Advances in Clinical and Experimental Medicine
2017, vol. 26, nr 2, March-April, p. 269–276
Publication type: original article
Diagnosis and treatment of pelvic congestion syndrome: Single-centre experiences
1 4th Military Clinical Hospital, Wrocław, Poland
2 Department of Radiology, Wroclaw Medical University, Poland
3 Chair and Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Poland
Background. One of the underestimated causes of chronic pelvic pain (CPP) in women may be pelvic congestion syndrome (PCS) that is defined as the presence of varicose of ovarian and pelvic veins associated with chronic pain in the region of the pelvis. This pain is present longer than 6 months and intensifies with prolonged standing, coitus and menstruation. The disease constitutes a diagnostic as well as therapeutic problem, thus posing a challenge for the clinician. Transcatheter ovarian vein embolization might be a safe and effective option for PCS treatment.
Objectives. The objective of this study was to evaluate the efficacy of ovarian vein embolization ovarian as a method of the PCS treatment.
Material and Methods. Between 2002–2012, 11 embolization procedures were performed in 10 women (age range: 34–43; median age 39) with the diagnosis of PCS. One patient underwent embolization procedure twice. In 1 case the combined therapy of endovascular embolization and surgical phlebectomy of vulvar varices was performed.
Results. There were no major intrainterventional complications. In all the patients (100%) a significant improvement in the clinical status was noted. The procedure improved the quality of life in the patients. Three women (30%) had a mild recurrence of the symptoms at mid-term follow-up. Among 8 women who had complained of dyspareunia prior to embolization 6 patients reported complete pain relief, in other 2 cases the pain subsided partially. There was a significant decrease in the severity of symptoms associated with hemorrhoids.
Conclusion. We consider embolization of insufficient ovarian veins an effective and safe way of treatment in a well-selected group of patients with PCS.
chronic pelvic pain, pelvic congestion syndrome, transcatheter embolization, ovarian vein insufficiency
- APGO Educational Series on Women’s Health Issues. Chronic pelvic pain: An integrated approach Crofton, Md: APGO, January 2000.
- Harris R, Holtzman S, Poppe A. Clinical outcome in female patients with pelvic pain and normal pelvic US findings. Radiology. 2000;216: 440–443.
- Francica G, Giardiello C, Angelone G, et al. Abdominal wall endometriomas near cesarean delivery scars. J Ultrasound Med. 2003;22: 1041–1047.
- Kuligowska E, Deeds L, Lu K. Pelvic pain: Overlooked and underdiagnosed gynecologic conditions. Radiographics. 2005;25(1):3–20.
- Waliszewski P. Masywny zator tętnicy płucnej w przebiegu zakrzepicy splotów żylnych miednicy mniejszej. Przew Lek. 2000;9:105–108.
- Belenky A, Bartal G, Atar E, et al. Ovarian varices in healthy female kidney donors: Incidence, morbidity, and clinical outcome. Am J Roentgenol. 2002;179(3):625–627.
- Coakley F, Varghese S, Hricak H. CT and MRI of pelvic varices in women. J Comput Assist Tomogr. 1999;23:429–434.
- Capasso P, Simons C, Trotteur G, et al. Treatment of symptomatic pelvic varices by ovarian vein embolization. Cardiovasc Intervent Radiol. 1997;20:107–111.
- Tarazov P, Prozorovskij K, Ryzhkov V. Pelvic pain syndrome caused by ovarian varices: Treatment by transcatheter embolization. Acta Radiol. 1997;38:1023–1025.
- Gargiulo T, Mais V, Brokaj L, et al. Bilateral laparoscopic transperitoneal ligation of ovarian veins for treatment of pelvic congestion syn-drome. J Am Assoc Gynecol Laparosc. 2003;10:501–504.
- Beard R, Highman J, Pearce S, et al. Diagnosis of pelvic varicosities in women with chronic pelvic pain. Lancet. 1984;2:946–949.
- Maleux G, Stockx L, Wilms G, et al. Ovarian vein embolization for the treatment of pelvic congestion syndrome: Long-term technical and clinical results. J Vasc Interv Radiol. 2000;11:859–864.
