Tratamento Endovascular da Síndrome de Congestão Pélvica: Série de Casos/Endovascular Treatment of Pelvic Congestion Syndrome: Case Series

RESUMO Introdução: As varizes pélvicas fazem parte de uma entidade clínica, a síndrome da congestão pélvica (SCP), que acomete mulheres em idade reprodutiva, geralmente multíparas, e cursa com como dor e sensação de peso crônico na região pélvica, dispareunia, dismenorreia, congestão vulvar e disúria. A síndrome é decorrente do refluxo de veias ovarianas incompetentes e dilatadas. O refluxo pélvico também apresenta-se como um fator causal importante no que diz respeito ao surgimento e recidiva da doença venosa nos membros inferiores. Casuística: Foram descritos três casos de pacientes portadoras de SCP com sintomas clássicos, com diagnóstico tardio. Todas foram submetidas à embolização percutânea das varizes através do implante de molas fibradas de liberação livre através do aceso femoral, e obtiveram resultado satisfatório, semelhantes aos citados na literatura. Discussão: O diagnóstico da SCP é difícil e o tratamento envolve terapia medicamentosa para melhora dos sintomas e, em casos refratários, o uso de técnicas minimamente invasivas como a embolização das veias gonadais. Trata-se de uma condição comum e subdiagnosticada, sendo muitas das vezes um achado de exclusão de outras patologias. Conclusão: A embolização percutânea das veias ovarianas é um método simples, eficaz, com baixos índices de complicações e com resultado satisfatório a curto e médio prazo. A recidiva é frequente no longo prazo, e pode estar relacionada à progressão da doença varicosa ao longo do tempo e suas diferentes manifestações clínicas.Palavras-chave: Varizes, Dor pélvica, Embolização terapêutica. ABSTRACTIntroduction: Pelvic varices are part of a clinical entity, Pelvic Congestion Syndrome. This disease affects women at reproductive age, multiparous and presents symptoms such as chronic pelvic pain, feeling of heaviness in the pelvic region, dyspareunia, dysmenorrhea, vulvar congestion and urinary symptoms such as dysuria. Case Report: The aim of this study is to report a small case series of treatment of pelvic varices by embolization. We described three cases of patients suffering from pelvic varices with classic symptoms, which showed a delayed diagnosis, that caused emotional, aesthetic and marital problems. All of them underwent percutaneous embolization of varices, achieved satisfactory results and have been in clinical monitoring. Discussion: The cause of the disturb is the reflux of incompetent and dilated ovarian veins. Pelvic reflux also presents itself as an important causative factor concerning the appearance and recurrence of venous disease in lower members. Diagnosis is difficult. It is a common and underdiagnosed condition, often being a finding that excludes other pathologies. The results found after treatment were similar to stated in literature. Conclusion: The embolization of pelvic varices has been shown simpler and effective, with lowest rates of complications and with satisfactory results at short and long term. However, more studies regarding the outcome of different treatment methods are needed.Keywords: Varicose veins, Pelvic pain, Therapeutic embolization.

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The Outcome of Treatment for Pelvic Congestion Syndrome

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2011.012s01 ◽

2012 ◽

Vol 27 (1_suppl) ◽

pp. 74-77 ◽

Cited By ~ 16

Author(s):

P Coleridge Smith

Keyword(s):

Lower Limb ◽

Varicose Veins ◽

Pelvic Congestion Syndrome ◽

Pelvic Vein ◽

Computed Tomographic ◽

Computed Tomographic Venography ◽

Clinical Series ◽

Pelvic Varices ◽

Pelvic Congestion

Pelvic congestion syndrome is one of many causes of chronic pelvic pain. It is generally accepted that this is attributable to ovarian and pelvic vein incompetence which may result in varices in the lower limb leading to presentation in varicose vein clinics. However, far more patients have pelvic varices associated with varicose veins in the lower limb than have pelvic congestion syndrome. Magnetic resonance imaging and computed tomographic venography are usually used in the diagnosis of this condition and criteria have been established to identify pelvic varices. Many different treatments have been used to manage the symptoms of pelvic congestion. Hysterectomy combined with oophrectomy open surgical ligation of ovarian veins and laparoscopic vein ligation have been used in the past. The most common treatments used currently involve embolization of pelvic and ovarian veins. The results of this treatment have been published in a limited number of clinical series, usually with fairly short follow-up periods. These treatments may be complicated by migration of embolization of coils used to occlude veins. The longest duration of follow-up currently reported is five years. Limited clinical evidence supports the use of embolotherapy in the management of pelvic congestion syndrome.

