Description
While vascular surgery is commonly associated with arterial and venous conditions, it also plays a role in various gynecological applications. One notable application is the treatment of pelvic congestion syndrome (PCS), a condition often characterized by chronic pelvic pain related to dilated pelvic veins. Vascular interventions, such as embolization or sclerotherapy, can be employed to address venous insufficiency and alleviate symptoms in PCS patients. Additionally, vascular surgery may be utilized in the management of certain gynecological tumors, such as uterine fibroids, where embolization can be performed to shrink the tumors by blocking their blood supply. These minimally invasive vascular procedures offer alternative options for gynecological conditions, providing effective outcomes with reduced recovery times and complications compared to traditional surgical approaches. Collaboration between gynecologists and vascular surgeons is crucial for comprehensive care in these specific applications.
Résumé
- Dr. Sah, a consultant vascular surgeon at Medcare Hospital, discussed endovascular therapy as an alternative option to surgery or conservative treatment for gynecological and obstetric diseases. He emphasized the importance of considering vascular solutions and promoted the use of embolization therapy and laser therapy.
- Embolization involves using agents to block blood vessels, classified as either temporary or permanent. Temporary agents like gel foam are used for hemorrhages, especially in young women who wish to conceive, as they are absorbable. Permanent agents, such as alcohol, sodium, and polyenol, are used for other conditions, with microser offering the ability to select artery or vessel size for occlusion.
- Pelvic congestion syndrome, fibroids, adenomyosis, postpartum hemorrhage, and hemorrhoids can be treated with embolization. He addressed the importance of understanding the SVVP classification system (symptoms, veins, pathology) to diagnose and treat pelvic congestion syndrome effectively, showing examples of various cases, including nutcracker syndrome.
- Uterine fibroid embolization (UFE) is a treatment option for symptomatic fibroids. MRI is essential before the procedure to rule out malignancy and evaluate adenomyosis. Although previously limited by size, the suitability of UFE now hinges on patient presentation. The intervention is painful and requires robust pain management.
- Embolization is also useful to manage postpartum hemorrhage. In such cases, the doctor recommended early consultation given a life-threatening situation. Strategies for preventing such bleeding include occlusion before the cesarean section or aortic balloon occlusion up to 15 minutes. Finally, hemorrhoid embolization through the inferior mesenteric artery was described as a way to reduce bleeding and pain for patients unsuitable for surgery or anesthesia.
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