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Master Thesis

Insuffisance veineuse pelvienne : identification de critères diagnostiques pertinents à l’IRM et recherche de facteurs pronostiques de succès de l’embolisation

Abstract : Purpose: to highlight the relevant diagnostic criteria for pelvic venous insufficiency (PVI) on MRI compared to phlebography and to search for factors predicting success of embolization. Methods: from 2008 to 2018, at Pellegrin Hospital, 170 patients underwent MRI and phlebography for suspicion of PVI. 168 of them were treated by embolization. The left renal, ovarian and iliac veins were analyzed successively. Anatomy, diameter, venous reflux and leak detection to the perineum and lower limbs were compared between MRI and phlebography. The identification of MRI predictive factors for successful embolization, complete disappearance of symptoms and recurrence was performed. Results: the dynamic sequence allowed detection of left ovarian vein (LOV) incompetence with a sensitivity of 92% and a specificity of 100%. The STIR sequence allowed indirect detection of LOV incompetence by peri-uterine varicosities and iliac insufficiency by presence of leaks with a sensitivity of 82 and 91%, respectively. The success of the embolization was 75% with complete improvement of symptoms in 20%. In multivariate analysis, a small diameter of the right ovarian vein was associated with successful embolization (p = 0.04) and small diameter of the LOV with complete improvement of symptoms (p = 0.04). Conclusion: MRI allows a satisfactory exploration of PVI. Few factors seem to explain the heterogeneity of the embolization outcomes. The small diameter of the LOV associated with a complete improvement of symptoms remains difficult to explain.
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Éva Fourage Jambon. Insuffisance veineuse pelvienne : identification de critères diagnostiques pertinents à l’IRM et recherche de facteurs pronostiques de succès de l’embolisation. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02432021⟩

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