Abstract：
OBJECTIVE: This study aimed to evaluate the effectiveness and safety of coils plus glue (CPG) in slope embankment technology vs coils plus sclerosant (CPS) in treating reflux-type pelvic venous disorders.
METHODS: The analysis included patients diagnosed with reflux-type pelvic venous disorders who were treated with CPG or CPS from 2019 to 2021. The inclusion criteria were noncyclic pain lasting more than 6 months, atypical varicose, and transvaginal Doppler ultrasound (TVDUS) and computed tomographic venography confirming the diagnosis and excluding compression factors and other diseases. Propensity score matching was performed at a 1:1.1 ratio based on the following covariates: age, pregnancy, body mass index, pretreatment visual analog scale (VAS), dysmenorrhea, dyspareunia, urinary urgency, tenesmus, low back pain, vulvar varicosities, vaginal varicosities, and lower limb varices. The pain was relieved by embolizing the target lesions with different embolic materials. The efficacy and safety of the different embolization materials were compared by VAS and TVDUS examinations at 1, 3, 6, 12, 24, and 36 months.
RESULTS: From a total of 495 patients, 88 patients were selected from the CPG group and 77 patients from the CPS group by propensity score matching. The patients were followed up for 36 months. The preoperative VAS score of the CPG group was 8 (range, 6-8), and the CPS score was 8 (range, 7-8; P = .64). The postembolization VAS score of the CPG group was 2.05 ± 0.37, and the CPS score was 2.14 ± 0.35 (P = .55). A total of 28 cases (16.9%) showed complications, most of which were transient pain after embolization. No serious complications such as coil embolization to the lungs occurred. In addition, the CPG group used fewer coils than the CPS group by using the slope embankment technique. The mean coil length of the CPG group was 77.18 ± 33.82 cm, and the CPS group was 105.29 ± 71 cm (P = .001). The CPG group had an average operative time of 44.49 ± 5.72 minutes, whereas the CPS group took 43.45 ± 4.18 minutes on average (P = .19). The radiation dose in the CPG group was 398.40 ± 76.16 mGy, and the radiation dose in the CPS group was 388 ± 44.23 mGy (P = .30). The median recurrence-free survival in the CPG group was 34.23 months (95% confidence interval, 33.2-35.2), and the median recurrence-free survival in the CPS group was 30.39 months (95% confidence interval, 28.2-32.6; log rank P = .018).
CONCLUSIONS: Embolization therapy for refluxing PeVD was safe and effective, and proficient use of slope embankment technique with CPG increased efficacy and reduced complications.
METHODS: The analysis included patients diagnosed with reflux-type pelvic venous disorders who were treated with CPG or CPS from 2019 to 2021. The inclusion criteria were noncyclic pain lasting more than 6 months, atypical varicose, and transvaginal Doppler ultrasound (TVDUS) and computed tomographic venography confirming the diagnosis and excluding compression factors and other diseases. Propensity score matching was performed at a 1:1.1 ratio based on the following covariates: age, pregnancy, body mass index, pretreatment visual analog scale (VAS), dysmenorrhea, dyspareunia, urinary urgency, tenesmus, low back pain, vulvar varicosities, vaginal varicosities, and lower limb varices. The pain was relieved by embolizing the target lesions with different embolic materials. The efficacy and safety of the different embolization materials were compared by VAS and TVDUS examinations at 1, 3, 6, 12, 24, and 36 months.
RESULTS: From a total of 495 patients, 88 patients were selected from the CPG group and 77 patients from the CPS group by propensity score matching. The patients were followed up for 36 months. The preoperative VAS score of the CPG group was 8 (range, 6-8), and the CPS score was 8 (range, 7-8; P = .64). The postembolization VAS score of the CPG group was 2.05 ± 0.37, and the CPS score was 2.14 ± 0.35 (P = .55). A total of 28 cases (16.9%) showed complications, most of which were transient pain after embolization. No serious complications such as coil embolization to the lungs occurred. In addition, the CPG group used fewer coils than the CPS group by using the slope embankment technique. The mean coil length of the CPG group was 77.18 ± 33.82 cm, and the CPS group was 105.29 ± 71 cm (P = .001). The CPG group had an average operative time of 44.49 ± 5.72 minutes, whereas the CPS group took 43.45 ± 4.18 minutes on average (P = .19). The radiation dose in the CPG group was 398.40 ± 76.16 mGy, and the radiation dose in the CPS group was 388 ± 44.23 mGy (P = .30). The median recurrence-free survival in the CPG group was 34.23 months (95% confidence interval, 33.2-35.2), and the median recurrence-free survival in the CPS group was 30.39 months (95% confidence interval, 28.2-32.6; log rank P = .018).
