Journal of Vascular Surgery: Venous and Lymphatic Disorders ( IF 2.8 ) Pub Date : 2021-03-18 , DOI: 10.1016/j.jvsv.2021.03.006
Gaurav Lakhanpal 1 , Rick Kennedy 1 , Sanjiv Lakhanpal 2 , Levan Sulakvelidze 1 , Peter J Pappas 2
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Background
We have previously reported that in women with a pelvic venous disorder secondary to pelvic venous insufficiency, 56% will present with an iliac vein stenosis (IVS) and ovarian vein reflux (OVR). The purpose of the present investigation was to determine whether women with combined disease can be treated using iliac vein stenting alone.
Methods
A retrospective review of prospectively collected data at the Center for Vascular Medicine was performed. We investigated women with pelvic pain or dyspareunia secondary to combined IVS and OVR who had undergone stenting alone. The patient demographics, pre- and 6-month postoperative visual analog scale (VAS) for pain scores, stent type, stent diameter, stent length, and ovarian vein diameters were assessed. All patients had undergone diagnostic venography of their pelvic veins, left ovarian veins, and pelvic reservoirs and intravascular ultrasonography of their iliac veins.
Results
From May 2016 to October 2019, 82 patients with a pelvic venous disorder secondary to IVS and OVR were identified. The present data analysis focused on 38 patients with complete pre- and postoperative VAS scores and duplex scan stent patency data at 6 months. The pelvic and dyspareunia VAS scores at the initial and 6-month follow-up visits were as follows: 6.83 ± 3.19 and 4.24 ± 2.65 and 1.72 ± 2.01 and 0.05 ± 2.0, respectively (P ≤ .001). At 6 months, 29 of the 38 women (76%) reported complete resolution of all symptoms, 26 of 28 (93%) reported complete resolution of their dyspareunia, 5 of 38 (13%) reported significant improvement, and 4 of 38 (10%) reported no improvement. The average ovarian vein diameter was 6.7 ± 2.5 mm. The average stent size and length was 18.20 ± 1.6 mm and 92.41 ± 18.5 mm, with 25 placed in the left common iliac, 2 in the right common iliac vein, and 3 bilaterally. Of the 38 patients, 7 required reintervention (18%). An untreated pelvic reservoir was observed in 17 of the 38 patients (44%). One of the two with no response and six of the patients with improvement had OVR and an untreated pelvic reservoir. The remaining 10 patients with a pelvic reservoir had experienced complete resolution of their symptoms with stenting alone.
Conclusions
Of the 38 women with pelvic pain secondary to combined IVS and OVR, 76% achieved complete symptom resolution with iliac vein stenting alone. Most of the women with a pelvic reservoir were asymptomatic and reported full symptom resolution after stenting alone. However, these data suggest that in some women, a relationship might exist between the presence of a pelvic reservoir and the persistence of symptoms. Therefore, for women with combined IVS and OVR, we recommend iliac vein stenting alone and staged ovarian vein embolization only for women with persistent symptoms.
中文翻译：
单纯髂静脉支架治疗继发于髂静脉狭窄和卵巢静脉反流的盆腔静脉功能不全
背景
我们之前曾报道，在继发于盆腔静脉功能不全的盆腔静脉疾病女性中，56% 的女性会出现髂静脉狭窄 (IVS) 和卵巢静脉反流 (OVR)。本研究的目的是确定是否可以单独使用髂静脉支架治疗合并疾病的女性。
方法
对血管医学中心前瞻性收集的数据进行了回顾性审查。我们调查了仅接受支架置入术的 IVS 和 OVR 联合继发性盆腔疼痛或性交困难的女性。评估了患者的人口统计学、术后前和术后 6 个月的疼痛评分、支架类型、支架直径、支架长度和卵巢静脉直径的视觉模拟量表 (VAS)。所有患者均接受了盆腔静脉、左侧卵巢静脉和盆腔储库的诊断性静脉造影以及髂静脉的血管内超声检查。
结果
从 2016 年 5 月到 2019 年 10 月，确定了 82 名继发于 IVS 和 OVR 的盆腔静脉疾病患者。目前的数据分析集中在 38 名患者的 6 个月时具有完整的术前和术后 VAS 评分和双工扫描支架通畅数据。初次和 6 个月随访时的盆腔和性交困难 VAS 评分如下：分别为 6.83 ± 3.19 和 4.24 ± 2.65 和 1.72 ± 2.01 和 0.05 ± 2.0（P≤ .001)。在 6 个月时，38 名女性中有 29 名（76%）报告所有症状完全消退，28 名女性中有 26 名（93%）报告性交困难完全消退，38 名女性中有 5 名（13%）报告有显着改善，38 名女性中有 4 名（ 10%) 报告没有改善。卵巢静脉平均直径为 6.7 ± 2.5 mm。平均支架尺寸和长度分别为 18.20 ± 1.6 mm 和 92.41 ± 18.5 mm，其中左侧髂总静脉 25 个，右侧髂总静脉 2 个，双侧 3 个。在 38 名患者中，7 名需要再次干预（18%）。38 名患者中有 17 名 (44%) 观察到未经治疗的盆腔贮水池。两名没有反应的患者和六名改善的患者中的一名患有 OVR 和未经治疗的盆腔储液罐。其余 10 名盆腔蓄积病患者仅通过支架置入即可完全缓解症状。
结论
在 IVS 和 OVR 联合后继发盆腔疼痛的 38 名女性中，76% 的患者仅通过髂静脉支架即可完全缓解症状。大多数有盆腔储层的女性没有症状，仅在支架植入后症状完全消失。然而，这些数据表明，在某些女性中，盆腔蓄水池的存在与症状的持续存在之间可能存在关系。因此，对于 IVS 和 OVR 联合的女性，我们建议仅对有持续症状的女性进行髂静脉支架置入术和分期卵巢静脉栓塞术。
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