Long-term follow-up for the treatment of symptomatic pelvic venous insufficiency secondary to combined iliac vein stenosis and ovarian vein reflux treated with iliac vein stenting alone.

IF 2.8 2区 医学 Q2 PERIPHERAL VASCULAR DISEASE Journal of vascular surgery. Venous and lymphatic disorders Pub Date : 2024-10-17 DOI:10.1016/j.jvsv.2024.101990
Ania Trzesniowski, Gaurav Lakhanpal, Levan Sulakvelidze, Richard Kennedy, Sanjiv Lakhanpal, Peter J Pappas
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Abstract

Background: We previously reported that in women with symptomatic pelvic venous insufficiency secondary to combined iliac vein stenosis (IVS) and ovarian vein reflux (OVR), treated with iliac vein stenting alone that 78% reported complete symptom resolution up to 6 months. The purpose of this investigation was to determine the long-term effectiveness of this treatment strategy, the poststent reintervention rate and the incidence of poststent ovarian vein embolization (OVE) for residual symptoms.

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 were treated with stenting alone. Patients whose primary complaint was dysmenorrhea and/or leg symptoms were excluded from the analysis. Assessments and interventions consisted of an evaluation for other causes of pelvic venous disorder by a gynecologist, documentation of preintervention and 3-, 6-, 12-, 24-, and 36-month visual analog scale pain scores; transabdominal duplex ultrasound examination; stent type, diameter, and length; vein territory covered; and reintervention rates. All patients underwent diagnostic venography of their pelvic, left ovarian veins, and pelvic reservoirs, and intravascular ultrasound examination of their iliac veins.

Results: From February 2018 to January 2023, 141 women with a pelvic venous disorder secondary to IVS and OVR were identified. The average age was 44.7 ± 10.5 years with 3.18 ± 1.82 pregnancies. The average follow-up time for the entire cohort was 12.0 ± 12.1 months (median, 10.65 months). Types of stents were Venovo 48 (34%), Wallstent 14 (10%), and Abre 79 (56%). The most common diameter and stent lengths used were 14 and 16 mm and 140 and 150 mm, respectively. The most common vein territories covered were the inferior vena cava to the left external iliac vein in 83% and inferior vena cava to right external iliac vein in 13%. Pelvic and dyspareunia VAS scores before the intervention and at 3, 6, 12, 24, and 36 months after the intervention were as follows: 6.4 ± 73 (n = 141), 2.6 ± 3.3 (n = 98), 1.71 ± 2.83 (n = 77), 2.04 ± 3.5 (n = 76), 2.4 ± 3.7 (n = 30), and 1.15 ± 3 (n = 13) (P ≤ .001). Of the entire cohort no patients required OVE and pelvic reservoir embolization. Pelvic reservoirs were present in 113 of 141 patients (83%). Stent reinterventions were required in 19 of 141 patients (13%).

Conclusions: The majority of women with pelvic pain secondary to combined IVS and OVR achieved near complete symptom resolution with iliac vein stenting alone, despite the presence of a pelvic reservoir in 83% of patients. Although most women complained of some minimal residual pelvic pain or dyspareunia, the majority were satisfied with their outcomes and did not require further intervention. In this patient population, iliac vein stenting should be considered the primary treatment modality. OVE should be reserved for patients with persistent or recurrent pelvic pain unresolved with stenting.

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单用髂静脉支架治疗合并髂静脉狭窄和卵巢静脉反流引起的症状性盆腔静脉功能不全的长期随访。
简介我们曾报道过,在合并髂静脉狭窄(IVS)和卵巢静脉反流(OVR)的症状性盆腔静脉功能不全(PVI)女性患者中,78%的患者在接受单纯髂静脉支架治疗后6个月内症状完全消失。这项调查的目的是确定这种治疗策略的长期有效性、支架术后再次介入率以及支架术后卵巢静脉栓塞(OVE)治疗残余症状的发生率:方法:我们对血管医学中心前瞻性收集的数据进行了回顾性分析。我们调查了因合并 IVS 和 OVR 而继发盆腔疼痛或排便困难的妇女,她们都接受了单纯支架治疗。主诉为痛经和/或腿部症状的患者不在分析范围内。评估和干预措施包括:由妇科医生评估是否有其他原因导致PeVD;记录治疗前、3个月、6个月、12个月、24个月和36个月的视觉模拟疼痛评分(VAS);经腹双相超声检查;支架类型、直径、长度、覆盖静脉区域和再干预率。所有患者均接受了盆腔、左卵巢静脉、盆腔储血池的诊断性静脉造影术和髂静脉血管内超声造影术:从2018年2月至2023年1月,共发现141名继发于IVS和OVR的盆腔静脉疾病(PeVD)女性。平均年龄为(44.7±10.5)岁,妊娠次数为(3.18±1.82)次。平均随访时间为(12±12.1)个月(中位:10.65个月)。支架类型如下Venovo 48(34%)、Wallstent 14(10%)、Abre 79(56%)。最常用的支架直径和长度分别为 14 毫米和 16 毫米以及 140 毫米和 150 毫米。最常覆盖的静脉区域是下腔静脉(IVC)至左髂外静脉(83%)和IVC至右髂外静脉(13%)。干预前、干预后 3、6、12、24 和 36 个月的骨盆和排便障碍 VAS 评分如下:6.4±73(n=141)、2.6±3.3(n=98)、1.71±2.83(n=77)、2.04±3.5(n=76)、2.4±3.7(n=30)和 1.15±3(n=13)(P≤0.001)。在所有患者中,没有患者需要进行 OVE 和盆腔储库栓塞。113/141(83%)例患者存在盆腔储库。19/141(13%)名患者需要进行支架再介入治疗:结论:尽管 83% 的患者存在盆腔蓄水池,但大多数因 IVS 和 OVR 合并症而继发盆腔疼痛的女性患者在单纯髂静脉支架置入术后症状得到了近乎完全的缓解。虽然大多数女性都抱怨有轻微的残余盆腔疼痛或排便困难,但她们中的大多数人都对治疗结果感到满意,不需要进一步干预。在这类患者中,髂静脉支架植入术应被视为主要治疗方式。卵巢切除术应保留给持续或复发性盆腔疼痛且支架植入术无法解决的患者。
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来源期刊
Journal of vascular surgery. Venous and lymphatic disorders
Journal of vascular surgery. Venous and lymphatic disorders SURGERYPERIPHERAL VASCULAR DISEASE&n-PERIPHERAL VASCULAR DISEASE
CiteScore
6.30
自引率
18.80%
发文量
328
审稿时长
71 days
期刊介绍: Journal of Vascular Surgery: Venous and Lymphatic Disorders is one of a series of specialist journals launched by the Journal of Vascular Surgery. It aims to be the premier international Journal of medical, endovascular and surgical management of venous and lymphatic disorders. It publishes high quality clinical, research, case reports, techniques, and practice manuscripts related to all aspects of venous and lymphatic disorders, including malformations and wound care, with an emphasis on the practicing clinician. The journal seeks to provide novel and timely information to vascular surgeons, interventionalists, phlebologists, wound care specialists, and allied health professionals who treat patients presenting with vascular and lymphatic disorders. As the official publication of The Society for Vascular Surgery and the American Venous Forum, the Journal will publish, after peer review, selected papers presented at the annual meeting of these organizations and affiliated vascular societies, as well as original articles from members and non-members.
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