Aug 23, 2015
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Check out these journal primer posts created by SIR-RFS committee members, and comment on the discussion questions!

Evaluation of the efficacy of endovascular treatment of pelvic congestion syndrome


SIR-RFS Journal Primer


PURPOSE

To retrospectively access the effectiveness of venous embolization treatments in pelvic congestion syndrome and to compare findings of embolization technique and clinical efficacy against findings reported in literature



QUICK SUMMARY

BOTTOM LINE
• Using a retrospective study of 33 female patients diagnosed with pelvic congestion syndrome, pelvic venous embolization was shown to be a efficacious treatment in relieving symptoms, as measured with the Visual Analog Scale (VAS).

MAJOR POINTS

• Treatment was effective in 93% of the cases
• Brachial venous approach can help avoid some of the difficulties typically experience in catheterizing the right ovarian vein
• VAS before embolization 7.37± 0.99 and VAS after embolization 1.36 ± 1.73
• 85% experienced complete improvement in dyspareunia post-treatment
• 4 cases of genital varicose veins converted to non-genital varicose veins after initial embolization
• Venous embolization treatment is effective with few side effects, but recurrence can be seen in areas that were not originally embolized

CRITICISM
• Small sample size, n= 33 at a single institution
• Retrospective study
• No studies on post-embolization pain
• Exclusion of patients with PCS involving saphenous varicose veins from sample population


STUDY DESIGN
SINGLE CENTER RETROSPECTIVE REVIEW
• 33 female patients with pelvic congestion syndrome treated with pelvic venous embolization between January 2008 and May 2012

INCLUSION CRITERIA
• Ages 20 – 65, average age 41.4
• Transabdominal Doppler ultrasound and/or pelvic MRI w/ angiography identified pelvic varicosities
• No venous return obstruction
• Dilated refluxing vein (left gonadal or pelvic) > 5 mm

EXCLUSION CRITERIA
• Patients with pelvic congestion syndrome involving saphenous varicose veins


INTERVENTION: VENOUS EMBOLIZATION
All subjects had pelvic congestion syndrome (n = 33)

PELVIC CONGESTION SYNDROME EVALUATION
• 18 cases of genital varicose veins; 1 case of non-genital varicose veins; 14 cases of mixed varicose disease
• Dilated refluxing vein (left gonadal or pelvic) > 5 mm und and diagnostic phlebography to identify the symptomatic segments
• All cases received venous embolization treatment under transdermal local anesthesia via the brachial venous approach
• Average follow up period within 26 months of initial treatment for status of symptoms

STATISTICAL ANALYSIS
• Normally distributed values were compared with the student t-test
• Non-parametric values were compared with the Wilcoxon test
• P < 0.05 was considered statistically significant


OUTCOME

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From this study population, 85% experienced a resolution of dyspareunia by the follow up period, and 93% had effective results from the venous embolization treatments. Before and after measurements of the VAS showed a significant decrease after treatment. However, there is a need for continued follow up with these patients as recurrence is likely in veins that were not embolized in the initial treatment. Overall, the results of this study were consistent with the findings of other published studies.


DISCUSSION QUESTIONS
· What would be contraindications to having pelvic venous embolization?
· What would be alternative methods of treatment for pelvic congestion syndrome?
· Why would a brachial approach be preferred in a pelvic venous embolization?
· What are some possible side effects of venous embolization?


FULL CITATION:
Hocquelet, A., Y. Le Bras, E. Bailian, M. Bouzgarrou, M. Meyer, G. Rigou, N. Grenier. “Evaluation of the efficacy of endovascular treatment of pelvic congestion syndrome.” Diagnostic and Interventional Imaging 95 (2014): 301 – 306.
 
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