;20(6):873-6. (in Russian)

León FX, Alba B, Arribas A, García R, García I, Quezada C. Redkij sluchaj legochnoj embolii iz-za endovaskulyarnoj spiralnoj embolii i obzor literatury. Mezhdunar Zhurn Raspiratornaya i Legochnaya Medicina. DOI: 10.23937/2378-3516/1410094, https://clinmedjournals.org/articles/ijrpm/international-journal-of-respiratory-and-pulmonary-medicine-ijrpm-5-094.php?jid=ijrpm (in Russian)

Published
2020-12-31
How to Cite
Altman, I. (2020). Optimization of the tactics of endovascular treatment of chronic pelvic pain syndrome caused by varicous diseases of the pelvic veins in women. Endovascular Neuroradiology, 33(3), 39-55. https://doi.org/10.26683/2304-9359-2020-3(33)-39-55