Senechal Quentin, Echegut Perrine, Bravetti Marine, Florin Marie, Jarboui Lamia, Bouaboua Mehdi, Teriitehau Christophe, Feignoux Jacques, Legou Francois, Pessis Eric
Centre Cardiologique du Nord, Saint-Denis, France.
Front Cardiovasc Med. 2021 Nov 17;8:751178. doi: 10.3389/fcvm.2021.751178. eCollection 2021.
To evaluate medium-term clinical outcomes of transcatheter embolization and stenting in women with several pelvic venous disorders responsible for chronic pelvic pain and varicose veins of the lower limbs. The study population included 327 consecutively recruited patients referred to the interventional radiology unit from January 2014 to December 2019 due to chronic pelvic congestion (91; 27.83%), lower limb varices (15; 4.59%), or a combination of both the symptoms (221; 67.58%). Preprocedural pelvic, transvaginal Doppler ultrasound (US), and MRI were conducted in all the patients and revealed anatomical varicosities and incompetent pelvic veins in 312 patients. In all the patients, selective catheterization demonstrated uterine venous engorgement, ovarian plexus congestion, or pelvic vein filling. Retrograde flow was detected on catheter venography in the left ovarian vein (250; 78%), the right ovarian vein (85; 26%), the left internal iliac vein (222; 68%), and the right internal iliac vein (185; 57%). Patients were followed-up at 1, 6, and 12 months, and years thereafter systematically by the referring angiologist and the interventional radiologist of center. They were contacted by telephone in November and December 2020 to assess pain perception and quality of life by using the visual analog scales from 0 to 10 with assessments made at the baseline and last follow-up. Of the 327 patients (mean age, 42 ± 12 years), 312 patients were suffering from pelvic congestion syndrome and 236 patients was suffering from lower limb varices. All underwent embolization by using ethylene vinyl alcohol copolymer (Onyx). Eighty-five right ovarian veins, 249 left ovarian veins, 510 tributaries of the right internal iliac vein, and 624 tributaries of the left internal iliac vein were embolized. A cohort of patients also underwent nutcracker syndrome angioplasty (6.7%) and May-Thurner syndrome angioplasty (14%) with a stent placement. The initial technical success rate was 80.9% for embolization of pathological veins and 100% for stenting of stenoses. Overall, 307 patients attended 12-month follow-up visits and 288 (82%) patients completed the telephone survey at mean 39 (±18)-month postintervention. Main pelvic pain significantly improved from 6.9 (±2.4) pre- to 2.0 (±2.4) postembolization ( < 0.001), as did specific symptoms in each category. Improvement or disappearance of pain was achieved in 266/288 (92.36%) patients with improved quality of life in 276/288 (95.8%) patients. There were 16 minor and 4 major adverse events reported on the follow-up. Pelvic vein embolization (Onyx) is an effective and safe procedure with high clinical success and quality of life improvement rates.
评估经导管栓塞和支架置入术对患有多种导致慢性盆腔疼痛和下肢静脉曲张的盆腔静脉疾病的女性的中期临床疗效。研究人群包括2014年1月至2019年12月因慢性盆腔充血（91例；27.83%）、下肢静脉曲张（15例；4.59%）或两者症状兼具（221例；67.58%）而连续招募至介入放射科的327例患者。所有患者均在术前接受盆腔、经阴道多普勒超声（US）和MRI检查，结果显示312例患者存在解剖学上的静脉曲张和盆腔静脉功能不全。所有患者经选择性插管均显示子宫静脉充血、卵巢丛充血或盆腔静脉充盈。在导管静脉造影中，左侧卵巢静脉（250例；78%）、右侧卵巢静脉（85例；26%）、左侧髂内静脉（222例；68%）和右侧髂内静脉（185例；57%）检测到逆流。患者在术后1个月、6个月和12个月接受随访，此后由转诊的血管造影医师和中心的介入放射科医师进行系统随访。在2020年11月和12月通过电话联系患者，使用0至10的视觉模拟量表评估疼痛感知和生活质量，评估在基线和最后一次随访时进行。在327例患者（平均年龄42±12岁）中，312例患有盆腔充血综合征，236例患有下肢静脉曲张。所有患者均使用乙烯-乙烯醇共聚物（Onyx）进行栓塞。85条右侧卵巢静脉、249条左侧卵巢静脉、510条右侧髂内静脉分支和624条左侧髂内静脉分支接受了栓塞。一组患者还接受了胡桃夹综合征血管成形术（6.7%）和May-Thurner综合征血管成形术（14%）并置入支架。病理性静脉栓塞的初始技术成功率为�0.9%，狭窄部位支架置入的成功率为100%。总体而言，307例患者参加了12个月的随访，288例（82%）患者在干预后平均39（±18）个月完成了电话调查。主要盆腔疼痛从栓塞前的6.9（±2.4）显著改善至2.0（±2.4）（<0.001），各分类中的特定症状也有改善。266/288（92.36%）的患者疼痛得到改善或消失，276/288（95.8%）的患者生活质量得到改善。随访期间报告了16例轻微不良事件和4例严重不良事件。盆腔静脉栓塞（Onyx）是一种有效且安全的手术，临床成功率和生活质量改善率高。
