Duplex Ultrasound in Assessing the Results of Treatment of Pelvic Venous Disorders

Objective — to study the opportunities of duplex ultrasound (DUS) in evaluating the results of surgical and endovascular treatment of pelvic venous disorders (PVD). Material and methods. A prospective cohort study included 89 patients with PVD: 55 — pelvic congestion syndrome (PCS), 34 — May-Thurner syndrome (MTS) combined with PCS. Endoscopic gonadal vein resection (EGVR) was performed in 32 patients with PCS, endovascular gonadal vein embolization (EGVE) — in 23 patients. Endovascular stenting (ES) of the left common iliac vein (LCIV) was performed in 34 patients with combination of MTS and PCS. Clinical efficacy was assessed considering NRS score of chronic pelvic pain (CPP). DUS of pelvic and retroperitoneal veins was performed in all patients before EGVR, EGVE and ES of the LCIV, as well as 1, 10, 30 days, 6, and 12 months later. We analyzed patency, vein diameter, presence and duration of reflux, stent patency and its position in the LCIV. Results. CPP relief within a month was noted in 96.7% and 91.3% of patients after EGVR and EGVE, respectively (p=0.2) Reflux in gonadal veins (GVs) disappeared in 100% of cases. Reflux in parametrial (PVs) and uterine veins (UVs) decreased by 6 months in 100% of patients after EGVR (from 4.3±1.2 to 0.6±0.2 s in PVs, p=0.01; from 2.3±0.3 to 0.6±0.2 s in UVs, p=0.01) and EGVE (from 4.1±0.7 to 0.8±0 .5 s in PVs, p=0.01; from 2.2±0.3 to 1.1±0.3 in UVs, p=0.03). Similar dynamics of refluxes in PVs and UVs was noted after ES according to DUS. Coincidence of clinical and ultrasound data after EGVR and EGVE was observed in 100% and 91.3% of cases, respectively. According to DUS data, pelvic vein thrombosis (PVT) the next day after EGRV and EGVE occurred in 12.6% and 21.7% of patients, respectively. There was no pelvic vein and stent thrombosis after ES of the LCIV. Among 34 patients after ES, 11 women underwent EGVE six months later due to persistent CPP and reflux in the left GVs >2 s. Coincidence of clinical and ultrasound data regarding effectiveness of ES of the LCIV was found in 67.6% of patients. Conclusion. DUS is an objective and highly informative method for assessing treatment outcomes, complications and undesirable effects after interventions on gonadal and iliac veins. Repeated DUS is advisable in all patients after interventions on gonadal and iliac veins.