Comparison Of Results Of Coil And Surgical Treatment Of Ovarian Reflux

Patients treated by surgery from 1989 until 1998, and endovascular treatment from 1999 until June 2002 were studied using a questionnaire with visual analog scales. Statistical analysis of pelvic heaviness and overall satisfaction showed no difference between endovascular and surgical treatment.25 Both treatments resulted in statistically significant improvement after treatment. A decision to treat in both groups was based on clinical findings and ultrasound assessment, and there was no statistical difference in the presenting features of patients in either the surgical or the endovascular series.

Patients undergoing coil treatment were also subjected to follow-up ultrasound studies at six weeks-six months and also abdominal radiographs. There was no evidence of coil migration in 34 patients. Early ultrasounds showed two clots in broad ligament veins, no significant reduction in diameter at six to 10 weeks, but some evidence of reduction by six months.

Long-term results of endovascular treatment have not yet been reported. Re-canalization remains possible but should be amenable to further endovascular treatment. Although the great majority of patients tolerate coil treatment with little discomfort, anxious patients are more difficult to cannulate the femoral vein, and spasm of the ovarian vein could lead to perforation. Patients have far less loin discomfort than after surgery, but it seems excessive exercise should be restricted. A few patients have severe pain and this could be due to thrombosis of the ovarian vein or perforation.

Patient satisfaction justifies ablation of an ovarian vein shown by ultrasound to reflux.

Provided endovascular ovarian vein ablation can be delivered safely and at reasonable cost, then there are definite advantages over surgical treatment. Complications can occur from either method. The incidence of long-term recan-alization is unknown.

There is no evidence that endovascular treatment produces better results than surgery. Provided patients are prepared to accept the scar, pain, hospitalization, and other potential complications of an operation, at this point one cannot say surgical treatment has been superseded.

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