Simultaneous uterine arteries and ovarian veins embolization as a management for chronic pelvic pain due to adenomyosis and pelvic venous disorders.

Simultaneous uterine arteries and ovarian veins embolization as a management for chronic pelvic pain due to adenomyosis and pelvic venous disorders. | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 5 June 2025 V1 Latest version Share on Simultaneous uterine arteries and ovarian veins embolization as a management for chronic pelvic pain due to adenomyosis and pelvic venous disorders. Authors : Filip Szkodziak 0000-0002-2138-4694 [email protected] , Sławomir Woźniak , Piotr Szkodziak 0000-0002-3582-067X , Krzysztof Pyra , Tomasz Paszkowski , and Michał Sojka Authors Info & Affiliations https://doi.org/10.22541/au.174912504.40978086/v1 164 views 121 downloads Contents Information & Authors Metrics & Citations View Options References Figures Tables Media Share Simultaneous uterine arteries and ovarian veins embolization as a management for chronic pelvic pain due to adenomyosis and pelvic venous disorders. Authors. Filip Szkodziak 1 , Sławomir Woźniak 1 , Piotr Szkodziak 1 , Krzysztof Pyra 2 , Tomasz Paszkowski 1 , Michał Sojka 3 1. 3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland. 2. Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland. 3. Department of Vascular Surgery of the University Clinical Hospital No. 4 in Lublin, Medical University of Lublin, Lublin, Poland. Corresponding author. Filip Szkodziak (ORCID: 0000-0002-2138-4694), 3rd Chair and Department of Gynaecology, Medical University of Lublin, 20-954 Lublin, ul. Jaczewskiego 8, Poland, [email protected] , phone number: +48817244848, fax number: +48817244847. Simultaneous uterine arteries and ovarian veins embolization as a management for chronic pelvic pain due to adenomyosis and pelvic venous disorders. Among many others, the gynaecological origin of Chronic Pelvic Pain (CPP) includes adenomyosis and Pelvic Venous Disorders (PeVD) [1]. Both conditions may co-occur, resulting in the exacerbation and overlapping of disease symptoms. A 45-year-old woman with a history of three vaginal delivery was referred for treatment due to CPP. The main symptoms presented by the patient included abdominal, back and hip pain that was worsened by prolonged standing, postcoital ache. Patient also suffered from dysmenorrhoea and menorrhagia resulting in anaemia (haemoglobin [Hb] level upon admission – 9.8 g/dl). Transvaginal ultrasound examination revealed the features of PeVD (left ovarian vein dilatation (6.0 mm) with low blood flow (2.82 cm/s) (Figure A)) and adenomyosis (myometrial cysts, hyperechogenic islands, subendometrial lines and buds and irregular junctional zone (Figure B)) [2,3]. In the 24 months preceding hospitalization, the patient underwent therapy with dienogest, venoactive drugs, lifestyle change and pelvic physiotherapy [4,5]. Despite this, the symptoms persisted. Due to the lack of therapeutic effect of conservative treatment and the patient’s lack of consent for surgical treatment, the patient has been qualified for simultaneous uterine arteries and ovarian veins embolization. The qualification was carried out by a team of gynaecologists, interventional radiologists and angiologists after performing a pelvis Magnetic Resonance Imaging (MRI) examination. Simultaneous uterine arteries and ovarian veins embolization was performed by an interventional radiologist under local anaesthesia through an access point in the right groin area, appropriately via the femoral vein and artery. In the case of embolization for venous insufficiency, angiography of the left and right ovarian veins was performed, followed by imaging of the iliac veins. Embolization of incompetent veins was carried out using a sclerosing agent and a coil. Conversely, after imaging the arterial bed within the uterus, uterine arteries embolization for the treatment of adenomyosis was performed using 500 μm particles (Figure C), (Figure D), (Figure E), (Figure F). After the procedure, the vascular access site was compressed manually and secured with a pressure