血管外科医生对治疗盆腔充血综合症的兴趣在于，血管外科治疗生殖静脉的年平均复发率在15%~20%之间，他们大多与第一次手术的技术或战术缺陷有关，其他与新生血管有关，但8%至16%盆腔来源。 首先，高质量的静脉造影一直是盆腔充血综合症诊断的金标准。高质量的静脉造影的定义，和获取方法是值得进一步探讨的问题。通常在病人平卧的情况下，影响高质量盆腔静脉造影的质量。一个可以半立位的胃肠造影床可能是获取高质量盆腔静脉造影的关键。  后来：治疗没有慢性浅表静脉功能不全的孤立性盆腔淤血综合症
再往后：治疗继发性盆腔淤血综合症，包括 1. May-Thurner， 2. 血栓形成后综合症 Post thrombotique syndrom 3. 胡桃夹综合症 Nutcracker syndrom 胡桃夹子综合症
May Thurner
盆腔充血栓塞的选择包括 Embolization options for pelvic congestion Several approaches: （Hocquelet et al, DII, 2016； Maleux et al. JVIR 2000；Kiliani et al, DII, 2016） - 硬化治疗（Sclerotherapy） - Coil - Liquid embolic Agent
为什么要用Onyx? Coil 的局限性
硬化治疗的局限性？Limitation of sclerotherapy - Risk of migration/stroke（PF） - Allergy 胶的局限性 - Risk of migration Onyx 栓塞系统的优点
三种不同粘滞性产品可供选择  操作（Procedure） All procedures were performed under local anesthesia or sedation/ general anesthesia A DMSO compatible microcatheter (Direxion™* microcatheter, Boston Scientific, USA or Progreat™* microcatheter, Terumo, Tokyo, Japan) was used to selectively catheterize pelvic vein varicosity through the left ovarian vein and through iliac vein. For the embolization, ethylene vinyl alcohol copolymer (Onyx™ 18 liquid For the embolization system, Medtronic, USA) was used. ‘ ’Embolization of the left ovarian vein with coils (Concerto™ detachable coil, Medtronic, or IDC™ * detachable coil, Boston Scientific) and Onyx liquid embolic system was performed at the end of procedure until inferior sacro- iliac articulation. 143 -yearyear -old female with Pelvic congestion syndrome
36 -yearyear -old female with PCS, and vulvo -vaginal varicosities
Embolization of controlateral obturator vein
At this time it is too early to propose an embolization by Onyx in first intention, but this technique seems interesting in complex cases with large connections to decrease the number of coïls and the pain in the immediate follow up. More data and longer follow up are necessary
目前，提出Onyx栓塞为时尚早，但这项技术在广泛交通的复杂病例的病例中似乎可以获益，以减少Cols的数量和其后随访时的疼痛。需要更多的数据和更长的随访时间。 Onyx栓塞的安全性已经得到证实
文献中既没有轻度的，也没有严重的并发症，平均Onyx用量5.2ml （2-9）
*Results are from different clinical studies and not directly comparable; data may differ in head to comparisons.
Strengths
• Low risk for microcatheter entrapment
– Onyx Onyx ™ liquid embolic system forms a cast and is cohesive
• Low migration risk Low migration risk Low migration risk Low migration risk Low migration risk Low migration risk Low migration risk
– Cast formation and cohesive nature prevents segment breaks if delivered per IFU (as physician experience)
• Avoid use of multiple coils in relatively large long veins.
Conclusion
• Onyx Onyx ™ liquid embolic system is useful in achieving complete embolization of pelvic varicosities through an ovarian vein and iliac vein, potentially limiting the risk of migration embolic material
|
