Percutaneous treatment of pelvic congestion syndrome

Pelvic congestion syndrome and chronic pelvic pain are enigmatic clinical conditions that may have considerable impact on the social and relational life of women. Patients usually complain of lower abdominal pain that has lasted for more than six months, is intermittent or continuous, and may become worse during menses or after a hard day's work. Sometimes the pain is accompanied by dyspareunia, urinary urgency or constipation. The traditional treatment of pelvic congestion syndrome has included both medical (analgesics, hormones) and surgical approaches (hysterectomy, ovarian vein ligation). Recently, percutaneous transcatheter embolization has also been proposed. We report our experience with the percutaneous management of pelvic congestion syndrome, using the transbrachial approach and sclerosis alone.

Between 1996 and 2001, 33 women underwent percutaneous treatment for pelvic congestion syndrome at our department. All the women had chronic pelvic pain which was continuous in 69%; 20 patients had dyspareunia, whereas 8 had urinary urgency; 72% took analgesics on a regular basis. All the patients underwent percutaneous treatment of pelvic congestion syndrome on a outpatient basis in a radiological suite, after receiving local anaesthesia. Sclerosis was performed with 3% sodium tetradecyl sulfate. Follow-up consisted of a questionnaire at one month and gynaecological and ultrasound examinations at 6/12 months.

The pre-procedural ultrasound examination had revealed a mean diameter of 4.5 mm for the right ovarian vein and of 6.3 mm for the left. We found one pelvic congestion syndrome on the right, 11 on the left and 21 bilaterally. At the one-month follow-up, chronic pelvic pain was present in 13 patients (39%); the pain was continuous in three and intermittent in ten. At the follow-up after 6/12 months the symptoms were unchanged. Ultrasound revealed a reduction in periovarian varicosities, recording a mean diameter of 3.19 mm on the right and 4.5 mm on the left. Symptoms persisted in women with pelvic varicosities measuring over 5 mm at ultrasound.

Pelvic congestion syndrome and chronic pelvic pain that do not respond to medical therapy can be resolved by percutaneous management. Less expensive than surgery, this therapeutic option is safe, effective, minimally invasive and capable of restoring patients to normal function. We propose the transbrachial approach as the first-choice treatment for bilateral pelvic congestion syndrome.