dressing. The patient was discharged on the second day after the procedure. The perioperative period passed without complications. After 6 months, the patient underwent a follow-up visit. Previously reported symptoms like abdominal, back and hip pain, dysmenorrhoea and menorrhagia subsided completely. The postcoital ache persisted but with less intensity (assessed with the Visual Analogue Scale - a reduction from 7 to 3). A follow-up MRI examination (Figure G) revealed signs of adenomyosis of lesser severity than the previous examination (Figure H), and no signs of PeVD. As we believe it is the first time when the simultaneous uterine arteries and ovarian veins embolization as a management for CPP due to adenomyosis and PeVD has been described. Although the benefits of this procedure have to be confirmed in, a well-designed clinical trial, it seems that this method may be a promising therapeutic option for patients with CPP of complex aetiology. Figures. Figure A – TVUS examination revealing features of PeVD – dilatation (6.0 mm) of left ovarian vein (I) with low (2.82 cm/s) blood flow (II). Figure B – TVUS examination revealing features of adenomyosis - myometrial cysts (I), hyperechogenic islands (II), subendometrial lines and buds (III) and irregular junctional zone (III). Figure C - Embolization of the left uterine artery (I). In the background, spirals used to embolize the left ovarian vein are visible (II). Figure D - Control angiography after left uterine artery embolization. No blood flow into the uterine vascular bed was observed. Figure E - Embolization of the right uterine artery (I). In the background, spirals used to embolize the left ovarian vein are visible (II). Figure F - Control angiography after right uterine artery embolization. No blood flow into the uterine vascular bed was observed. Figure H – Pelvis MRI conducted before simultaneous uterine arteries and ovarian veins embolization revealing features of adenomyosis. Figure G – Pelvis MRI conducted after simultaneous uterine arteries and ovarian veins embolization revealing features of less severe adenomyosis. References. 1. Marcelin C, Le Bras Y, Molina Andreo I, Jambon E, Grenier N. Diagnosis and Management of Pelvic Venous Disorders in Females. Diagnostics (Basel). 2022 Sep 27;12(10):2337. doi: 10.3390/diagnostics12102337. 2. Szkodziak F, Wozniak S, Szkodziak PR, Pyra K, Paszkowski T. Noninvasive diagnostic imaging of pelvic venous disorders. Ultraschall Med. 2024 Dec;45(6):597-603. doi: 10.1055/a-2263-7193. 3. Harmsen MJ, Van den Bosch T, de Leeuw RA. Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure. Ultrasound Obstet Gynecol. 2022 Jul;60(1):118-131. doi: 10.1002/uog.24786. 4. Ali MK, Hussein RS, Abdallah KS, Mohamed AA. The use of dienogest in treatment of symptomatic adenomyosis: A systematic review and meta-analysis. J Gynecol Obstet Hum Reprod. 2024 Sep;53(7):102795. doi: 10.1016/j.jogoh.2024.102795. 5. Gora KB, Wozniak S. Evaluation of effectiveness of pharmacological treatment in pelvic congestion syndrome. Ginekol Pol. 2023 Aug 7. doi: 10.5603/GP.a2023.0078. Information & Authors Information Version history V1 Version 1 05 June 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords adenomyosis: basic science adenomyosis: diagnosis adenomyosis: drug treatment adenomyosis: surgery genito-urinary medicine pelvic pain Authors Affiliations Filip Szkodziak 0000-0002-2138-4694 [email protected] Medical University of Lublin View all articles by this author Sławomir Woźniak Medical University of Lublin View all articles by this author Piotr Szkodziak 0000-0002-3582-067X Medical University of Lublin View all articles by this author Krzysztof Pyra Medical University of Lublin View all articles by this author Tomasz Paszkowski Medical University of Lublin View all articles by this author Michał Sojka University Clinical Hospital View all articles by this author Metrics & Citations Metrics Article Usage 164 views 121 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Filip Szkodziak, Sławomir Woźniak, Piotr Szkodziak, et al. 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