Optimization of the tactics of endovascular treatment of chronic pelvic pain syndrome caused by varicous diseases of the pelvic veins in women

Abstract

Objective – to improve the selection criteria and the algorithm for examining patients with chro-nic pelvic pain syndrome caused by varicose pelvis veins. Optimize the technique of embolization of ovarian veins and veins of the pelvic venous plexus, to improve the results of endovascular treatment and prevent possible complications that may arise during the embolization procedure. Materials and methods. The analysis of 24 sources of scientific and medical literature on the problem of etiology, pathogenesis, diagnostic and endovascular treatment of chronic pelvic pain syndrome in women by embolization of ovarian veins and veins of the pelvic venous plexus. The authors present their own results of endovascular treatment of 31 patients with varicose veins of the small pelvis and ovarian veins. Results. The improved patient selection criteria based on careful history taking, preoperative confirmation of ovarian and pelvic varicose veins. The technique of phlebographic examination, embolization of ovarian veins and veins of the pelvic venous plexus was optimized. The causes of complications that arise during the embolization procedure have been analyzed. Practical recommendations for endovascular surgeons are given for the prevention of such complications in the future. Conclusions. The failure of the ovarian and pelvic veins underlies the etiology of pelvis veins varicose. Pain syndrome against the background of pelvis veins varicose is the main reason for referring to gynecologists in 10–30 % of cases. Selective phlebography of the ovarian and pelvic veins has become the gold standard in the diagnosis of venous pelvic insufficiency, since only this technique is most likely to show the connection between the incompetent ovarian and internal iliac veins. Conservative therapy of pelvic congestion syndrome often turns out to be ineffective, and surgical approaches do not exclude organ loss. Endovascular surgery showed a disappearing or decrease in the clinical manifestations of chronic pelvic pain syndrome by up to 94 %, while maintaining a positive treatment result for up to 12–36 months. The main complication during embolization is the migration of the coils to the right heart and pulmonary artery. Careful adherence to the embolization technique, the correct selection of the length and diameter of the coil can minimize the occurrence of embolic complications and improve the results of treatment of chronic pelvic pain syndrome.

Keywords

• pelvis veins varicose; pelvic congestion syndrome; chronic pelvic pain syndrome; ovarian vein embolization; pelvic venous plexus vein embolization.