- Desimpelaere J, Seynaeve P, Hagers Y, et al. Pelvic congestion syndrome: Demonstration and diagnosis by helical CT. Abdom Imaging. 1999;24:100–102.
- Topolanski-Sierra R. Pelvic phlebography. J Obstet Gynecol. 1958; 76(1):44–52.
- Rundqvist E, Sandholm L, Larsson G. Treatment of pelvic varicosities causing lower abdominal pain with extraperitoneal resection of the left ovarian vein. Ann Chir Gynaecol. 1984;73:339–341.
- Soysal M, Soysal S, Vidcan K, et al. A randomized controlled trial of goserelin and medroxyprogesterone acetate in the treatment of pelvic congestion. Reprod Hum. 2001;16(5):931–939.
- Hiromura T, Nishioka T, Nishioka S, et al. Reflux in the left ovarian vein: Analysis of MDCT findings in asymptomatic women. Am J Roentgenol. 2004;183(5):1411–1415.
- Beard R, Kennedy R, Gangar K, et al. PubMed Bilateral oophorectomy and hysterectomy in the treatment of intractable pelvic pain associat-ed with pelvic congestion. Br J Obstet Gynaecol. 1991;98(10): 988–992.
- Carter J. Review Surgical treatment for chronic pelvic pain. JSLS. 1998;2(2):129–139.
- Takeuchi K, Mochizuki M, Kitagaki S. Laparoscopic varicocele ligation for pelvic congestion syndrome. Int J Gynaecol Obstet. 1996; 55:177–178.
- Edwards R, Robertson J, MacLean A, et al. Case report: Pelvic pain syndrome- successful treatment of a case by ovarian vein embolization. Clin Radiol. 1993;47:429–431.
- Kim H, Malhotra A, Rowe P, Lee J, Venbrux A. Embolotherapy for pelvic congestion syndrome: Long-term results. J Vasc Interv Radiol.
- Nascimento A, Mitchell D, Holland G. Ovarian veins: Magnetic resonance imaging findings in an asymptomatic population. J Magn Reson Imaging 2002;15(5): 551–556.
- Ignatio E, Dua R, Sarin S, et al. Pelvic congestion syndrome: Diagnosis and treatment. Semin Intervent Radiol. 2008;25(4):361–368.
- Rozenblit A, Ricci Z, Tuvia J, et al. Incompetent and dilated ovarian veins: A common CT finding in asymptomatic parous women. Am J Roent-genol. 2001;176(1):119–122.
- Venbrux A, Chang A, Kim H. Pelvic congestion syndrome (pelvic venous incompetence): Impact of ovarian and internal iliac vein embolo-therapy on menstrual cycle and chronic pelvic pain. J Vasc Interv Radiol. 2002;13:171–178
- Pieri S, Agresti P, Morucci M. Percutaneous treatment of pelvic congestion syndrome. Radiol Med. 2003;105:76–82.
- Kim H, Malhotra A, Rowe P, et al. Embolotherapy for pelvic congestion syndrome: Long-term results. J Vasc Interv Radiol. 2006;17:289–297.
- Kwon S, Oh J, Ko K, et al. Transcatheter ovarian vein embolization using coils for the treatment of pelvic congestion syndrome. Cardiovasc Intervent Radiol. 2007;30(4):655–661.
- Gandini R, Chiocchi M, Konda D, et al. Transcatheter foam sclerotherapy of symptomatic female varicocele with sodium-tetradecyl-sulfate foam. Cardiovasc Intervent Radiol. 2008;31(4):778–784.
- Naoum J. Endovascular therapy for pelvic congestion syndrome. Methodist Debakey Cardiovasc J. 2009;5(4):36–38.
- Kies D, Kim H. Pelvic congestion syndrome: A review of current diagnostic and minimally invasive treatment modalities. Phlebology. 2012;27(Suppl 1):52–57.
- Tu F, Hahn D, Steege J. Pelvic congestion syndrome-associated pelvic pain: A systematic review of diagnosis and management. Obstet Gyne-col Surv. 2010;65(5):332–340
- Ball E, Khan K, Meads C. Does pelvic congestion syndrome exist and can it be treated? Acta Obstet Gynecol Scand. 2012;91:525–528.