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Hanna J, Bruinsma J, Temperley HC, Fernando D, O'Sullivan N, Hanna M, Brennan I, Ponosh S. Efficacy of embolotherapy for the treatment of pelvic congestion syndrome: A systematic review. Ir J Med Sci 2024; 193:1441-1451. [PMID: 38294607 PMCID: PMC11128397 DOI: 10.1007/s11845-024-03608-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
Pelvic congestion syndrome (PCS) poses a significant health, diagnostic, and economic challenges. Transcatheter embolisation has emerged as a promising treatment for PCS. A systematic review was performed in order to assess the safety and efficacy of transcatheter embolisation in the treatment of PCS. A systematic search of electronic databases was performed using 'PubMed', 'Embase', 'Medline (OVID)', and 'Web of Science', for articles pertaining to efficacy of embolotherapy for the treatment of pelvic congestion syndrome. A total of 25 studies were included in this systematic review with a combined total of 2038 patients. All patients included were female with a mean average age of 37.65 (31-51). Of the 25 studies, 18/25 studies reported pre- and post-procedural pelvic pain outcomes using a visual analogue scale (VAS). All studies showed a reduction in VAS post-procedure. Transcatheter embolisation had a high technical success rate (94%) and an overall complication rate of 9.0%, of which 10.4% were major and 89.6% were minor. Fifteen out of 19 (78.9%) major complications required a subsequent intervention. Transcatheter embolisation using various techniques is effective and safe in treating PCS. A low quality of evidence limits the currently available literature; however, embolisation has shown to improve symptoms in the majority of patients with low complication rates and recurrence rates.
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Affiliation(s)
- Joseph Hanna
- Department of Surgery, St. John of God Subiaco, Perth, WA, Australia
| | - Joshua Bruinsma
- Department of Surgery, St. John of God Subiaco, Perth, WA, Australia
| | | | | | | | - Mark Hanna
- Department of Surgery, St. John of God Subiaco, Perth, WA, Australia
| | - Ian Brennan
- Department of Radiology, St. James's Hospital, Dublin, Ireland
| | - Stefan Ponosh
- Department of Surgery, St. John of God Subiaco, Perth, WA, Australia
- Ponosh Vascular, Hollywood Consulting Centre, Perth, WA, Australia
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Kavallieros K, Pope T, Tan M, Kaur H, Gianesini S, Lazarashvili Z, Jaworucka-Kaczorowska A, Narayanan S, Gwozdz AM, Davies AH. Identification of outcomes in clinical studies for pelvic venous disorders. J Vasc Surg Venous Lymphat Disord 2024:101865. [PMID: 38452895 DOI: 10.1016/j.jvsv.2024.101865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/19/2024] [Accepted: 02/17/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE There is increasing recognition that health systems need to measure and improve the value of patient care by measuring outcomes. Chronic pelvic pain secondary to pelvic venous insufficiency can have a significant impact on the quality of life (QOL) of women affected. Despite growing recognition, pelvic venous disorders (PeVDs), an important cause of chronic pelvic pain, remain underdiagnosed. Developing a core outcome set (COS) for benchmarking care delivery enhances the standardization of care. However, there is no consensus regarding a standardized minimum set of outcomes for PeVD. We aimed to generate a list of outcomes reported in previous PeVD treatment studies to lay the foundation for developing a COS for PeVD. METHODS This scoping review was undertaken according to the PRISMA-ScR guidelines. Initially, screening, full-text review and extraction was conducted on studies published between 2018 and 2023. Subsequently, the search was expanded using 1-year intervals, until, over a 1-year interval, no new outcomes were recorded. Closely related outcomes were classified into domains, and domains into three core areas: disease-specific, treatment-related, and QOL-related outcomes. RESULTS Of the 1579 records identified, 51 publications were included. From these studies, 108 different outcomes were identified. The median number of outcomes per study was 8 (interquartile range, 6-13). Closely related outcomes were organized into 42 outcome domains, which were then categorized into 3 core outcome areas; 47.6% (20/42) were disease specific, 35.7% (15/42) treatment related, and 16.7% (7/42) were QOL related. Of the 51 included studies, disease-specific outcomes were identified in 96.1% of the studies (49/51), treatment-related outcomes in 94.1% (48/51), and QOL outcomes in only 13.7% (7/51). CONCLUSIONS There was significant heterogeneity in outcomes reported in PeVD studies. Most PeVD treatment studies evaluated disease-specific and treatment-related outcomes of PeVD, but few reported outcomes that measured the impact on QOL. These findings will inform the next steps in developing a COS for PeVD.
