Dos Santos Scott J, Holdstock Judy M, Harrison Charmaine C, Whiteley Mark S
1 The Whiteley Clinic, Stirling House, Guildford, Surrey, UK.
2 Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK.
Phlebology. 2017 Feb;32(1):27-33. doi: 10.1177/0268355515623898. Epub 2016 Jul 9.
Background Pelvic venous reflux has been proven to contribute to the development of primary and recurrent varicose veins, vulval/labial varicose veins and pelvic congestion syndrome. It is associated with lower limb varicose veins in 20% of patients who have a history of at least one prior vaginal delivery. Pelvic vein embolisation is known to be a safe and effective treatment for the abolition of pelvic venous reflux. However, the effect of a subsequent pregnancy on a previously embolised patient remains largely unknown. This study aims to report the effect of pregnancy on patients that have undergone pelvic vein embolisation. Methods Patients that had previously undergone pelvic vein embolisation for pelvic venous reflux at our unit were sent a questionnaire asking if they had had a pregnancy and subsequently delivered post-embolisation. Patients responding positively were invited to attend our unit for transvaginal duplex ultrasonography of their pelvic veins. Post-pregnancy transvaginal duplex ultrasonography results were compared to pre-embolisation and 6-week post-embolisation scans. Results Eight women, aged 32-48 years (mean 38.8), were retrospectively analysed. Parity prior to embolisation ranged from 1 to 5 (mean 2.8). Initial outcomes at 6 weeks Pelvic venous reflux was completely eliminated in five patients, two patients achieved complete elimination of truncal reflux with very minor vulval reflux and one patient had persistent, mild reflux in the right internal iliac vein. Post-pregnancy outcomes Pelvic venous reflux was completely eliminated in three patients and five patients displayed pelvic venous reflux in at least one truncal vein, with or without concurrent vulval reflux. No patient showed any coil displacement or embolisation as a result of the pregnancy. Conclusions Pregnancy is associated with recurrent reflux in the pelvic veins in women who had previously been treated with coil embolisation. Following recovery from pregnancy, repeat embolisation can eliminate recurrent reflux. Pregnancy appears to be safe following coil embolisation of pelvic veins.
背景 盆腔静脉反流已被证实与原发性和复发性静脉曲张、外阴/阴唇静脉曲张以及盆腔淤血综合征的发生有关。在有至少一次既往阴道分娩史的患者中，20%与下肢静脉曲张相关。盆腔静脉栓塞术是一种已知的安全有效的消除盆腔静脉反流的治疗方法。然而，后续妊娠对先前接受栓塞治疗的患者的影响在很大程度上仍不清楚。本研究旨在报告妊娠对接受盆腔静脉栓塞术患者的影响。
方法 向我们单位先前因盆腔静脉反流接受盆腔静脉栓塞术的患者发送问卷，询问他们是否怀孕以及栓塞术后是否分娩。对回答为阳性的患者邀请其到我们单位进行盆腔静脉经阴道双功超声检查。将妊娠后的经阴道双功超声检查结果与栓塞术前及栓塞术后6周的扫描结果进行比较。
结果 对8名年龄在32 - 48岁（平均38.8岁）的女性进行了回顾性分析。栓塞术前的产次范围为1至5次（平均2.8次）。
6周时的初始结果 5例患者盆腔静脉反流完全消除，2例患者主干反流完全消除，仅有非常轻微的外阴反流，1例患者右侧髂内静脉持续存在轻度反流。
妊娠后的结果 3例患者盆腔静脉反流完全消除，5例患者至少有一条主干静脉出现盆腔静脉反流，伴有或不伴有外阴反流。没有患者因妊娠出现任何线圈移位或栓塞。
结论 妊娠与先前接受线圈栓塞治疗的女性盆腔静脉反流复发有关。妊娠恢复后，重复栓塞可消除复发的反流。盆腔静脉线圈栓塞术后妊娠似乎是安全的。
