Complications of Gonadal Vein Embolization with Coils: Causes and Consequences

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OBJECTIVE

To study the incidence and causes of complications after GVE with coils in patients with PCS.

MATERIAL AND METHODS

A retrospective cohort study included 150 female patients with PCS who underwent GVE with coils between 2000 and 2021. GVE was performed according to standard technique. Gianturco coils were used in 23% of patients, MReye coils — in 77% of patients. Severity of pain before and after procedure was assessed using a visual analogue scale (VAS). All patients underwent Doppler ultrasound after GVE. Patients with persistent pain syndrome and suspected gonadal vein perforation required CT venography. Complications after GVE were recorded within 30 days after procedure. We assessed unfavorable events according to the Society for Interventional Radiology (SIR) grading system.

RESULTS

Within 30 days after GVE, pelvic pain decreased in 109 (72.6%) patients (from preoperative 8.2±1.5 to 1.7±0.8 scores after surgery; p=0.002) and persisted in 41 (27.4%) patients (8.1±0.7 scores at baseline and 7.8±0.4 scores after embolization; p=0.71). Complications occurred in 85 (56.6%) patients. Minor complications included access-site hematoma (4%) and allergic reactions (1.3%). Major adverse events included protrusion of coils (5.3%), post-embolization syndrome (22%), thrombosis of parametrial, uterine and deep veins of the calf (24%).

CONCLUSION

GVE with coils in the treatment of PCS is often associated with complications. Improvement of GVE technique, new embolization agents, choice of treatment approach depending on constitutional characteristics of patients and postoperative anticoagulation will be valuable to minimize postoperative morbidity.

Keywords:

pelvic congestion syndrome

chronic pelvic pain

gonadal vein embolization with coils

complications

Authors:

Gavrilov S.G.

Pirogov Russian National Research Medical University

SPIN RSCI: 7375-4712
Scopus AuthorID: 8312153800
ResearcherID: E-6089-2016
ORCID: 0000-0002-2307-2176

Mishakina N.Yu.

Pirogov Russian National Research Medical University

ORCID: 0000-0002-3626-0299

Kirsanov K.V.

Pirogov Russian National Research Medical University

Efremova O.I.

Pirogov Russian National Research Medical University

SPIN RSCI: 2387-8935
Scopus AuthorID: 55790396800
ORCID: 0000-0001-5906-8120

Received:

20.04.2022

Accepted:

12.05.2022

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