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Affiliation(s)
- Konstantinos Kavallieros
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tasneem Pope
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Matthew Tan
- Section of Vascular Surgery, Department of Surgery and Cancer, London, UK
| | - Harmeena Kaur
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sergio Gianesini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD
| | | | | | - Sriram Narayanan
- Venus Clinic and The Harley Street Heart and Vascular Centre, Singapore, Singapore
| | - Adam M Gwozdz
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Alun H Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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Galea M, Brincat MR, Calleja-Agius J. A review of the pathophysiology and evidence-based management of varicoceles and pelvic congestion syndrome. HUM FERTIL 2023; 26:1597-1608. [PMID: 37190955 DOI: 10.1080/14647273.2023.2212846] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 04/25/2023] [Indexed: 05/17/2023]
Abstract
Pelvic congestion syndrome (PCS) in females and varicoceles in males may be regarded as closely related conditions since the main pathophysiological cause for both processes is pelvic venous insufficiency. Varicoceles are more prevalent amongst sub-fertile males, with an approximate incidence of 15% in the general male population. PCS is commonly diagnosed amongst premenopausal multiparous women, representing one of the leading causes of chronic pelvic pain. Both conditions appear to be predominantly left-sided and are associated with oxidative stress and pro-inflammatory cascades with subsequent effects on fertility. Clinical examination and pelvic ultrasonography play an essential role in the assessment of varicoceles, PCS and chronic pelvic pain. Venography is generally considered as a gold-standard procedure for both conditions. There is still much debate on how these conditions should be managed. This review article provides a comparative analysis of the underlying pathophysiological mechanisms of both PCS and varicoceles, their impact on fertility, as well as their clinical management.
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Affiliation(s)
- Matteo Galea
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Mark R Brincat
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Department of Obstetrics and Gynaecology, Mater Dei Hospital, Msida, Malta
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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CARVALHO SFCD, METZGER. PB, FERNANDEZ MG, RIBEIRO WB, NOGUEIRA AKS, SOUZA JPRE. PELVIC VENOUS REFLUX EMBOLIZATION IN THE TREATMENT OF SYMPTOMATIC PELVIC CONGESTIVE SYNDROME: A SYSTEMATIC REVIEW WITH META-ANALYSIS. J Vasc Surg Venous Lymphat Disord 2022. [DOI: 10.1016/j.jvsv.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Arnaoutoglou C, Variawa RS, Zarogoulidis P, Ioannidis A, Machairiotis N. Advances of Laparoscopy for the Diagnosis of Pelvic Congestion Syndrome. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1041. [PMID: 34684078 PMCID: PMC8539457 DOI: 10.3390/medicina57101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/13/2021] [Accepted: 09/26/2021] [Indexed: 11/25/2022]
Abstract
The objective of this review is to describe the effectiveness of laparoscopy in the diagnosis and treatment of pelvic congestion syndrome (PCS). PCS is a cause of chronic pelvic pain (CPP) and is associated with dysfunction of the pelvic venous system. PCS is more common in women of reproductive age, and hormonal changes are associated with its development along with other reasons (e.g., working and living habits). There is an urgent need to establish an effective algorithm for the diagnosis and treatment of CPP, which could have a dramatic effect in patients' everyday life. This algorithm should be able to overcome known issues that lead to the underdiagnosis of PCS, such as the overlap of its symptoms with other diseases. Here, we present our findings from literature articles about the methods used in practice today for the diagnosis of this syndrome. We also compare the methods to propose the most promising technique for providing a diagnosis with high accuracy. In our understanding, laparoscopy is superior when compared to other methods. It can provide a diagnosis of PCS while excluding or identifying other comorbidities and can also lead toward the next steps for the treatment of PCS.
