ABSTRACT
PURPOSE: To develop a strategy for the iliac vein stenting in patients with a combination of the left common iliac vein (LCIV) compression stenosis and pelvic venous insufficiency (PVI). METHODS: This prospective comparative cohort study included 55 patients with hemodynamically significant LCIV stenosis out of 285 females with PVI screened in 2014-2022. All 55 patients underwent duplex ultrasound, multi-detector computed venography, ovarian venography, and multiplanar pelvic venography. Patients underwent LCIV stenting or the left gonadal vein (LGV) embolization as the primary intervention. The endpoints (chronic pelvic pain [CPP] relief, patency of stents, and reduction in pelvic venous reflux [PVR]) were evaluated 1 and 10 days, as well as 1, 6, and 12 months after the procedure. All patients received antithrombotic therapy after the interventions. RESULTS: The primary LCIV stenting was performed in 49 patients and resulted in the CPP relief in 69.4%, pain reduction from 7.9±1.3 to 1.7±1.1 visual analog scale (VAS) scores (p=0.005), and substantial reduction of PVR in LGV (from 4.3±0.6 seconds to 1.9±0.3 seconds, p=0.003). The LGV embolization as the second stage of treatment was performed in 30.6% of patients with the LGV reflux greater than 5 seconds as a possible cause for the CPP persistence. The primary LGV embolization failed in 100% of patients (no changes in CPP and PVR). The LCIV stenting at the second stage resulted in the CPP relief within 10 days and the pelvic venous reflux (PVR) reduction. There were no complications of stenting, and the patency of stents in the follow-up period was 100%. Postembolization syndrome occurred in 9.5% of patients. No thromboses of the veins of the pelvis and lower extremities were identified. CONCLUSION: Treatment of patients with a combination of LCIV compression and PVI involves staged endovascular interventions: the LCIV stenting should be considered the first-line treatment, while the LGV embolization is performed when the PVI symptoms persist for more than 6 months and is not acceptable as the first-line treatment. CLINICAL IMPACT: The developed strategy of endovascular treatment for the combination of left common iliac vein (LCIV) and pelvic venous insufficiency (PVI) provides an effective elimination of chronic pelvic pain (CPP) and reflux in the pelvic veins and avoids unnecessary embolizations of the gonadal veins, thereby eliminating possible risks related to complications of embolization. The use of antithrombotic therapy is an effective and safe approach for preventing venous thromboembolic events after endovascular interventions.
ABSTRACT
Background: The linear geometry of the meshes undergoes significant changes after the transabdominal preperitoneal (TAPP) inguinal hernia repair, caused not only by the presence or absence of mesh fixation but also by reparative processes occurring in the area of surgical intervention. Objective: To assess the position of mesh in the preperitoneal space after the TAPP inguinal hernia repair using ultrasonography in the immediate and late postoperative periods. Materials and Methods: A total of 65 patients who underwent inguinal hernia repair with TAPP were examined. In all cases, a lightweight large-pore monofilament polypropylene mesh (size 10 × 15 cm) was used as a prosthesis. Follow-up examinations and ultrasonography of the mesh were carried out on the first postoperative day and at 1, 3, 6, and 12 months of the follow-up period. Results: Ultrasonography demonstrated mesh in two distinctly different appearances. Although it was seen as an echogenic structure with mild acoustic shadowing, the shape was either wavy or straight linear depending on the method and time elapsed from surgery. Thus, in patients without mesh fixation, it has a wavy appearance on the first day and at 1 month after TAPP, whereas at 3 months it took the appearance of a straight line, and at 12 months the implant has retained the shape of a straight line. Among patients who underwent mesh fixation in the immediate postoperative period, implant appeared as a straight line, and starting from the third month it began to acquire a wavy outline. Conclusion: Geometry of mesh used for TAPP inguinal hernia repair undergoes significantly different changes depending on the method of mesh fixation and time of postoperative period.