Post-embolization syndrome in endovascular interventions on the gonadal veins.

Abstract Objective The study was aimed at evaluating the incidence of post-embolization syndrome (PES) after endovascular coil embolization of the gonadal veins (EEGV) in patients with pelvic congestion syndrome (PCS) and investigating its medical treatment. Methods EEGV was performed in 70 female patients with PCS (left-sided in 58, right-sided in 3, and bilateral in 9 patients). For embolization, 0.035” coils with diameter of 8-12 mm and length of 10-20 cm were used. Assessments of the EEGV results and possible PES symptoms were performed on Days 1, 5, 10, 20 and 30 after the procedure and included transvaginal and transabdominal duplex ultrasound scanning (DUS) of the pelvic veins and at the embolization site. Results PES was manifested by an increased pelvic pain, tenderness along the embolized vein and hyperthermia up to 37.5-37.8 °С and was diagnosed in 14 (20%) patients. For PES treatment, non-steroidal anti-inflammatory drugs (diclofenac 75 mg daily for 3-7 days, mean 4.2 ± 1.1 days) and venoactive drugs (micronized purified flavonoid fraction [MPFF] 1000 mg daily for 2 months) were used. Medical treatment was associated with a significant reduction in the PES symptoms in all patients within 14 days and their complete relief by Day 30 after embolization. DUS revealed thrombosis of parametrial veins in 12 (21.4%) out of 56 patients with successful EEGV and 3 (21.4%) out of 14 patients with PES. Conclusion In patients after EEGV, an increased pelvic pain, occurrence of tenderness along the embolized vein and hyperthermia should be considered as PES manifestations. In our study, PES occurred in 20% of treated patients.