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Affiliation(s)
- Christos Arnaoutoglou
- 1st Department of Obstetrics & Gynecology, Papageorgiou Hospital, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Rita S. Variawa
- Independent Pharmacovigilance (Evaluation & Risk Management) Scientist, London E14 4HB, UK;
| | - Paul Zarogoulidis
- 3rd Surgery Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece;
| | - Aris Ioannidis
- Surgery Department, “Genesis” Private Clinic, 57001 Thessaloniki, Greece;
| | - Nikolaos Machairiotis
- Fellow in Endometriosis and Minimal Access Surgery, Northwick Park, Central Middlesex and Ealing Hospitals, Acton Ln, London NW10 7NS, UK;
- London North West University Healthcare NHS Trust, London HA1 3UJ, UK
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Akhmetzianov RV, Bredikhin RA, Ignat'ev IM. [Immediate and remote results of endovascular embolization of ovarian veins]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:49-60. [PMID: 33332306 DOI: 10.33529/angio2020410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Presented in the article is a prospective study of endovascular embolization of ovarian veins in female patients suffering from primary pelvic varicose veins, with the assessment of the immediate and remote results, as well as a 1-year follow up. AIM The aim of our investigation was a comprehensive clinical and instrumental assessment of efficacy of endovascular embolization in women with pelvic varicose veins. PATIENTS AND METHODS Our single-centre study included a total of 29 female patients presenting with pelvic varicose veins and undergoing embolization of ovarian veins using microcoils, in 5 cases the procedure was supplemented with injecting a foam sclerosant. RESULTS The technical success of endovascular occlusion of ovarian veins amounted to 100%. Two women immediately after the operation were subjected to a redo intervention: in one case - resection of the ovarian vein and in the second case - repositioning of the microcoils. In the remote period, one patient due to recurrent relapses underwent repeat embolization followed by retroperitoneal resection of the ovarian vein. The findings of the clinical methods of examination demonstrated a decrease in the intensity of manifestations of pelvic varicose veins according to the pelvic venous clinical severity score and visual analogue scale, as well as improvement of the women's quality of life. CONCLUSION Endovascular occlusion of ovarian veins is a highly effective, minimally invasive, and safe method of treatment of female patients with incompetent ovarian veins. Endovascular treatment may be regarded as a method of choice in management of the primary form of pelvic varicose veins.
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Affiliation(s)
- R V Akhmetzianov
- Department of Vascular Surgery, Interregional Clinical and Diagnostic Centre, Kazan, Russia; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
| | - R A Bredikhin
- Department of Vascular Surgery, Interregional Clinical and Diagnostic Centre, Kazan, Russia; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
| | - I M Ignat'ev
- Department of Vascular Surgery, Interregional Clinical and Diagnostic Centre, Kazan, Russia; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
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Moriarty HK, Clements W, Koukounaras J, S Goh G, Joseph T, Phan T. ArtVentive endoluminal occlusion system for proximal splenic artery embolization. Diagn Interv Radiol 2020; 26:488-491. [PMID: 32673205 DOI: 10.5152/dir.2020.19417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We aimed to discuss and evaluate the technical success and efficacy of the ArtVentive endoluminal occlusion system (EOS) device for splenic embolization. A retrospective review was undertaken for all patients in whom the EOS device was deployed for the purpose of splenic embolization. Data was collected by a search of splenic artery embolization procedures in the hospital computer database. Data was reviewed for all patients in whom an EOS plug was deployed. Patient demographics, technical aspects of the procedure and follow-up at one month were reviewed. We review the technical success and efficacy of this occlusion device. Six patients underwent splenic embolization with the EOS plug. There were 5 male and 1 female patients; age range was 24-88 years. Five 8 mm and one 5 mm EOS plugs were deployed for the occlusion of the splenic artery. The technical success rate was 100% occurring in all 6 splenic arteries. One patient underwent a second angiogram and subsequent splenectomy for persistent splenic hemorrhage. One patient had a subsequent splenectomy for bacteremia with the spleen as the suspected source. This early data supports the efficacy of the EOS plug for the embolization of the proximal splenic artery.
