MRI associated factors of clinical efficacy of embolization in patients with pelvic venous insufficiency.

PURPOSE: The purpose of this study was to identify anatomical findings at magnetic resonance imaging (MRI) associated with successful percutaneous embolization in women with pelvic venous insufficiency (PVI). MATERIAL AND METHODS: Between 2008 and 2018, 168 consecutive women (mean age, 39±9 [SD] years; range: 21-69 years) who underwent percutaneous embolization for PVI confirmed by MRI and phlebography were included. Clinical efficacy of embolization was evaluated by patients' opinion or visual analogue scale. Associated factors of success of embolization were searched by comparing MRI findings in women with successful embolization with those in women with failed embolization using univariate analyses. RESULTS: The mean follow-up was 36±29 (SD) months (range: 12-138 months). Clinical efficacy of embolization was obtained in 126/168 women (75%), complete symptom improvement in 33/168 women (20%) and significant partial improvement in 92/168 women (55%). No symptom improvement and symptoms exacerbation were observed in 17/168 (10%) and 2/168 (1%) women, respectively. At univariate analysis, right ovarian vein diameter≤7mm and vulvar varicosities were associated with successful embolization (P=0.04 and P=0.01, respectively) and left ovarian vein diameter≤7mm was associated with a complete improvement of symptoms (P=0.03). At multivariate analysis, a small right ovarian vein diameter was the single MRI variable associated with clinical efficacy of embolization (P=0.04). CONCLUSION: Small ovarian vein diameters on MRI are associated with best clinical efficacy of percutaneous embolization in PVI. Right ovarian vein diameter>7mm should warrant further phlebography to exclude venous insufficiency.

Evaluation of the efficacy of endovascular treatment of pelvic congestion syndrome.

AIM: To assess the efficacy of venous embolization treatment for the pelvic congestion syndrome (PCS). PATIENTS AND METHODS: Retrospective study of 33 female patients undergoing pelvic venous embolization between January 2008 and May 2012 in Bordeaux. The inclusion criteria were clinical symptoms of PCS documented by transabdominal Doppler ultrasound and/or pelvic magnetic resonance imaging. Patients with pelvic varicose veins feeding saphenous varicose veins were excluded. The efficacy of treatment was assessed on a Visual Analog Scale (VAS). RESULTS: Thirty-three patients were included and the mean follow up period was 26months (3-59months). The VAS was 7.37 (standard deviation: 0.99) before embolization and 1.36 (standard deviation: 1.73) after embolization (P<0.0001). Twenty patients reported that their symptoms had completely disappeared, 11 had partially disappeared and two had gained no improvement. A significant fall was found in the number of patients with dyspareunia (P<0.0001). A single technical embolization failure was reported. CONCLUSION: Our series demonstrates the efficacy of embolization treatment with a significant fall in the VAS in patients with PCS.

[Pelvi-perineal venous insufficiency and varicose veins of the lower limbs: duplex Doppler diagnosis and endoluminal treatment in thirty females]. / Insuffisance veineuse pelvipérinéale et varices des membres inférieurs. Diagnostic par écho-doppler et traitement endoluminal chez trente patientes.

Pelvic congestion is the most commonly recognized consequence of pelvi-perineal venous insufficiency (PPVI). The implication of PPVI in the generation of varicoceles and varicose veins of the lower limbs arising from perineal varices has not been studied specifically. We report our duplex-Doppler findings in a series of 150 women seen over a period of 36 months. All patients presented perineal varices and, more specifically, utero-ovarian venous reflux. Thirty women were retained for phlebography then treatment by embolization. All of the left utero-ovarian veins were incontinent, the right utero-ovarian vein could not be explored in one patient, and only three of the eight opacified veins were incontinent. Twenty-two patients presented an associated incontinence of the hypogastric branch (7 left, 15 bilateral). Embolization was performed on 29 left utero-ovarian veins and one right vein with, as complementary treatment, embolization of 15 hypogastric branches, six during a second session. There were no serious complications. At six months (range 2-20 months), no improvement was noted in 10% of the patients, symptoms had improved or the varices had diminished in 59%, and all symptoms had disappeared in 31%. A duplex-Doppler exploration should be performed to search for perineal involvement in all patients presenting varicose veins of the lower limbs. The good preliminary results obtained after embolization of the pelvic veins, and particularly the left utero-ovarian vein, suggests this therapeutic approach should be pursued. The long-term effect should be assessed because of the plexiform nature of recurrent venous disorders.