SIR 2024
Women's Health
Victoria A. Risner, BS
Medical Student
UNC Chapel Hill
Financial relationships: Full list of relationships is listed on the CME information page.
Estefania Gonzales (she/her/hers)
Medical Student
UNC School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Nicole Keefe, MD (she/her/hers)
Assistant Professor, Program Director
University of North Carolina at Chapel Hill
Financial relationships: Full list of relationships is listed on the CME information page.
Priya Mody, MD (she/her/hers)
Assistant Professor
University of North Carolina at Chapel Hill
Financial relationships: Full list of relationships is listed on the CME information page.
Gloria Salazar, MD (she/her/hers)
Vice Chair Diversity and Health Equity
UNC
Financial relationships: Full list of relationships is listed on the CME information page.
Pelvic venous disorders (PeVD) include gonadal venous reflux with periuterine veins, resulting in venous congestion. Gonadal Vein Embolization (GVE) is an interventional treatment for PeVD; however, about 30% of patients do not have symptom improvement post-GVE. Given variability in GVE technique, this study aimed to determine if patient or procedural factors influence post-procedural symptom improvement in PeVD.
Materials and Methods: In this IRB-approved study, a retrospective analysis of female patients who underwent GVE in the past ten years was performed. Data was collected on patient demographic information, medical history, and symptoms pre- and post-GVE. Procedural data included location of embolization, number and brand of coils, type and amount of sclerosant, and use of vascular plugs. Post-GVE symptom improvement was assessed from chronic and postural pain, severity scores, pelvic fullness, dyspareunia, and irregular bleeding, Symptoms were categorized as "no change," "some improvement," or "significant improvement," and values were aggregated into a score of overall improvement. We applied an exploratory Poisson regression with a logit link, modeling symptom improvements as a function of patient and procedural characteristics. We employed a forward selection strategy to parse models, with a criterion of p=0.05 for inclusion in the model.
Results: Preliminary analysis included 45 female patients, with ages ranging from 22-79, who underwent embolization for PeVD. Number of coils, vascular plug use, total number of VIR procedures, and history of varicosities were significant in predicting symptom improvement after GVE. As the number of coils (ranging from 1 to 26), increased, symptom improvement scores decreased (p< 0.0001). The use of vascular plugs was also negatively associated with symptom improvement (p< 0.0001). Patients with two procedures (15.6% of patients) had higher predicted symptom improvement (p=0.0029). Patients with a history of superficial varicosities in the pelvic area (vulvar, groin, gluteal, or perineal) had higher symptom improvement compared to patients without this diagnosis (p=0.0062).
Conclusion: Number of coils, vascular plug use, number of procedures, and history of superficial pelvic varicosities are predictors for post-GVE symptom improvement in PeVD patients. This study highlights the importance of patient selection and choices of procedural interventions in patient outcomes, emphasizing the need for a more comprehensive analysis to develop GVE recommendations for PeVD patients.