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Affiliation(s)
| | - Warren Clements
- Department of Radiology, Alfred hospital, Melbourne, Australia;Department of Surgery, Monash University, Clayton, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred hospital, Melbourne, Australia;Department of Surgery, Monash University, Clayton, Australia
| | - Gerard S Goh
- Department of Radiology, Alfred hospital, Melbourne, Australia;Department of Surgery, Monash University, Clayton, Australia
| | - Tim Joseph
- Department of Radiology, Alfred hospital, Melbourne, Australia
| | - Tuan Phan
- Department of Radiology, Alfred hospital, Melbourne, Australia
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Comprehensive review of pelvic congestion syndrome: causes, symptoms, treatment options. Curr Opin Obstet Gynecol 2020; 32:237-242. [DOI: 10.1097/gco.0000000000000637] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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9
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Yetkin E, Ozturk S, Cuglan B, Turhan H. Symptoms in Dilating Venous Disease. Curr Cardiol Rev 2020; 16:164-172. [PMID: 32164514 PMCID: PMC7536814 DOI: 10.2174/1573403x16666200312101245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/08/2020] [Accepted: 02/14/2020] [Indexed: 11/22/2022] Open
Abstract
Lower extremity venous diseases or insufficiency include clinically deteriorating conditions with morphological and functional alterations of the venous system, including venous hypertension, vascular wall structural abnormality, and venous valvar incompetency in association with an inflammatory process. In fact, the same pathophysiological processes are the main underlying mechanisms of other venous insufficiencies in different vascular territories such as Peripheral Varicose Vein (PVV), varicocele, Pelvic Varicosities or Congestion Syndrome (PCS) and Hemorrhoidal Disease (HD). Regarding the anatomical continuity of lower extremity venous system, urogenital system (pampiniform plexus in male and broad ligament and ovarian veins in female) and anorectal venous system, it is reasonable to expect common symptoms such as pain, burning sensation, pruritis, swelling, which arise directly from the involved tissue itself. High coexistence rate of PVV, varicocele/PCS and HD between each other underlines not only the same vascular wall abnormality as an underlying etiology but also the existence of common symptoms originating from the involved tissue in dilating venous disease. Accordingly, it might be reasonable to query the common symptoms of venous dilating disease in other venous vascular regions in patients with complaints of any particular venous territory.
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Affiliation(s)
- Ertan Yetkin
- Address correspondence to this author at the Department of Cardiology, Istinye University Liv Hospital, Istanbul, Turkey; Tel: +90 532 713 6721; E-mail:
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Antignani PL, Lazarashvili Z, Monedero JL, Ezpeleta SZ, Whiteley MS, Khilnani NM, Meissner MH, Wittens CH, Kurstjens RL, Belova L, Bokuchava M, Elkashishi WT, Jeanneret-Gris C, Geroulakos G, Gianesini S, de Graaf R, Krzanowski M, Al Tarazi L, Tessari L, Wikkeling M. Diagnosis and treatment of pelvic congestion syndrome: UIP consensus document. INT ANGIOL 2019; 38:265-283. [PMID: 31345010 DOI: 10.23736/s0392-9590.19.04237-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | | | - Javier L Monedero
- Unity of Vascular Pathology, Ruber Internacional Hospital, Madrid, Spain
| | - Santiago Z Ezpeleta
- Unity of Radiology for Vascular Diseases, Ruber Internacional Hospital, Madrid, Spain
| | | | - Neil M Khilnani
- Division of Interventional Radiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Mark H Meissner
- University of Washington School of Medicine, Seattle, WA, USA
| | - Cees H Wittens
- Department of Venous Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ralph L Kurstjens
- Department of Obstetrics and Gynecology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Ludmila Belova
- Faculty of Medicine, Ulyanovsk State University, Ulyanovsk, Russia
| | - Mamuka Bokuchava
- Tbilisi State Medical University, N. Bokhua Memorial Cardiovascular Center, Tbilisi, Georgia
| | | | - Christina Jeanneret-Gris
- Department of Angiology, University Clinic of Internal Medicine, KSBL Bruderholz, Baselland, Switzerland
| | - George Geroulakos
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
| | | | - Rick de Graaf
- Clinic for Diagnostic and Interventional Radiology/Nuclear Medicine, Clinical Center of Friedrichshafen, Friedrichshafen, Germany
| | | | - Louay Al Tarazi
- Varicose Veins and Vascular Polyclinic (VVVC), Damascus, Syria
| | - Lorenzo Tessari
- Bassi-Tessari Foundation, Veins&Lymphatics Association ONLUS, Varese, Italy
| | - Marald Wikkeling
- Department of Vascular Surgery Heelkunde Friesland, Location MCL and Nij Smellinghe Hospital, Drachten, the Netherlands
