Síndrome da Congestão Venosa Pélvica e resultados do tratamento endovascular: série de casos

Abstract

Pelvic Congestion Syndrome (PCS) is a cause of chronic pelvic pain that primarily affects multiparous women of reproductive age. Embolization of pelvic varicose veins offers excellent results for treatment of this syndrome. We describe an initial series of patients treated with embolization of pelvic varicose veins and their respective postoperative follow-up results. We provide clinical data, details of the procedures performed and results of follow-up and imaging exams for six patients. The technical success rate with these patients was 100% and there were no reports of serious intraoperative or postoperative complications. In all cases there was relief from symptoms and improvements in the results of imaging exams during short-term follow-up. The results of this small series of cases indicate that embolization is a safe and effective treatment for PCS.Keywords: Pelvic Congestion Syndrome; pelvic venous incompetence; chronic pelvic pain; embolization; endovascular treatment; case series. ResumoA Síndrome da Congestão Venosa Pélvica (SCVP) é uma causa de dor pélvica crônica, que afeta principalmente mulheres multíparas em idade reprodutiva. Para o tratamento desta síndrome, a embolização de varizes pélvicas tem demonstrado excelentes resultados. Relatamos uma série inicial de pacientes submetidas a tratamento com embolização de varizes pélvicas e os respectivos resultados de acompanhamento pós-operatório. São apresentados dados clínicos, detalhes do procedimento e resultados do acompanhamento e de exames de imagem de seis pacientes. Dentre estas pacientes, o sucesso técnico foi de 100% e não houve relato de complicações trans ou pós-operatórias graves. Em todos os casos, pôde-se observar alívio dos sintomas e melhora nos resultados de exames de imagens no acompanhamento de curto prazo. Os resultados nesta pequena série de casos indicam que a embolização é um tratamento seguro e efetivo para a SCVP. Palavras-chave:Síndrome da Congestão Venosa Pélvica; incompetência venosa pélvica; dor pélvica crônica; embolização; tratamento endovascular; série de casos.

Síndrome da congestão pélvica e embolização de varizes pélvicas

“…18 After ruling out other more common causes of chronic pelvic pain including endometriosis, pelvic inflammatory disease, interstitial cystitis, and leiomyomas, pelvic ultrasound is employed to view the gonadal vessels. 19 The association between PCS and lower limb venous insufficiency was demonstrated in a study conducted in Turkey, which showed that PCS was the cause of chronic pelvic pain in 30% of 100 consecutive patients, and that 70% of these cases also had symptoms of lower limb venous insufficiency, with reflux of the common femoral vein being the most frequent finding. 20…”

Tratamento endovascular de síndrome congestiva venosa pélvica em paciente com duplicação de veia cava inferior e anatomia venosa pélvica incomum: revisão bibliográfica

“…16 Although several different diagnostic methods are under analysis for their potential to identify and diagnose PVC, including transvaginal ultrasound, computed tomography, and magnetic resonance, 4,6 angiography is still the gold standard, for diagnosis both of PVC and of anatomic anomalies of the IVC and iliac veins, because it enables assessment of the different flow patterns and also allows treatment by coil embolization or decompression of venous trunks by stenting during the same intervention. 4,8,17 Certain angiographic criteria should be present to confirm a diagnosis of PVC, specifically: reflux demonstrated by proximal injection of contrast into the ovarian vein with filling of the distal ovarian venous plexus, incompetent pelvic veins with 5 to 10 mm diameters, flow stasis in the ovarian venous plexus, with visualization of pelvic veins at the median line, vulvovaginal, and proximal thighs. 6,17 There is no standardized treatment for PVC.…”

“…4,8,17 Certain angiographic criteria should be present to confirm a diagnosis of PVC, specifically: reflux demonstrated by proximal injection of contrast into the ovarian vein with filling of the distal ovarian venous plexus, incompetent pelvic veins with 5 to 10 mm diameters, flow stasis in the ovarian venous plexus, with visualization of pelvic veins at the median line, vulvovaginal, and proximal thighs. 6,17 There is no standardized treatment for PVC. All of the different treatment methods must be tailored to each patient on the basis of their symptoms and needs.…”