Postembolization syndrome in endovascular interventions on the gonadal veins

Sg, Gavrilov; Krasavin, G.V.; Mishakina, N.Yu.; Kirsanov, Konstantin V.

doi:10.1016/j.jvsv.2020.09.003

Cited by 10 publications

(14 citation statements)

References 20 publications

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“…Hysterectomy is a surgical alternative that fails to reduce CPP symptoms and has therefore been eliminated as a first option ( 19 ). Open or laparoscopic surgery to ligate insufficient veins has been proposed as a replacement treatment ( 13 , 20 , 21 ). To date, a consensus regarding indications for either surgery or endovascular embolization of the ovarian veins is lacking, and this topic requires further research.…”

Section: Discussionmentioning

confidence: 99%

“…As previously reported ( 7 , 8 ), conventional embolic materials used for OVE include sclerosing agents and metal coils and have a clinical efficacy ranging from 58 to 93%. However, sclerotherapy involves a difficult monitoring process using fluoroscopy, and coils pose risks of migration, hypersensitivity, or further recanalization ( 7 – 13 ). Although, a consensus on which embolic materials are most suitable for OVE is lacking.…”

Section: Introductionmentioning

confidence: 99%

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Ovarian Vein Embolization With N-butyl-2 Cyanoacrylate Glubran-2® for the Treatment of Pelvic Venous Disorder

Gong

Zhao

et al. 2021

Front. Surg.

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Background: There are few reports in the literature on the use of Glubran-2 for the embolization of ovarian veins in patients with pelvic venous disorder (PeVD). In addition, a consensus on the efficacy and safety of Glubran-2 has not been reached.Purpose: To investigate the safety and efficacy of ovarian vein embolization (OVE) with N-butyl-2 cyanoacrylate (NBCA) Glubran-2 for the treatment of PeVD.Material and Methods: Between January 2013 and January 2020, 21 women (mean age, 43.9 ± 13.3 years) with PeVD who underwent OVE with Glubran-2 were evaluated. Of those patients, ovarian vein or pelvic venous plexus insufficiency was verified by duplex ultrasound and/or multislice computer tomography (MSCT). The symptoms and signs of PeVD included chronic pelvic pain (CPP) (21/21; 100%), dyspareunia (12/21; 57.1%), dysmenorrhea (10/21; 47.6%), and vulvar varices (3/21; 14.3%). The medical data were retrospectively reviewed.Results: Glubran-2 was employed as the sole embolic material in 18 cases (85.7%) and used to perform rescue embolization in 3 cases (14.3%) due to CPP recurrence 1 month after initial embolization using microcoils. Technically successful embolization was achieved using Glubran-2 in all patients. No Glubran-2 related complications were noted. Neither persistent nor recurrent CPP was observed during follow-up, for which the mean was 62 ± 38 months (range, 12–102 months). Clinical efficacy was evaluated, and all patients exhibited complete or slight improvement of CPP after embolization. The visual analog scale (VAS) score significantly decreased from pre-intervention to post-intervention (p < 0.001). Six patients (28.6%) gave birth to healthy babies during follow-up after embolization with Glubran-2.Conclusions: Ovarian vein embolization with Glubran-2 is a feasible and safe treatment for CPP secondary to PeVD. This treatment may represent a potential and attractive alternative when patients desire symptom relief and want to continue reproducing. Larger studies are warranted to confirm the findings of this study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ovarian Vein Embolization With N-butyl-2 Cyanoacrylate Glubran-2® for the Treatment of Pelvic Venous Disorder

Gong

Zhao

et al. 2021

Front. Surg.

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“…The methodology of these studies is described in detail elsewhere. 11,14 Pelvic veins (gonadal, parametrial, and uterine) were considered dilated if their diameter was greater than 5 mm. 15 Reflux in the pelvic veins was considered pathological if it lasted for more than 1 s. 15,16…”

Section: Methodsmentioning

confidence: 99%

“…In our previous studies, we have demonstrated the comparable efficacy and safety of embolization and resection of gonadal veins (GV) in the treatment of patients with PeVD and reported incidence rates of postembolization syndrome (PES) after embolization with coils. 11,14 However, previous studies were based on the evaluations of treatment outcomes by doctors. In the present study, we attempted to assess treatment results by patients in the short- and long-term period.…”

Section: Introductionmentioning

confidence: 99%

Use of a novel Likert scale instrument to assess patient satisfaction following endovascular and surgical treatment of pelvic venous disorders