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Almeida GRD, Silvinato A, Simões RS, Buzzini RF, Bernardo WM. Pelvic congestion syndrome - treatment with pelvic varicose veins embolization. Rev Assoc Med Bras (1992) 2019; 65:518-523. [DOI: 10.1590/1806-9282.65.4.518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2018] [Indexed: 11/22/2022] Open
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12
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Kuetting D, Meyer C, Schild HH, Pieper CC. In Vitro Evaluation of the Occlusive Properties of the ArtVentive Endoluminal Occlusion System Occlusion Device for Transrenal Ureteral Occlusion. J Endourol 2017; 31:1084-1089. [PMID: 28816077 DOI: 10.1089/end.2017.0493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Current techniques for percutaneous ureteral occlusion are either technically difficult or not satisfactory because of frequent ureteral recanalization. The purpose of this in vitro study was to evaluate the occlusive properties of an "off the shelf" solution (Endoluminal Occlusion System [EOS™]; ArtVentive Medical Group, Inc., Carlsbad, CA) for transrenal ureteral occlusion. MATERIALS AND METHODS Both 8 and 11 mm expanded polytetrafluoroethylene-covered ArtVentive EOS devices were used in 10 porcine models. Experiments were performed in explanted porcine ureters to simulate physiologic conditions. EOS devices were deployed in a midureteral position using a transrenal approach. Contrast agent (Iopamidol 300) diluted in saline solution was infused into the renal pelvis under continuous fluoroscopic guidance. Intrapelvic pressure measurements were performed until leakage, plug dislocation, or until pelvic blow out occurred. RESULTS All EOS devices were deployed effectively and achieved prompt total ureteral occlusion. Ureteral leakage occurred with intraureteral pressures between 60 to 109 cm H2O (8 mm EOS) and between 65 and 125 cm H2O (11 mm EOS). Before leakage, tubular reflux was seen in all cases, pelvic blowout occurred in half of the cases. CONCLUSIONS The ArtVentive EOS occlusive device is an effective tool for "off the shelf" ureteral occlusion. Both the 8 mm and the 11 mm devices fully occluded ureters at pressure levels that are to be expected in vivo.
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Affiliation(s)
| | - Carsten Meyer
- Department of Radiology, University of Bonn , Bonn, Germany
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Marcelin C, Izaaryene J, Castelli M, Barral PA, Jacquier A, Vidal V, Bartoli JM. Embolization of ovarian vein for pelvic congestion syndrome with ethylene vinyl alcohol copolymer (Onyx ®). Diagn Interv Imaging 2017. [PMID: 28647478 DOI: 10.1016/j.diii.2017.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of pelvic embolization using ethylene vinyl alcohol copolymer (Onyx®) for pelvic congestion syndrome. MATERIAL AND METHODS Between March 2012 to September 2016, 17 women (mean age, 44.7± 12.2 (SD) years; range: 34-71years) presenting with pelvic congestion syndrome were evaluated for transvenous embolization with Onyx®. Pelvic congestion syndrome was initially diagnosed by clinical examination and the results of transvaginal Doppler ultrasound and further confirmed by pelvic venography. Primary and secondary clinical efficacy was defined respectively by the resolution of the symptoms after embolization and at the end of the follow-up, irrespective to the number of embolization procedures. RESULTS Technical efficacy of embolization was 100% with no significant complications during and after embolization. After a mean follow-up time of 24.2 months (range: 6-69months) a primary and secondary clinical efficacy of 76.4% (13/17 women) and 94.1% (16/17 women) respectively were observed. Four women (23.5%) underwent a second embolization procedure with one woman requiring a third embolization procedure. These additional embolization procedures were associated with direct puncture of vulvar varices for sclerotherapy in two women. Five women (29%) had recurrent symptoms 21 months post-treatment (7-42months). CONCLUSION Pelvic embolization using ethylene vinyl alcohol copolymer (Onyx®) has a favorable clinical success for pelvic congestion syndrome.
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Affiliation(s)
- C Marcelin
- Department of Medical Imaging, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - J Izaaryene
- Department of Medical Imaging, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - M Castelli
- Department of Medical Imaging, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - P A Barral
- Department of Medical Imaging, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - A Jacquier
- Department of Medical Imaging, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - V Vidal
- Department of Medical Imaging, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - J M Bartoli
- Department of Medical Imaging, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
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