MRI associated factors of clinical efficacy of embolization in patients with pelvic venous insufficiency - 24/07/20

Doi : 10.1016/j.diii.2020.06.004

E. Jambon ^a, Y. Le Bras ^a, F. Petitpierre ^a, E. Balian ^b, D. Midy ^c, N. Grenier ^a, C. Marcelin ^a,⁎
^a Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
^b Departement of Functional Vascular Explorations, Tondu Hospital, 151, rue du Tondu, 33000 Bordeaux, France
^c Department of Vascular Surgery, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France

^⁎Corresponding author.

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Highlights

•	Pelvic venous insufficiency can be classified into pelvic congestion syndrome, varicose veins of the lower limbs or externalized varicose veins on the pelvic floor.
•	Embolization in women with pelvic venous insufficiency results in effective in 75% women with complete symptom improvement in 20% and significant partial improvement in 55% of women.
•	Small ovarian vein diameters on MRI are associated with best clinical efficacy of percutaneous embolization in PVI.
•	Right ovarian vein diameter>7mm should warrant further phlebography to exclude venous insufficiency.

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Abstract

Purpose

The purpose of this study was to identify anatomical findings at magnetic resonance imaging (MRI) associated with successful percutaneous embolization in women with pelvic venous insufficiency (PVI).

Material and methods

Between 2008 and 2018, 168 consecutive women (mean age, 39±9 [SD] years; range: 21–69 years) who underwent percutaneous embolization for PVI confirmed by MRI and phlebography were included. Clinical efficacy of embolization was evaluated by patients’ opinion or visual analogue scale. Associated factors of success of embolization were searched by comparing MRI findings in women with successful embolization with those in women with failed embolization using univariate analyses.

Results

The mean follow-up was 36±29 (SD) months (range: 12–138 months). Clinical efficacy of embolization was obtained in 126/168 women (75%), complete symptom improvement in 33/168 women (20%) and significant partial improvement in 92/168 women (55%). No symptom improvement and symptoms exacerbation were observed in 17/168 (10%) and 2/168 (1%) women, respectively. At univariate analysis, right ovarian vein diameter≤7mm and vulvar varicosities were associated with successful embolization (P=0.04 and P=0.01, respectively) and left ovarian vein diameter≤7mm was associated with a complete improvement of symptoms (P=0.03). At multivariate analysis, a small right ovarian vein diameter was the single MRI variable associated with clinical efficacy of embolization (P=0.04).

Conclusion

Small ovarian vein diameters on MRI are associated with best clinical efficacy of percutaneous embolization in PVI. Right ovarian vein diameter>7mm should warrant further phlebography to exclude venous insufficiency.

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Keywords : Magnetic resonance imaging, Venous insufficiency, Pelvic pain, Varicose veins, Percutaneous embolization

Abbreviations : LOV, MRI, PCS, PVI, ROV, SD, STIR, VAS, VVLL