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Pelvic congestion syndrome as a cause of chronic pelvic pain

Obstetrics Gynecology and Reproduction ◽

10.17749/2313-7347/ob.gyn.rep.2021.236 ◽

2021 ◽

Vol 15 (4) ◽

pp. 451-460

Author(s):

N. Yu. Novikova ◽

V. I. Tsibizova ◽

P. D. Puzdriak ◽

E. V. Komlichenko ◽

I. G. Tsnobiladze ◽

...

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Varicose Veins ◽

Venous Pressure ◽

Chronic Pelvic Pain Syndrome ◽

Pain Syndrome ◽

Pelvic Pain Syndrome ◽

Clinical Criteria ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

Altered pelvic venous circulation, which may occur due to pelvic venous congestion and varicose veins of the vulva, may be among the causes for developing chronic pelvic pain syndrome. Pelvic congestion syndrome (PCS) is characterized by chronic discomfort in the pelvic area, which may be aggravated during coitus or acquire orthostatic position, and result in severe dysfunction of the pelvic organs. Varicose veins of the vulva develop due to obstruction of the veins, increased venous pressure, and venous insufficiency in the pelvis. Varicose veins may be isolated or associated with varicose veins of the lower extremities. The diagnosis and treatment of such patients are limited by the lack of definitive clinical criteria for early diagnostics, which were discussed in the current study.

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Etiopathogenetic Approach to Conservative Treatment of Pelvic Congestion Syndrome

HEALTH OF WOMAN ◽

10.15574/hw.2016.111.52 ◽

2016 ◽

pp. 52-57

Author(s):

S.I. Zhuk ◽

◽

A.N. Grigorenko ◽

A.A. Shluakhtina ◽

◽

...

Keyword(s):

Conservative Treatment ◽

Clinical Laboratory ◽

Varicose Veins ◽

Dynamic Balance ◽

Blood Rheology ◽

Reproductive Age ◽

Complex Treatment ◽

Women Of Reproductive Age ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

Aim of research is clinical, laboratory and instrumental evaluation of efficiency of proposed pathogenetic conservative treatment for Pelvic Congestion Syndrome in women of reproductive age. Complex treatment consisted of oral use of diosmin, chondroitin sulfate for 6 months and physiotherapy. The results of the study suggest that proposed treatment is effective enough. It provides recovery of varicose veins endothelium functions, dynamic balance between vasodilatory and vasoconstrictor factors, normalization of blood rheology and metabolic processes in connective tissue. Key words: Pelvic Congestion Syndrome, conservative treatment, venotonic therapy.

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Pelvic Congestion Syndrome: Surgical Treatment

Austin Journal of Surgery ◽

10.26420/austinjsurg.2021.1268 ◽

2021 ◽

Vol 8 (2) ◽

Author(s):

Zekilah SR ◽

◽

Sallam EM ◽

Mashaal AB ◽

Ageez MN ◽

...

Keyword(s):

