Pelvic Congestion Syndrome: Diagnosis and Treatment

ABSTRACT

The diagnosis of pelvic congestion syndrome (PCS) continues to challenge all physicians involved especially those in such specialties as anesthesia, gastroenterology, general surgery, obstetrics and gynecology, and interventional radiology. When other pelvic pathology is ruled out, an interventional radiologist may be consulted for additional evaluation and treatment of PCS. A heightened awareness and clinical suspicion for the specific symptomatology and associated findings may bring about a more rapid progression toward treatment. For most interventional radiologists who treat PCS patients, magnetic resonance imaging/MR venography (MRI/MRV), diagnostic venogram, and embolotherapy are at the center of diagnosis and treatment of PCS.

KEYWORDS

Chronic pelvic pain - embolization - ovarian vein embolotherapy - pelvic - congestion syndrome - pelvic varices

REFERENCES

• 1 Robinson J C. Chronic pelvic pain.  Curr Opin Obstet Gynecol. 1993;  5 740-743
• 2 Taylor H C. Vascular congestion and hyperemia: their effects on structure and function in the female reproductive system.  Am J Obstet Gynecol. 1949;  57 637-653
• 3 Stones R W. Pelvic vascular congestion: half a century later.  Clin Obstet Gynecol. 2003;  46(4) 831-836
• 4 Park S J, Lim J W, Ko Y T et al.. Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography.  AJR Am J Roentgenol. 2004;  182(3) 683-688
• 5 Beard R W, Highman J H, Pearce S et al.. Diagnosis of pelvic varicosities in women with chronic pelvic pain.  Lancet. 1984;  2 946-949
• 6 Coakley F V, Varghese S L, Hricak H. CT and MRI of pelvic varices in women.  J Comput Assist Tomogr. 1999;  23 429-434
• 7 Umeoka S, Koyama T, Togashi K, Kobayashi H, Akuta K. Vascular dilatation in the pelvis: identification with CT and MR imaging.  Radiographics. 2004;  24 193-208
• 8 Kuligowska E, Deeds L, Kang L. Pelvic pain: overlooked and underdiagnosed gynecologic conditions.  Radiographics. 2005;  25(1) 3-20
• 9 Venbrux A C, Chang A H, Kim H S et al.. Pelvic congestion syndrome (pelvic venous incompetence): impact of ovarian and internal iliac vein embolotherapy on menstrual cycle and chronic pelvic pain.  J Vasc Interv Radiol. 2002;  13(2) 171-178
• 10 Venbrux A C, Lambert D L. Embolization of the ovarian veins as a treatment for patients with chronic pelvic pain caused by pelvic venous incompetence (pelvic congestion syndrome).  Curr Opin Obstet Gynecol. 1999;  11 395-399
• 11 Topolanski-Sierra R. Pelvic phlebography.  Am J Obstet Gynecol. 1958;  76 44-45
• 12 Soysal M E, Soysal S, Vidcan K, Ozer S. A randomized controlled trial of goserelin and medroxyprogesterone acetate I in the treatment of pelvic congestion.  Hum Reprod. 2001;  16(5) 931-939
• 13 Rundqvist E, Sandholm L E, Larsson G. Treatment of pelvic varicosities causing lower abdominal pain with extraperitoneal resolution of left ovarian vein.  Ann Chir Gynaecol. 1984;  73 339-341
• 14 Beard R W, Kennedy R G, Gangar K F et al.. Bilateral oophorectomy and hysterectomy in the treatment of intractable pelvic pain associated with pelvic congestion.  Br J Obstet Gynaecol. 1991;  98(10) 988-992
• 15 Carter J E. Surgical treatment for chronic pelvic pain.  JSLS. 1998;  2(2) 129-139
• 16 Takeuchi K, Mochizuki M, Kitagaki S. Laparoscopic varicocele ligation for pelvic congestion syndrome.  Int J Gynaecol Obstet. 1996;  55 177-178
• 17 Edwards R D, Robertson J R, MacLean A B, Hemmingway A P. Case report: pelvic pain syndrome – successful treatment of a case by ovarian vein embolization.  Clin Radiol. 1993;  47 429-431
• 18 Kim H S, Malhotra A D, Rowe P C, Lee J M, Venbrux A C. Embolotherapy for pelvic congestion syndrome: long-term results.  J Vasc Interv Radiol. 2006;  17 289-297
• 19 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
• 20 Walling M K, Reiter R C, O'Hara M W et al.. Abuse history and chronic pain in women: prevalences of sexual abuse and physical abuse.  Obstet Gynecol. 1994;  84 193-199
• 21 Stones W, Cheong Y C, Howard F M. Interventions for treating chronic pelvic pain in women.  Cochrane Database Syst Rev. 2005;  (2) , CD000387. DOI:10.1002/14651858. CD000387
• 22 Farquhar C M, Rogers V, Franks S et al.. A randomized controlled trial of medroxyprogesterone acetate and psychotherapy for the treatment of pelvic congestion.  Br J Obstet Gynaecol. 1989;  96(10) 1153-1162
• 23 Reginald P W, Beard R W, Kooner J S. Intravenous dihydroergotamine to relieve pelvic congestion with pain in young women.  Lancet. 1987;  2 351-353
• 24 Gargiulo T, Mais V, Brokaj L, Cossu E, Melis G B. Bilateral laparoscopic transperitoneal ligation of ovarian veins for treatment of pelvic congestion syndrome.  J Am Assoc Gynecol Laparosc. 2003;  10(4) 501-504
• 25 Chung M-H, Huh C-Y. Comparison of treatments for pelvic congestion syndrome.  Tohoku J Exp Med. 2003;  201 131-138
• 26 Ganeshan A, Upponi S, Hon L, Uthappa M C, Warakaulle D R, Uberoi R. Chronic pelvic pain due to pelvic congestion syndrome: the role of diagnostic and interventional radiology.  Cardiovasc Intervent Radiol. 2007;  30 1105-1111