A Keep-It-Simple embolisation approach to treat Pelvic Congestion Syndrome without compromising clinical effectiveness.

Abstract

Abstract Background: There are two approaches to treat Pelvic Congestion Syndrome (PCS): 1. the Keep-It-Simple (KIS) approach, embolising only the refluxing vein(s), typically only the left ovarian vein (LOV), unless right ovarian vein (ROV), left or right internal iliac vein (IIV) tributaries were also refluxing; and 2. the extensive (EXT) approach, embolising empirically almost all of the LOV, ROV, left and right IIV tributaries. The aim of the study is to show if the KIS approach is sufficient to effectively treat PCS, minimising the number of veins treated and number of coils used, and without injecting sclerosing agents into the pelvic veins or the use of occlusion balloons. Materials and Methods: This is a single institution retrospective cohort study. Our records identified 154 women who had undergone venogram for possible PCS, with a view to proceed with embolisation. Refluxing veins were treated with the KIS approach, using minimal number of coils “sandwiching” sclerosing foam. Short term follow up was conducted at 6 weeks; long term follow-ups (between 12-60 months) were conducted by an electronic survey consists of 19 questions, assessing pelvic pain/ pressure, leg and back pain, fatique, bladder and menstrual symptoms. Results: Most women (73.4%) required unilateral OV embolisation only; just 14.4% required bilateral OV embolisation; and only 12.2% required pelvic vein embolisation. Most cases required only 4 pushable coils. Clinical success was 89.1% at 6 weeks and 83.7% at 1-5 years. VAS drop of 5.2 (7.8 to 2.7) was achieved. There was no coil dislodgement or other complications. Conclusion: The KIS approach embolising only the refluxing veins can achieve similar effective clinical outcome for PCS as the EXT approach. This carries implications for potential savings in procedure time, cost, and radiation does. The EXT approach of empirically embolising all 4 sets of veins may not be necessary to achieve an effective outcome.