Surgical Treatment ◽

Pelvic Pain ◽

Varicose Veins ◽

University Hospital ◽

Pelvic Congestion Syndrome ◽

Pain Scores ◽

Internal Iliac ◽

Work Up ◽

Pelvic Congestion

Aims: To evaluate the mid and long term efficacy of surgical interruption of the refluxing ovarian veins as a treatment modality for pelvic congestion syndrome. Study Design: A prospective non comparative interventional study. Place and Duration of Study: This study was conducted between February 2015 and October 2019 in Alexandria Medical Centre and Tanta Main University Hospital. Methodology: The study included a 27 patient’s undergone surgical interruption of refluxing ovarian veins with or without sclerotherapy of vulval, perineal or thigh varices, and data were collected prospectively. Detailed history was taken and clinical examination was done for every patient along with routine laboratory investigations and radiological work up was transvaginal and abdominal venous duplex. Follow up was done considering the change in pelvic venous images and pelvic pain scores in comparison to the pre-operative state. Results: Twenty seven female patients were treated for pelvic congestion syndrome using single session surgical intervention with or without sclerotherapy to pudendal varices. The patients age ranged from 21 to 43 (mean 33.1). All patients presented with chronic continuous pelvic pain. Other associated symptoms as dyspareunia, dysmenorrhea and pudendal varices were found in some cases. Surgical ligation of the ovarian veins were done to all cases, sclerotherapy/ligation of internal iliac varices was done for 6 cases and scerotherapy or surgical interruption of pudendal or thigh varicose veins was done in 21 cases. Technical success was achieved in all patients. Mean pelvic pain score was improved from 7.33 preoperatively to 1.33 and 0.89 in 6 and 12 months of the post-operative recordings. On sonographic basis pelvic reflux disappeared in 26 patients by the end of the follow up. Out of 27 patients treated there were 24 patients satisfied of the procedures at the end of the follow up. Conclusion: Surgical treatment for pelvic congestion syndrome combined with sclerotherapy to the associated varices was found to be effective, safe and affordable modality of treatment.

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Pelvic pain syndrome caused by ovarian varices

Acta Radiologica ◽

10.1080/02841859709172123 ◽

1997 ◽

Vol 38 (6) ◽

pp. 1023-1025 ◽

Cited By ~ 3

Author(s):

P. G. Tarazov ◽

K. V. Prozorovskij ◽

V. K. Ryzhkov

Keyword(s):

Chronic Pain ◽

Pelvic Pain ◽

Clinical Effect ◽

Pain Syndrome ◽

Therapeutic Embolization ◽

Pelvic Pain Syndrome ◽

Percutaneous Embolization ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

Purpose: the aim of this study was to evaluate the clinical effect of therapeutic embolization in the pelvic congestion syndrome caused by ovarian varices Material and Methods: Six women, aged 25–40 years, with pelvic pain syndrome and marked left (n=5) or bilateral (n=1) ovarian varicocele were treated by transcatheter retrograde venous embolization Results: the pelvic pain syndrome disappeared in all patients within 4 weeks, and there was regression of the periodic pain in 2 women with dysmenorrhoea. the patients were free of symptoms during the 1–4-year follow-up Conclusion: Marked ovarian varices may cause a pelvic pain syndrome. Percutaneous embolization improves both the chronic pain and the dysmenorrhea in these patients. Transcatheter treatment could be considered as an alternative to surgical or laparoscopic ligation in ovarian varicocele

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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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Pelvic congestion syndrome as a predisposing factor of "two-level" varicose veins development

Acta Phlebologica ◽

10.23736/s1593-232x.18.00417-4 ◽

2019 ◽

Vol 19 (3) ◽

Author(s):

Larysa Chernukha ◽

Alla Guch ◽

Vadym Kondratyuk ◽

Olenka Vlasenko ◽

Alla Bobrova

Keyword(s):

Varicose Veins ◽

Predisposing Factor ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

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Diagnostic imaging of pelvic congestive syndrome

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514568063 ◽

2015 ◽

Vol 30 (1_suppl) ◽

pp. 67-72 ◽

Cited By ~ 11

Author(s):

CWKP Arnoldussen ◽

MAF de Wolf ◽

CHA Wittens

Keyword(s):

Chronic Pelvic Pain ◽

Lower Abdominal Pain ◽

Clinical Suspicion ◽

Venous Disease ◽

Pelvic Congestion Syndrome ◽

Pelvic Vein ◽

Interventional Imaging ◽

Surgery Department ◽

Vein Insufficiency ◽

Pelvic Congestion

Many female patients are affected by chronic pelvic pain and a significant number of referrals to the gynecology department result in a clinical suspicion of pelvic congestion syndrome. Additionally, patients referred to the vascular surgery department for venous disease can also present with complaints of a persistent dull lower abdominal pain in addition to typically distributed leg varicosities (that extend from the leg through the pelvic floor) which should be evaluated for the presence of pelvic congestion syndrome. In this article, we focus on imaging pelvic vein insufficiency and related (extending) varicosities: how should we evaluate the pelvic veins, what are the signs to look for, and what are the currently established criteria for (pre-interventional) imaging.

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