Vascular Surgery Department, Mansoura Faculty of Medicine, Mansoura, Egypt.
Vascular Surgery Department, Mansoura Faculty of Medicine, Mansoura, Egypt.
J Vasc Surg Venous Lymphat Disord. 2023 Jul;11(4):801-808. doi: 10.1016/j.jvsv.2022.10.018. Epub 2023 Mar 30.
Chronic pelvic pain in women is a disorder brought on by pelvic vein incompetence (PVI). In this prospective, randomized study, the effects of percutaneous coil embolization and surgical ovarian vein ligation and division combined with retrograde sclerotherapy were compared with regard to ovarian vein occlusion, improvement of pelvic congestion symptoms, and their influence on estradiol level after intervention.
A total of 50 patients with PVI were enrolled, with a mean age of 31.9 ± 4.7 years and a pain score of 9 (range, 0-10; from 0 [no pain] to 10 [the highest level of pain]). Both percutaneous coil embolization of ovarian veins (endovascular group) and surgical ovarian vein ablation with retrograde sclerotherapy were offered to the patients at random.
In the open group, the pain level decreased to 2, whereas in the endovascular group, it decreased to 1 (range, 0-10). Estradiol levels were 224 (range, 9-612) in the open group and 478 (range, 18-613) in the endovascular group before the intervention, with no significant change (P = .1120). After 1 week of intervention, estradiol levels in the open group were 89 (range, 18-243) and 124 (range, 22-298) in the endovascular group, respectively, with statistical insignificance (P = .225). After 1 month of intervention, the endovascular group's estradiol level was 101 (range, 20-196) and the open group's was 89 (range, 15-190) (P = .382). After 3 months of intervention, the open group's estradiol level was 78 (range, 12-132) and the endovascular group's was 65 (range, 18-110) (P = .045).
In addressing PVI, both methods seemed to have promising results. Nevertheless, endovascular management was more effective at decreasing estrogen levels and relieving discomfort. Three months should be the time at which estradiol levels are measured, because this is when they are at their lowest. In both the open and endovascular groups as well as in the pooled data, there was a significant association between estradiol level from before the intervention and improvement in pain scores (P = .005). Because it was linked to a lower pain score, the high preoperative estradiol level can be used to predict postintervention improvement.
女性慢性盆腔痛是由盆腔静脉功能不全（PVI）引起的疾病。在这项前瞻性、随机研究中，比较了经皮线圈栓塞术和卵巢静脉结扎及逆行硬化治疗联合手术治疗对卵巢静脉闭塞、盆腔充血症状改善的影响，以及对干预后雌二醇水平的影响。
共纳入 50 例 PVI 患者，平均年龄 31.9±4.7 岁，疼痛评分为 9 分（0-10 分；0 分[无痛]至 10 分[最高疼痛水平]）。随机向患者提供经皮卵巢静脉线圈栓塞（血管内组）和卵巢静脉消融联合逆行硬化治疗。
在开放组中，疼痛程度降至 2 分，而在血管内组中，疼痛程度降至 1 分（0-10 分）。开放组干预前雌二醇水平为 224（9-612），血管内组为 478（18-613），差异无统计学意义（P=0.1120）。干预后 1 周，开放组雌二醇水平分别为 89（18-243）和 124（22-298），差异无统计学意义（P=0.225）。干预后 1 个月，血管内组雌二醇水平为 101（20-196），开放组为 89（15-190）（P=0.382）。干预后 3 个月，开放组雌二醇水平为 78（12-132），血管内组为 65（18-110）（P=0.045）。
在治疗 PVI 方面，两种方法似乎都有很好的效果。然而，血管内治疗在降低雌激素水平和缓解不适方面更有效。应在 3 个月时测量雌二醇水平，因为此时水平最低。在开放组、血管内组和汇总数据中，雌二醇水平与疼痛评分的改善呈显著正相关（P=0.005）。由于术前高雌二醇水平与较低的疼痛评分相关，因此可用于预测术后改善。
