Transcatheter Ovarian Vein Embolization for Pelvic Congestion Syndrome: Short-Term Outcome

PURPOSE: To evaluate the short-term therapeutic effectiveness of ovarian vein embolization using coils for pelvic congestion syndrome (PCS), a common cause of chronic pelvic pain, and to determine patient satisfaction. MATERIALS AND METHODS: Forty-four multiparous women aged 26-73 (mean, 39.9) years in whom chronic pelvic pain due to unknown causes had lasted for more than six months, and whose gynecologic findings and laboratory data suggested PCS, underwent transabdominal or transvaginal ultrasonography and selective ovarian venography. PSC was finally diagnosed in 21 of th 44, who underwent 22 ovarian vein embolizations (in one case, bilaterally). The simple pain rating system was used at admission, with a 'minimal' or 'moderate' grade representing discomfort in daily life, and 'severe' indicating the need for medication. Indications for coil embolization included dilatation of the ovarian vein to a diameter of more than 6 mm, reflux involving an incompetent valve, congestion of the pelvic venous plexus (involving the stasis of contrast media), and/or opacification of the ipsilateral internal iliac vein (or contralateral filling). Embolizations were undertaken using coils of optimal size and number, and the mean follow-up period was 217 (31-267) days. By means of a telephone questionnaire, the outcome was classified as a cure, pain reduction, or 'no change, or aggravation', and on the basis of whether or not they would opt for the same treatment, or recommend embolization to others, patient satisfaction was graded as 'substantial', 'moderate', or 'absent. RESULTS: Venous occlusion was confimed at postembolization venography in all 22 cases. Clinical treatment led to symptomatic relief in 76.2% of patients a cure in 33.3% (7/21), pain reduction in 42.9% (9/21) and no imchange, or aggravation, in 23.8% (5/21). Eighteen patients (85.8%) were very (9/21, 42.9%) or moderately (9/21, 42.9%) satisfied with coil embolization. In two, the coil migrated, and was successfully retrieved using a snare loop. CONCLUSION: In this study, ovarian vein embolization using coils for PCS appeared to be both safe and effective in controlling pain. If other causes of pelvic pain are absent, it is thought to be a valuable alternative to surgical procedures.

Lymphocele Developed After Pelvic Lymphadenectomy: Treatment by Percutaneous Catheter Drainage

PURPOSE: To evaluate the efficacy of percutaneous catheter drainage for the treatment of postoperative lymphoceles following pelvic lymphadenectomy. MATERIALS AND METHODS: Between January 1995 and May 1996, 23 symptomatic lymphoceles in 20 patients who had undergone pelvic lymphadenectomy for uterine cancer were subjected to percutaneous catheter drainage under sonographic guidance. All the lymphoceles were confirmed by biochemical and cytological examination. When the amount of drainage decreased to less than 5-10ml/day and when the lymphocele was seen on US or sinography to have collapsed, the catheter was removed. US and sinography were performed to evaluate the efficacy of treatment at 1 week after catheter drainage, and all patients were followed up with US at 1, 3, and 6 months after catheter removal. RESULTS: On follow-up sonography, 20 of 23 lymphoceles (87.0%) were seen to have collapsed completely and three had recurred. Of these latter, two were treated by secondary percutaneous catheter drainage, and the other, which was asymptomatic and small, had collapsed spontaneously during the fifth months after catheter removal. Successful treatment of lymphocele was eventually achieved in all patients. The duration of catheter drainage ranged from 3 to 49 (mean, 22) days, and the size of lymphocele on initial sinogram varied from 5x4x3cm to 25x10x10cm; the total volume of drainage ranged from 300 to 17,240 (mean2,012)ml. Complications during the procedure and drainage arose in three cases. In one, there was secondary infection of the lymphocele, and in two, infection at the site of catheter insertion was seen; treatment involved changing the catheter and antibiotics. CONCLUSION: Percutaneous catheter drainage is thought to be a safe and effective alternative to surgery for the treatment of symptomatic lymphoceles following pelvic lymphadenectomy for uterine cancer.