Grishenkova

Mishakina

et al. 2022

Phlebology

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Objective The study was aimed at assessing satisfaction with endovascular and surgical treatment, using a novel Likert scale procedure satisfaction instrument, in patients with pelvic venous disorder (PeVD) caused by the gonadal vein reflux. Methods This prospective cohort study included 100 women with PeVD who underwent gonadal veins embolization with coils (GVE group, n = 71) or gonadal veins endoscopic resection (GVR group, n = 29) in 2012–2020. The GVE was performed under local anesthesia and sedation, and was left-sided in 61, right-sided in three, and bilateral in seven patients. The GVR was performed under general anesthesia through transperitoneal ( n = 19) or retroperitoneal ( n = 10) access with three access ports in both cases. The GVR was left-sided in 19, right-sided in one, and bilateral in nine patients. To assess satisfaction with GVE and GVR treatment of PeVD, patients were asked to evaluate statements related to their experience using a new Likert scale instrument. The responses for each item were compared between the groups at Day 7 (D7) and at Month 6 (M6) after the procedure, as was a summary score of all the responses at both time points. The summary score allowed categorization on a spectrum from “completely satisfied” to “completely dissatisfied.” Results The comparison between GVЕ and GVR groups at D7 showed that 80% and 100% of patients, accordingly, reported the overall summary satisfaction, 49% and 79% agreed with a complete pelvic pain relief by D7, 79% and 0% agreed with the absence of a significant discomfort during the first postoperative day, 71% and 100% reported no need for analgesics to relief pain in the assess area, 80% and 100% reported fast return to daily activity, and 19.7% and 100% still experienced pelvic pain at D7 (pain in the GVR group was more severe and required the use of analgesics) (all p < .05). At the same time, 94% and 96% patients were satisfied with the aesthetic result of the procedure at D7 ( p = n.s.). The comparison between GVЕ and GVR groups at M6 showed that 100% of patients in both groups reported overall satisfaction with treatment ( p = n.s.), 96% and 100% confirmed a complete pelvic pain relief by M6, 79% and 65% agreed with the absence of a significant discomfort after the procedure, 79% and 65% reported no need for analgesics, 83% and 100% reported about the return to daily activity (all p < .05), and 100% in both groups were satisfied with the aesthetic result of the procedure ( p = n.s.). Conclusions In patients with PeVD, both GVE and GVR are associated with a high, although not significantly different, overall treatment satisfaction in the long term and have advantages and disadvantages. GVE is associated with less severe post-procedural pain, while GVR provides faster relief of pelvic pain and a return to usual daily activity.

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“…Postembolization syndrome may occur in 20% of patients. It is characterised by increased pelvic pain, hyperthermia and tenderness around the embolised vein, and usually resolves with NSAIDs [ 125 ]. A potentially dangerous complication may be coil or vascular plug migration to the pulmonary artery.…”

Section: Treatmentmentioning

confidence: 99%

Comprehensive overview of the venous disorder known as pelvic congestion syndrome

2021

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Pelvic venous disorders (PeVD) also known as Pelvic Congestion Syndrome (PCS) affect a great number of women worldwide and often remain undiagnosed. Gynecological symptoms caused by vascular background demand a holistic approach for appropriate diagnosis. This is a relevant cause of chronic pelvic pain and atypical varicose veins. The diagnosis is based on imaging studies and their correlation with clinical presentation. Although the aetiology of PCS still remains unclear, it may result from a combination of factors including genetic predisposition, anatomical abnormalities, hormonal factors, damage to the vein wall, valve dysfunction, reverse blood flow, hypertension and dilatation. The following paper describes an in-depth overview of anatomy, pathophysiology, symptoms, diagnosis and treatment of PCS. In recent years, minimally invasive interventions have become the method of first choice for the treatment of this condition. The efficacy of a percutaneous approach is high and it is rarely associated with serious complications. Key Messages Pelvic venous disorders demand a holistic approach for appropriate diagnosis. This article takes an in-depth look at existing therapies of Pelvic Congestion Syndrome and pathophysiology of this condition. Embolisation is an effective and safe treatment option.

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Postembolization syndrome in endovascular interventions on the gonadal veins

Cited by 10 publications

References 20 publications

Ovarian Vein Embolization With N-butyl-2 Cyanoacrylate Glubran-2® for the Treatment of Pelvic Venous Disorder

Ovarian Vein Embolization With N-butyl-2 Cyanoacrylate Glubran-2® for the Treatment of Pelvic Venous Disorder

Use of a novel Likert scale instrument to assess patient satisfaction following endovascular and surgical treatment of pelvic venous disorders

Comprehensive overview of the venous disorder known as pelvic congestion syndrome

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