Pelvic congestion syndrome (PCS), also called pelvic venous incompetence (PVI), may be one of many causes of chronic pelvic pain (CPP). CPP is described as continuous or intermittent noncyclic pain, localized to the pelvic region, which lasts for six or more months.
Blood pooling in pelvic or ovarian veins may result in engorgement or thrombosis, causing pain and discomfort. Risk factors associated with PCS include congestion of veins in the lower extremities, hormonal imbalance, multiple pregnancies and polycystic ovarian disease.
Risk factors associated with PCS include congestion of veins in the lower extremities, hormonal imbalance, multiple pregnancies and polycystic ovarian disease. Symptoms of pelvic congestion syndrome include the following: Continuous or recurring pain for at least six months.
Drazic and colleagues (2019) stated that PVI may cause PCS that is characterized by chronic pelvic pain exacerbated by prolonged standing, sexual activity or menstrual cycle. It may be treated by embolizing the dysfunctional pelvic venous drainage and sometimes resecting vulvar, perineal and thigh varices. These researchers evaluated the results of embolization of insufficient pelvic or ovarian veins on PCS. Analysis of 17 women aged 32 to 53 years, who underwent a selective coil embolization of insufficient pelvic and/or ovarian veins via the jugular, basilic or cephalic veins. In the pre-operative period, all patients had a lower extremity venous duplex pelvic ultrasound (US) examination and some had an abdominal and pelvic CT angiogram. The technical success of the procedure was 100 % and no complications were registered. During a 32-month follow-up, no patient had symptoms of PVI or relapse of vulvar or thigh varices. The authors concluded that embolization of insufficient pelvic and ovarian veins was a safe and successful procedure for the treatment of PVI or vulvar varices.
Hasjim and colleagues (2020) stated that PCS is defined as non-cyclical pelvic pain or discomfort caused by dilated para-uterine, para-ovarian, and vaginal veins; and is characterized by ovarian venous incompetence that may be due to pelvic venous valvular insufficiency, hormonal factors, or mechanical venous obstruction. These investigators described the case of a 38-year old multi-parous woman with a history of pelvic pressure, vulvar varices, and dyspareunia. She underwent left gonadal vein coil embolization in 2014 for PCS that resulted in symptomatic relief of her pain. Four years later, the patient returned for recurrent symptoms, and magnetic resonance venography (MRV) demonstrated dilated pelvic varices. The previously embolized left gonadal vein remained thrombosed, and there was no evidence of right gonadal vein insufficiency; however, catheter-based venography revealed a large, dilated, and incompetent median sacral vein. Pelvic venography demonstrated left gonadal vein embolization without any evidence of reflux. The right gonadal vein was also non-dilated without reflux. Internal iliac venography showed large cross-pelvic collaterals and retrograde flow via a large, dilated median sacral vein. Coil embolization of the median sacral vein resulted in a dramatic reduction of pelvic venous reflux and resolution of symptoms. The authors concluded that recurrence of PCS could occur after ovarian vein embolization via other tributaries in the venous network. The median sacral vein is a rare cause of PCS.
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) [metallic coils or foam/gel sclerotherapy]