Our experience in the endovascular treatment of female varicocele Poster No.: C-0347 Congress: ECR 2013 Type: Authors: Keywords: DOI: Scientific Exhibit A. Sáez de Ocáriz García, M. M. Mendigana Ramos, F. Urtasun Grijalba, I. Insausti Gorbea, A. Martínez De la Cuesta, A. Gargallo Vaamonde; Pamplona/ES Interventional vascular, Catheter venography, CT-Angiography, MR-Angiography, Embolisation, Varices 10.1594/ecr2013/C-0347 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 9
Purpose Female varicocele is a common health problem among women, characterised by more than six months pelvic pain, associated with pressure and heaviness, due to a venous dilatation and congestion because of valvular insufficiency in ovarian veins. The prevalence of pelvic congestion syndrome is related to the frequency of ovarian varicose veins that appear in 10% of the women population. A 60% of those women will develop Pelvic Congestion Syndrome. The aim of this study was to analyse the results of the endovascular treatment in patients with chronic pelvic pain due to female varicocele (Pelvic Congestion Syndrome). Methods and Materials Patients' selection: Between November 2002 and June 2011, 15 women (the main age was 44.5 years and the range was 31-66 years) were referred to our section from Vascular Surgery Service with suspicion of pelvic congestion syndrome. The clinical presentation was: pelvic pain (53.3%), heaviness (33.3%) and painful menstruation and sex (PMS) (13.4%) (Graphic 1). In 10 of them the symptomatology was also associated to pelvic varicose veins (1 case), genital varicose veins (4 cases) and inferior extremities varicose veins (5 cases). Technique: The diagnostic techniques of female varicocele were flebography in 11 patients, MRA in 2, CT angiography in 1 case and US in 1 out of 15 patients (Graphic 2). Embolisation was performed via right basilic vein, by affected internal ovarian vein catheterisation. In 8 of the cases were emboloisated left ovarian veins and in 7 of them both right and left ovarian veins, using coils as embolisation material in all of the them (15 patients). Page 2 of 9
After embolisation, all patients underwent clinical follow-up. Images for this section: Fig. 1: Graphic 1: Clinical presentation. Page 3 of 9
Fig. 2: Graphic 2: Diagnostic techniques. Page 4 of 9
Results As it is shown in Table 1, the embolisation was technically successful in 100% of the cases. In 5 of them (33.4%) reembolisation was necessary due to symptomatology recurrence (cases 3, 4, 11, 14 and 15). None of them had complications due to embolisation. In 14 out of 15 patients (93.4%) was achieved a significant clinical improvement. We show a case of a 42 year old woman with pelvic heaviness and abdominal pain. An abdomino-pelvic CT angiography was performed, proceeding after that to the left ovarian varicocele embolisation. After 2 years with persistent symptoms, bilateral embolisation was performed, achieving clinical remission (Figures 1, 2 and 3). Images for this section: Table 1 Page 5 of 9
Fig. 3: CT Angiography: 64 row CT with intravenous contrast in arterial and venous phases, with multiplanar reconstruction, MIP and 3D. Page 6 of 9
Fig. 4: First embolization Page 7 of 9
Fig. 5: Second embolization Page 8 of 9
Conclusion Endovascular treatment is an effective, safe and minimally invasive technique in the treatment of patients with female varicocele, achieving a significant improvement in patients with chronic pelvic pain due to pelvic congestion, without significant changes in ovarian function. References 1.- Hyun S. Kim, MD, Amit D. Malhotra, MD, Peter C. Rowe, MD, Judy M. Lee, MD, MPH, and Anthony C. Venbrux, MD. Embolotherapy for Pelvis Congestion Síndrome: Longterm results. J VascIntervRadiol 2006; 17:289-297. 2. -EwaKuligowska, MD, Linda Deeds, MS, III, Kang Lu, MS, III. Pelvic pain: Overlooked and underdiagnosed Gynecologic conditions. RadioGraphics 2005; 25:3-20. 3.- SigheakiUmeoka, MD, Takashi Koyama, MD, Kaori Togashi, MD, Hisato Kobayashi, MD, KeizoAkuta, MD. RadioGraphics 2004; 24:193-208. Personal Information Page 9 of 9