CONCLUSIONS: Embolization therapy for refluxing PeVD was safe and effective, and proficient use of slope embankment technique with CPG increased efficacy and reduced complications.
摘要：
目的：本研究旨在评估在斜坡堤防技术中线圈加胶水与线圈加硬化剂治疗反流型盆腔静脉疾病的有效性和安全性。
方法：分析包括2019年至2021年诊断为反流型盆腔静脉疾病的患者，这些患者接受了线圈加胶（CPG）或线圈加硬化剂（CPS）治疗。纳入标准为非循环性疼痛持续6个月以上,非典型静脉曲张,经阴道多普勒超声（TVDUS）和CT静脉造影（CTV）确认诊断并排除压迫因素和其他疾病。基于以下协变量，以1:1.1的比例进行倾向评分匹配：年龄，怀孕,BMI,预处理VAS,痛经,性交困难,尿急,重弹,腰痛,外阴静脉曲张,阴道静脉曲张和下肢静脉曲张。通过用不同的栓塞材料栓塞靶病变，疼痛得到缓解。在1、3、6、12、24和36个月时通过视觉模拟量表（VAS）和TVDUS检查比较不同栓塞材料的疗效和安全性。
结果：从总共495名患者中，通过倾向评分匹配，从CPG组中选择88例患者，从CPS组中选择77例患者。随访36个月。线圈加胶（CPG）组术前VAS评分为8（范围6-8），线圈加硬化剂（CPS）得分为8（范围7-8），P=0.64。CPG组栓塞后VAS评分为2.05±0.37,CPS评分为2.14±0.35(P=0.55)。共有28例(16.9%)出现并发症,大部分为栓塞后一过性疼痛。未发生线圈栓塞肺部等严重并发症。此外,通过使用边坡路堤技术（SET），CPG组使用的线圈比CPS组少。CPG组的平均线圈长度为77.18±33.82cm，CPS组为105.29±71cm(P=0.001)。CPG组手术时间平均44.49±5.72min,CPS组平均治疗时间为43.45±4.18min(P=0.19)。CPG组的辐射剂量为398.40±76.16mGy,CPS组的辐射剂量为388±44.23mGy(P=0.30)。CPG组的中位无复发生存期（RFS）为34.23个月（95％CI33.2-35.2），CPS组的中位RFS为30.39个月（95％CI28.2-32.6），LogRank=0.018。
结论：栓塞治疗反流性PEVD安全有效，熟练使用带有线圈和胶水的SET可提高疗效并减少并发症。
方法：分析包括2019年至2021年诊断为反流型盆腔静脉疾病的患者，这些患者接受了线圈加胶（CPG）或线圈加硬化剂（CPS）治疗。纳入标准为非循环性疼痛持续6个月以上,非典型静脉曲张,经阴道多普勒超声（TVDUS）和CT静脉造影（CTV）确认诊断并排除压迫因素和其他疾病。基于以下协变量，以1:1.1的比例进行倾向评分匹配：年龄，怀孕,BMI,预处理VAS,痛经,性交困难,尿急,重弹,腰痛,外阴静脉曲张,阴道静脉曲张和下肢静脉曲张。通过用不同的栓塞材料栓塞靶病变，疼痛得到缓解。在1、3、6、12、24和36个月时通过视觉模拟量表（VAS）和TVDUS检查比较不同栓塞材料的疗效和安全性。
结果：从总共495名患者中，通过倾向评分匹配，从CPG组中选择88例患者，从CPS组中选择77例患者。随访36个月。线圈加胶（CPG）组术前VAS评分为8（范围6-8），线圈加硬化剂（CPS）得分为8（范围7-8），P=0.64。CPG组栓塞后VAS评分为2.05±0.37,CPS评分为2.14±0.35(P=0.55)。共有28例(16.9%)出现并发症,大部分为栓塞后一过性疼痛。未发生线圈栓塞肺部等严重并发症。此外,通过使用边坡路堤技术（SET），CPG组使用的线圈比CPS组少。CPG组的平均线圈长度为77.18±33.82cm，CPS组为105.29±71cm(P=0.001)。CPG组手术时间平均44.49±5.72min,CPS组平均治疗时间为43.45±4.18min(P=0.19)。CPG组的辐射剂量为398.40±76.16mGy,CPS组的辐射剂量为388±44.23mGy(P=0.30)。CPG组的中位无复发生存期（RFS）为34.23个月（95％CI33.2-35.2），CPS组的中位RFS为30.39个月（95％CI28.2-32.6），LogRank=0.018。
结论：栓塞治疗反流性PEVD安全有效，熟练使用带有线圈和胶水的SET可提高疗效并减少并发症。
