Hartung O
Department of Vascular Surgery, CHU Nord, Marseille, France
Phlebology. 2015 Mar;30(1 Suppl):81-5. doi: 10.1177/0268355515569129.
Pelvic venous insuffiency (PVI) can be responsible for pelvic congestion syndrome (PCS) and also lower limb varicose veins.
Charts of all women who had pelvic venography for PVI from September 2013 to August 2014 were reviewed. The procedure was performed under local anesthesia through left femoral approach. In case of reflux without associated obstructive lesions, embolization with coils and polidocanol foam was performed during the same procedure.
119 women, with median age 39 years were explored (86 with PCS and 102 with lower limb venous disease). Of these, 78 had an isolated reflux and were embolized and 41 had an obstructive disease (29 iliocaval obstructive lesions (ICOL), 4 nutcracker syndrome (NCS), and 8 with an association of both). Median follow-up was 4 months. Of the 12 NCS, 5 had surgical treatment and 7 had stenting of the left iliac vein without embolization. All patients with ICOL without NCS were treated by stenting in 28 and by a Palma procedure in 1 (failure to recanalize). Primary and secondary patency rates were 97% at 12 months. Embolization led to improvement of PCS in 91% (60% without any pain) and of lower limb varicose veins in 51% by itself. If 82% need an additional treatment of lower limb varicose veins, embolization allowed a switch of strategy from surgery to sclerosis.
PVI can cause lower limb symptoms. In most cases, it is due to reflux and can be treated under local anesthesia by embolization. This technique is safe and efficient. Obstructive lesions must be recognized and treated.
盆腔静脉功能不全（PVI）可导致盆腔淤血综合征（PCS）以及下肢静脉曲张。
回顾了2013年9月至2014年8月期间因PVI接受盆腔静脉造影的所有女性患者的病历。该操作在局部麻醉下通过左股动脉入路进行。对于无相关阻塞性病变的反流情况，在同一操作过程中进行弹簧圈和聚多卡醇泡沫栓塞。
共研究了119名女性，中位年龄39岁（86例患有PCS，102例患有下肢静脉疾病）。其中，78例为单纯反流并接受了栓塞治疗，41例患有阻塞性疾病（29例髂腔静脉阻塞性病变（ICOL），4例胡桃夹综合征（NCS），8例两者合并）。中位随访时间为4个月。在12例NCS患者中，5例接受了手术治疗，7例未进行栓塞仅对左髂静脉进行了支架置入。所有无NCS的ICOL患者中，28例接受了支架置入治疗，1例接受了Palma手术（再通失败）。12个月时的原发性和继发性通畅率为97%。栓塞本身使91%的PCS得到改善（60%无任何疼痛），51%的下肢静脉曲张得到改善。如果82%的患者需要额外治疗下肢静脉曲张，栓塞可使治疗策略从手术转变为硬化治疗。
PVI可引起下肢症状。在大多数情况下，这是由于反流所致，可在局部麻醉下通过栓塞进行治疗。该技术安全有效。必须识别并治疗阻塞性病变。
