Successful Treatment of Pelvic Congestion Syndrome by Percutaneous Embolisation of Left Ovarian Vein

Summary Pelvic congestion syndrome (PCS) is a frequently undiagnosed pathology, affecting mainly young women. According to literature, about one third of all women have this condition. The main symptoms include chronic pelvic pain, varicose pelvic veins, dysmenorrhea, and dyspareunia. The etiology of PCS is associated with valvular insufficiency in ovarian and pelvic veins. There are four main diagnostic methods: duplex ultrasound evaluation, computed tomography, magnetic resonance angiography including venous phase investigation and digital subtraction angiography. Nowadays percutaneous transcatheter embolization is an effective and safe treatment for ovarian vein reflux and thus PCS. In order to emphasize the need and possibilities to diagnose and treat PCS appropriately, here we present a well-documented case of PCS that was successfully cured by percutaneous transcatheter embolization.

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Successful ultrasound-guided foam sclerotherapy for vulval and leg varicosities secondary to ovarian vein reflux: a case study

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2009.009086 ◽

2010 ◽

Vol 26 (1) ◽

pp. 29-31 ◽

Cited By ~ 16

Author(s):

P Paraskevas

Keyword(s):

Varicose Veins ◽

Duplex Ultrasound ◽

Symptomatic Improvement ◽

Ovarian Vein ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

Pelvic Congestion Syndrome ◽

Vein Reflux ◽

Pelvic Congestion

Pelvic varicose veins secondary to ovarian vein reflux are common and can present with clinical pelvic congestion syndrome (PCS). After assessment with duplex ultrasound and venography, treatment often involves surgical ovarian vein ligation and more recently embolization of the ovarian vein(s) followed by ultrasound-guided foam sclerotherapy (UGFS) of the pelvic tributaries. This paper presents one out of many PCS patients treated with UGFS of the pelvic tributaries alone, with clinically symptomatic improvement.

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An Inconvenient Truth: The Added Value of Transvaginal Imaging of the Internal Iliac and Adnexal Veins for Pelvic Congestion Syndrome

Journal for Vascular Ultrasound ◽

10.1177/1544316719870069 ◽

2019 ◽

Vol 43 (3) ◽

pp. 113-115

Author(s):

Michelle Walsh ◽

Mary Ahern ◽

Nazha Zahiri ◽

Angela David ◽

Shannon Lyons ◽

...

Keyword(s):

Varicose Veins ◽

Valsalva Maneuver ◽

Duplex Ultrasound ◽

Iliac Vein ◽

Added Value ◽

Intravenous Contrast ◽

Pelvic Congestion Syndrome ◽

Ultrasound Evaluation ◽

Internal Iliac ◽

Pelvic Congestion

Pelvic congestion syndrome is a chronic condition involving varicose veins in the pelvic area, resulting in dull aching pain, pelvic heaviness, palpable varicosities, and dyspareunia. The primary diagnostic modalities, computed tomography (CT) angiography and magnetic resonance (MR) angiography, can be time-consuming, expensive, and carry the risks of diagnostic radiation (CT) and intravenous contrast (CT and MR), and may not offer dynamic vascular information (CT). Recently, an increased role for ultrasound has been proposed in the diagnosis of pelvic congestion; however, the role of transvaginal (TV) duplex ultrasound has not been thoroughly investigated. Our study aims to evaluate the utility of a TV approach in the evaluation of valvular incompetence time (VIT) in seconds of the internal iliac and adnexal veins. A waiver of consent was granted by our Institutional Review Board for this retrospective review. A cohort of 36 women undergoing ultrasound evaluation for pelvic congestion syndrome was analyzed. Transvaginal and transabdominal (TA) images were obtained with reverse Trendelenburg positioning for imaging of the internal iliac veins with Valsalva maneuver to evaluate VIT, at the same visit, and the yield of each approach was compared for the presence of VIT. The number of vessels visualized, VIT, diagnostic success, and number of abnormal vessels were recorded. Between September 2018 and February 2019, 36 women underwent both TA and TV imaging. A total of 72 (100%) internal iliac veins were visualized by TV, but only 15 (21%) by TA. Of the 72 internal iliac veins imaged, 12 (17%) were shown to have valvular incompetence by TV exam, whereas only 2 (3%) were identified by TA, both of which were identified TV. Transabdominal images, when limited, were usually due to bowel gas. Transvaginal images had a higher yield for detection of internal iliac vein VIT, suggesting that the TV approach may be more sensitive and potentially more accurate versus a TA-only protocol.

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Pelvic congestion syndrome and left renal compression syndrome - clinical features and therapeutic approaches

VASA ◽

10.1024/0301-1526/a000538 ◽

2016 ◽

Vol 45 (4) ◽

pp. 275-282 ◽

Cited By ~ 8

Author(s):

Christina Jeanneret ◽

Konstantin Beier ◽

Alexander von Weymarn ◽

Jürg Traber

Keyword(s):

Varicose Veins ◽

Left Renal Vein ◽

Standing Position ◽

Ovarian Vein ◽

Pelvic Congestion Syndrome ◽

Compression Syndrome ◽

Abstract Knowledge ◽

Increased Risk ◽

Definition Of ◽

Pelvic Congestion

Abstract. Knowledge of the anatomy of the pelvic, gonadal and renal veins is important to understand pelvic congestion syndrome (PCS) and left renal vein compression syndrome (LRCS), which is also known as the nutcracker syndrome. LRCS is related to PCS and to the presence of vulvar, vaginal and pudendal varicose veins. The diagnosis of the two syndromes is difficult, and usually achieved with CT- or phlebography. The gold standard is the intravenous pressure measurement using conventional phlebography. The definition of PCS is described as pelvic pain, aggravated in the standing position and lasting for more than 6 months. Pain in the left flank and microhaematuria is seen in patients with LRCS. Women with multiple pregnancies are at increased risk of developing varicose vein recurrences with pelvic drainage and ovarian vein reflux after crossectomy and stripping of the great saphenous vein. The therapeutic options are: conservative treatment (medroxyprogesteron) or interventional (coiling of the ovarian vein) or operative treatment (clipping of the ovarian vein). Controlled prospective trials are needed to find the best treatment.

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