Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia.
Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia.
J Vasc Surg Venous Lymphat Disord. 2023 Sep;11(5):1045-1054. doi: 10.1016/j.jvsv.2023.04.009. Epub 2023 May 6.
In the present study, we investigated the clinical outcomes after gonadal vein resection (GVR) and gonadal vein embolization (GVE) with coils in patients with pelvic venous disorder (PeVD). We also assessed the rates of procedural complications and disease recurrence.
Our multicenter retrospective cohort study included 361 female patients with PeVD-related chronic pelvic pain (CPP) and gonadal vein reflux who underwent GVR (n = 184) or GVE with coils (n = 177) from 1999 to 2020. The clinical outcomes (ie, presence and severity of CPP, procedural complications, disease recurrence) were assessed at 1 month and 1, 3, and 5 years after intervention. The pain intensity before and after treatment was assessed using a visual analog scale. All the patients underwent duplex ultrasound after GVR and GVE, and those with persistent CPP and suspected perforation of the gonadal vein by the coils were also evaluated by multiplanar pelvic venography.
GVR and GVE was associated with the reduction or elimination of CPP at 1 month after treatment in 100% and 74% of patients and postprocedural complications in 14% and 37% of patients, respectively (Р < 0.01 for both). The most common complication after either GVR or GVE was pelvic vein thrombosis (11% and 22% patients, respectively; P < .01 between groups). GVE was associated with postembolization syndrome in 20%, coil protrusion in 6%, and coil migration in 1% of patients. The long-term recurrence rate after GVR and GVE was 6% and 16%, respectively (P < .01).
Both GVR and GVE were found to be effective in treating patients with PeVD. However, GVR was associated with better efficacy in the relief of CPP and lower rates of procedural complications and disease recurrence.
本研究旨在探讨盆腔静脉疾病（PeVD）患者行精索静脉切除术（GVR）和精索静脉栓塞术（GVE）联合弹簧圈的临床疗效。我们还评估了手术并发症和疾病复发的发生率。
本多中心回顾性队列研究纳入了 1999 年至 2020 年间 361 例因 PeVD 相关慢性盆腔痛（CPP）和精索静脉反流而接受 GVR（n=184）或 GVE 联合弹簧圈（n=177）治疗的女性患者。分别于治疗后 1 个月、1、3 和 5 年评估临床疗效（即 CPP 的存在和严重程度、手术并发症、疾病复发）。治疗前后采用视觉模拟评分法评估疼痛强度。所有患者均在 GVR 和 GVE 后行双功超声检查，对于持续 CPP 且怀疑弹簧圈穿透精索静脉者，还进行多平面盆腔静脉造影检查。
GVR 和 GVE 治疗后 1 个月时，分别有 100%和 74%的患者 CPP 减轻或消除，分别有 14%和 37%的患者发生术后并发症（均 P<0.01）。两种方法术后最常见的并发症均为盆腔静脉血栓形成（分别为 11%和 22%；两组间比较 P<0.01）。GVE 术后还分别有 20%、6%和 1%的患者出现栓塞后综合征、弹簧圈突出和弹簧圈迁移。GVR 和 GVE 术后的长期复发率分别为 6%和 16%（P<0.01）。
GVR 和 GVE 均能有效治疗 PeVD 患者，但 GVR 在缓解 CPP 方面疗效更好，且手术并发症和疾病复发率更低。
