Mechanochemical endovenous obliteration of the gonadal vein (case report)

• Akhmetzianov R.V.
• Bredikhin R.A.
• Markin S.M.
• Volodyukhin M.Yu.

Abstract

Presented herein is a clinical case report regarding mechanochemical obliteration of the gonadal vein in a 42-year-old female patient suffering from manifestations of pelvic venous plethora for 6 previous years. The examination revealed a primary form of pelvic varicose disease with dilatation of the left ovarian and uterine veins, bilateral veins of the pampiniform plexus.

In conditions of the X-ray operating room, inserted into the lumen of the left ovarian vein was the Flebogrif device for mechanical ablation. Appropriate application of the device with simultaneous administration of a sclerosing agent resulted in mechanical and chemical damage of the venous wall. The outcome thus obtained was cessation of intraluminal blood flow. The woman was examined at 3, 6, 12 and 24 months postoperatively. Reduction of venous reflux was accompanied by normalization of pelvic phlebohemodynamics and regression of clinical symptomatology, confirmed by clinical and instrumental methods of examination.

This case report demonstrates feasibility, efficacy and safety of the procedure performed. The developed mechanochemical method makes it possible to improve outcomes of surgical treatment of women with pelvic varicose veins, since it is devoid of a series of disadvantages intrinsic to the traditional type of endovascular treatment involving implantation of foreign material in the form of embolizing microcoils. To confirm this hypothesis, it is necessary to carry out randomized comparative trials with participation of a sufficient number of patients.

Keywords:pelvic varicose veins; pelvic venous plethora syndrome; gonadal veins; ovarian vein; mechanochemical obliteration; Flebogrif; endovascular embolization

References

1. Daniels J.P., Champaneria R., Shah L., et al. Effectiveness of Embolization or Sclerotherapy of Pelvic Veins for Reducing Chronic Pelvic Pain: A Systematic Review. Journal of Vascular and Interventional Radiology. 2016; 27 (10): 1478–1486.e8. DOI: https://doi.org/10.1016/j.jvir.2016.04.016

2. Liu J., Han L., Han X. The Effect of a Subsequent Pregnancy After Ovarian Vein Embolization in Patients with Infertility Caused by Pelvic Congestion Syndrome. Academic Radiology. 2019; 26 (10):1373–1377. DOI: https://doi.org/10.1016/j.acra.2018.12.024

3. Gavrilov S.G., Krasavin G.V., Mishakina N.Yu., Kirsanov K.V. Post-Embolization Syndrome after Endovascular Interventions on the Gonadal Veins. Flebologiya. 2020; 14 (3): 214–220. DOI: https://doi.org/10.17116/flebo202014031214 (in Russian)

4. Leatherby R.J., Harries P., Shah S.S. The management of pelvic congestion syndrome – a word of caution. Journal of Obstetrics and Gynaecology. 2020; 40 (2): 283–284. DOI: https://doi.org/10.1080/01443615.2019.1599333

5. Stamm A., Kozlowski P., Brandenberger J. Surgical solution to an intracorporeal nickel allergy. Nature Reviews Urology. 2017; 19 (3): 195–197. DOI: https://doi.org/10.3909/riu0769.

6. Witte M.E., Zeebregts C.J., de Borst G.J., Reijnen M.M., Boersma D. Me-chanochemical endovenous ablation of saphenous veins using the ClariVein: A systematic review. Phlebology. 2017; 32 (10): 649–657. DOI: https://doi.org/10.1177/0268355517702068

7. Khryshchanovich V.Ya., Klimchuk I. P., Proczka R., et al. Results of Truncal Endovenous Mechano-Chemical Ablationin Varicose Disease. Novosti Khirurgii. 2019; 27 (6): 630–639. DOI: https://doi.org/10.18484/2305-0047.2019.6.630 (in Russian)

8. Ahmetzianov R.V., Bredihin R.A., Fomina E.E. Quality of Life Assessment in Patients with Pelvic Varicose Veins. Flebologiya. 2019; 13 (2): 133–139. DOI: https://doi.org/10.17116/flebo201913021133. (in Russian)

9. Ahmetzianov R.V., Bredihin R.A., Fomina E.E., Ignat’ev I.M. Method of determining disease severity in women with pelvic varicose veins. Angiology and Vascular Surgery. 2019; 25 (3): 79–86. DOI: https://doi.org/10.33529/2019303. (in Russian)

10. Gavrilov S.G., Sazhin A.V., Krasavin G.V., et al. Comparative Analysis of Efficacy and Safety of Endovascular and Endoscopic Interventions on the Gonadal Veins in the Treatment of Pelvic Congestion Syndrome. Flebologiya. 2020; 14 (3): 175–183. DOI: https://doi.org/10.17116/flebo202014031175. (in Russian)

11. Lopez A.J. Female pelvic vein embolization: indications, techniques and outcomes. CardioVascular and Interventional Radiology. 2015; 38 (4): 806–820. DOI: https://doi.org/10.1007/s00270-015-1074-7

12. Champaneria R., Shah L., Moss J., et al. The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness. Health Technology Assessment. 2016; 20 (5): 1–108. DOI: https://doi.org/10.3310/hta20050

13. Mahmoud O., Vikatmaa P., Aho P., et al. Efficacy of endovascular treatment for pelvic congestion syndrome. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2016; 4 (3): 355–370. DOI: https://doi.org/10.1016/j.jvsv.2016.01.002

14. Kim H.S., Malhotra A.D., Rowe P.C., et al. Embolotherapy for pelvic congestion syndrome: long-term results. Journal of Vascular and Interventional Radiology. 2006; 17 (2 Pt 1): 289–297. DOI: https://doi.org/10.1097/01.RVI.0000194870.11980.F8

15. Laborda A. Medrano J., de Blas I., et al. Endovascular treatment of pelvic congestion syndrome: visual analog scale (VAS) long-term follow-up clinical evaluation in 202 patients. CardioVascular and Interventional Radiology. 2013; 36 (4): 1006–1014. DOI: https://doi.org/10.1007/s00270-013-0586-2

16. Pyra K., Woźniak S., Drelich-Zbroja A., et al. Evaluation of Effectiveness of Embolization in Pelvic Congestion Syndrome with the New Vascular Occlusion Device (Art Ventive EOS™): Preliminary Results. CardioVascular and Interventional Radiology. 2016; 39 (8): 1122–1127. DOI: https://doi.org/10.1007/s00270-016-1380-8